title: Re-establishment of the atomic composition and the oxide structure of contaminated titanium surfaces by means of carbon dioxide laser and hydrogen peroxide: an in vitro study.
abstract: BACKGROUND
  In clinical situations with peri-implant bone resorption, re-integration of the exposed implant surface is sometimes preferable, which requires a clean surface. Previous investigations have shown that cleaning of contaminated titanium surfaces using chemical and abrasive methods is difficult.
  
  
  OBJECTIVE
  The aim of this investigation was to evaluate the efficacy of different combinations of chemical and physical methods (citric acid, hydrogen peroxide, and carbon dioxide [CO2] laser irradiation) for removal of contaminants and subsequent reconstruction of the surface oxide of intraorally contaminated titanium foils.
  
  
  METHODS
  Commercially pure titanium foils (99.6%, 5 x 5 mm in size) were contaminated by placement on dentures in volunteering patients, simulating a peri-implantitis situation. The contaminated foils and clean control foils were treated by seven and six combinations of citric acid, hydrogen peroxide, and CO2 laser irradiation, respectively. The effect of the cleaning procedures was evaluated by x-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM).
  
  
  RESULTS
  The initial elemental composition of the contaminated foils was 70% carbon (C), 20% oxygen (O), 10% nitrogen (N), and only traces of titanium (Ti) (< 1%). One treatment proved to be more effective than the others: irradiations by 5-second cycles of superpulsed CO2 laser at a power of 7 W, 10-millisecond pulse width, and with an 80-Hz frequency on a wet surface, followed by repeated application of supersaturated citric acid for 30 seconds, each time followed by rinsing with ultrapure water until all tissue remnants had been removed. Finally, hydrogen peroxide of 10-mM concentration was added to the implant surface and evaporated by CO2 laser at the same settings. This treatment protocol resulted in 10% Ti, 45% O, 41% C, and 2 to 3% N, a composition comparable to that of unused foils: 9% Ti, 40% O, 48% C, and traces of N and chlorine (CI). X-ray photoelectron spectroscopy profiles showed that the thickness of the surface oxide was restored and even augmented with this protocol for treatment of contaminated titanium.
  
  
  CONCLUSIONS
  A combination of citric acid, hydrogen peroxide, and CO2 laser irradiation seems to be effective for cleaning and reestablishment of the atomic composition and oxide structure of contaminated titanium surfaces.
authors.affiliation: Department of Oral and Maxillofacial Surgery, St. Pierre University Hospital, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Mouhyi
authors.forename: L
authors.initials: L
authors.lastname: Sennerby
authors.forename: A
authors.initials: A
authors.lastname: Wennerberg
authors.forename: P
authors.initials: P
authors.lastname: Louette
authors.forename: N
authors.initials: N
authors.lastname: Dourov
authors.forename: J
authors.initials: J
authors.lastname: van Reck
mesh_terms: D002244:Carbon / Q000032:analysis; D002245:Carbon Dioxide; D019343:Citric Acid / Q000627:therapeutic use; D015921:Dental Implants; D003902:Detergents / Q000627:therapeutic use*; D004577:Electron Probe Microanalysis; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D006861:Hydrogen Peroxide / Q000627:therapeutic use*; D053685:Laser Therapy; D018625:Microscopy, Atomic Force; D008855:Microscopy, Electron, Scanning; D009584:Nitrogen / Q000032:analysis; D016877:Oxidants / Q000627:therapeutic use*; D010087:Oxides / Q000737:chemistry* / Q000528:radiation effects; D010100:Oxygen / Q000032:analysis; D013499:Surface Properties; D014025:Titanium / Q000032:analysis / Q000737:chemistry* / Q000528:radiation effects; D014867:Water / Q000737:chemistry
chemical_list: D015921:Dental Implants; D003902:Detergents; D016877:Oxidants; D010087:Oxides; D014867:Water; D002245:Carbon Dioxide; D019343:Citric Acid; D002244:Carbon; D006861:Hydrogen Peroxide; D014025:Titanium; D009584:Nitrogen; D010100:Oxygen