title: Influence of mechanical instruments on the biocompatibility of titanium dental implants surfaces: a systematic review.
abstract: OBJECTIVE
  The objective of this systematic review was to evaluate the effect of mechanical instruments on the biocompatibility of titanium dental implant surfaces.
  
  
  METHODS
  MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to December 2013, to identify controlled studies on the ability of cells to adhere and colonize non-contaminated and contaminated, smooth and rough, titanium surfaces after instrumentation with different mechanical instruments.
  
  
  RESULTS
  A comprehensive search identified 1893 unique potential papers. Eleven studies met the inclusion criteria and were selected for this review. All studies were in vitro studies. Most studies used titanium discs, strips and cylinders. The air abrasive was the treatment mostly evaluated. The available studies had a high heterogeneity which precluded any statistical analysis of the data. Therefore, the conclusions are not based on quantitative data. Instrumentation seems to have a selective influence on the attachment of different cells. In the presence of contamination, plastic curettes, metal curettes, rotating titanium brushes and an ultrasonic scaling system with a carbon tip and polishing fluid seem to fail to restore the biocompatibility of rough titanium surfaces. The air-powder abrasive system with sodium bicarbonate powder does not seem to affect the fibroblast-titanium surface interaction after treatment of smooth or rough surfaces, even in the presence of contamination.
  
  
  CONCLUSIONS
  The available data suggest that treatment with an air-powder abrasive system with sodium bicarbonate powder does not seem to adversely affect the biocompatibility of titanium dental implant 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, VU University, Amsterdam, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Louropoulou
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, VU University, Amsterdam, The Netherlands.
authors.forename: Dagmar E
authors.initials: DE
authors.lastname: Slot
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, VU University, Amsterdam, The Netherlands.
authors.forename: Fridus
authors.initials: F
authors.lastname: Van der Weijden
mesh_terms: D020906:Air Abrasion, Dental / Q000295:instrumentation; D001422:Bacterial Adhesion; D001672:Biocompatible Materials; D003666:Decontamination; D015921:Dental Implants; D003762:Dental Instruments; D012534:Dental Scaling / Q000295:instrumentation; D066298:In Vitro Techniques; D008422:Materials Testing; D013499:Surface Properties; D014025:Titanium
chemical_list: D001672:Biocompatible Materials; D015921:Dental Implants; D014025:Titanium
keywords: biocompatibility; contaminated; dental implants; mechanical instruments; non-contaminated; systematic review; titanium implant surface