title: The effects of mechanical instruments on contaminated titanium dental implant surfaces: a systematic review.
abstract: OBJECTIVE
  The objective of this systematic review was to evaluate the ability of mechanical instruments to clean contaminated implant titanium surfaces.
  
  
  METHODS
  MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to May 2013 to identify controlled studies on the cleaning efficacy of mechanical instruments on contaminated titanium surfaces.
  
  
  RESULTS
  A comprehensive search identified 1893 unique potential papers. Fourteen studies met the inclusion criteria and were selected for this systematic review. Most of the studies were in vitro studies. Different surfaces and different contamination methods were used. Most studies used titanium discs, strips and cylinders. The air abrasive was the treatment mostly evaluated. The available studies had a high heterogeneity that precluded any statistical analysis of the data. Therefore, the conclusions are not based on quantitative data. Non-metal curettes and rubber cups were found to be ineffective. Positive results were reported for (ultra)sonic scalers with a metal tip on polished surfaces, (ultra)sonic scalers with a non-metal tip on smooth and sand-blasted and acid-etched (SLA) surfaces, metal curettes and rotating titanium brushes on SLA surfaces. The air abrasive was found to be effective in cleaning machined, SLA and titanium plasma-sprayed (TPS) surfaces.
  
  
  CONCLUSIONS
  The available data suggest that the air abrasive may remove plaque effectively from machined, SLA and TPS titanium surfaces. Positive results were also observed for rotating titanium brushes on SLA surfaces and ultrasonic scalers with non-metal tip on polished and SLA surfaces. However, the clinical impact of these findings requires further clarification.
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Louropoulou
authors.forename: Dagmar E
authors.initials: DE
authors.lastname: Slot
authors.forename: Fridus
authors.initials: F
authors.lastname: Van der Weijden
mesh_terms: D018441:Biofilms; D003666:Decontamination / Q000295:instrumentation*; D015921:Dental Implants / Q000382:microbiology*; D003762:Dental Instruments; D006801:Humans; D008422:Materials Testing; D013499:Surface Properties; D014025:Titanium
chemical_list: D015921:Dental Implants; D014025:Titanium
keywords: biofilm; cleaning efficacy; dental implants; mechanical instruments; systematic review; titanium implant surface