The maintenance of inserted titanium implants: in-vitro evaluation of exposed surfaces cleaned with three different instruments

Objective: Changes to titanium implants smooth-surfaces after instrumentation were comparatively analyzed using low-vacuum scanning electron microscopy (LV-SEM) and white-light confocal (WLC) profilometry, to accurately evaluate curved surfaces. Material and methods: Sixty titanium implants screwed to their abutments were randomly split into three groups for cleaning treatment with (S) stainless-steel Gracey-curettes, (T) titanium Langer-curettes, and (P) an ultrasonic-device with the probe covered with a plastic-tip. One sector of each implant was left unprocessed (U). The other sectors were cleaned for either 60 s, to simulate a single cleaning session, or 180 s to simulate a series of sessions. Surface morphology was analyzed by LV-SEM, without metal sputtering. Quantitative evaluations of the roughness of surfaces were performed using a WLC-profilometer. The Wilcoxon and the Mann-Whitney tests were used in statistical comparisons. Results: U-surfaces showed that thin transverse ridges and grooves, i.e. a polarized surface roughness was substantially compromised after S-instrumentation. Small surface alterations, increasing with time, were also recorded after T-·and·P-instrumentation, although to a lesser degree. The gap of the fixture-abutment connection appeared almost completely clean after T-, clotted with titanium debris after S-, and clotted with plastic debris after P-treatment. The mean roughness (Ra) was unchanged after P-, significantly increased after S- and decreased after T-treatment, when compared with U. The Rz roughness-parameter, calculated along the fixture Y-axis, of S, T, and P resulted similar and significantly lower than that of U. Rz (X-axis) resulted unchanged after P-, slightly increased (+40%) after T-, and greatly increased (+260%) after S-treatment, this latter being statistically significant when compared with U. Conclusions: The careful use of titanium-curettes could produce only minimal smooth surface alteration particularly over prolonged treatments, and avoid debris production that could endanger implant preservation.