Ultrasonic instrument effects on different implant surfaces

Aim: From the literature we infer that efficient peri- implant debridment cleaning result is obteined using metal tips rather than plastic material tips. Plastic tips allow to alter, the least possible, fixture superficial properties or analized specimens. Aim of this study was to evaluate in vitro effects of ultrasonic instrumentation using Acteon Implant Protect® ultrasonic grade IV titanium tips on implant surface micro- and macro-topography. Methods: Nine 6 mm diameter and 2,6 mm height titanium disks were used in this study, with 3 different kinds of surface: machined, laser-treated and sandblasted. Four 500x500 μm areas were selected on each surface. Each area was equidistant from the disk center and from the disk border. Each area was analized using a Talysurf CLI 1000® profilometer and captured with an optical microscope at 3x enlargement and with a scanning electron microscope at 100x and 300x enlargement. Successively thesurface of each titanium disk was instrumented for a total of 40 strokes by a single operator using Implant Protect® (Acteon®) ultrasonic tianium tip. The tip was angulated tangentially. Calibrations were performed with scales before the experiment, and the average pressure applied in this study was 30g. Back and forth movements were performed in the same direction for 40 times. For the Satelec® scaler a power setting 3/10 was set at 25 to 32 kHz. Instrumentation was achieved with a continuos water irrigation. Pictures were acquired again by optical microscope and scanning electron microscope. After instrumentation any contaminants were searched with SEM-EDX (Scanning Electron Microscope – Energy Dispersive X-ray spectrometry). All reserched values were subjected to statistical analysis. Results: Each image acquired with optical microscope and with Scanning Electron Microscope reveals instrumentation signs with tested tips. Machined and sandblasted surfaces showed a significant Ra reduction (p value < 0,05). Only laser-treated surface showed scratch signs without substantial Ra reduction. Contaminants were not found with EDX analysis before specimen instrumentation and after instrumentation neither. Before instrumentation and after instrumentation sandblasted surface presented a considerable quantity of Al and O. Conclusion: To be effective implant surface ultrasonic instrumentation has to be done with titanium tips, not whith plastic material tips. Nevertheless titanium tips instrumentation causes alterations of implant surface microtopography; in addition different implant surfaces undergo different kinds of structural alteration non-clinically definable.