title: Titanium surface alterations following the use of different mechanical instruments: a systematic review.
abstract: OBJECTIVE
  To systematically collect and evaluate existing evidence on the effects of different mechanical instruments on the surface characteristics of smooth and rough titanium surfaces.
  
  
  METHODS
  PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to December 2010 to identify appropriate studies. The eligible studies were controlled studies investigating titanium surface alterations following treatment with different mechanical instruments.
  
  
  RESULTS
  In total, 3275 unique papers were identified. A screening of the titles and abstracts resulted in 34 publications that met all of the eligibility criteria. Surface roughness was evaluated using scanning electron microscopy in most studies and using a profilometer in only 10 studies. The rough surfaces evaluated were titanium plasma sprayed and sandblasted and acid-etched surfaces only. Non-metal instruments were found to cause minimal or no damage to both smooth and rough titanium surfaces. Metal instruments were found to cause major damage to smooth surfaces. Burs seemed to be the instruments of choice, if smoothening of a rough surface was required.
  
  
  CONCLUSIONS
  Non-metal instruments and rubber cups seem to be the instruments of choice for the treatment of smooth surfaces. Similarly, for rough implant surfaces, non-metal instruments and air abrasives are the instruments of choice, if surface integrity needs to be maintained. Metal instruments and burs are recommended only in cases requiring the smoothening of the surface roughness. The clinical impact of these findings requires clarification.
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Louropoulou
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
authors.forename: Dagmar E
authors.initials: DE
authors.lastname: Slot
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
authors.forename: Fridus A
authors.initials: FA
authors.lastname: Van der Weijden
mesh_terms: D000134:Acid Etching, Dental; D000818:Animals; D001422:Bacterial Adhesion / Q000502:physiology; D003666:Decontamination; D015921:Dental Implants; D003762:Dental Instruments; D006801:Humans; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D036103:Nanotechnology; D057873:Peri-Implantitis / Q000209:etiology* / Q000517:prevention & control*; D013499:Surface Properties; D014025:Titanium / Q000737:chemistry*
chemical_list: D015921:Dental Implants; D014025:Titanium