title: The maintenance of inserted titanium implants: in-vitro evaluation of exposed surfaces cleaned with three different instruments.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bertoldi
authors.affiliation: Private Practice, Parma, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Lusuardi
authors.affiliation: Private Practice, Parma, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Battarra
authors.affiliation: Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sassatelli
authors.affiliation: Private Practice, Sassuolo MO, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Spinato
authors.affiliation: Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Davide
authors.identifier: http://orcid.org/0000-0003-1241-385X
authors.initials: D
authors.lastname: Zaffe
mesh_terms: D015921:Dental Implants; D012534:Dental Scaling / Q000295:instrumentation*; D006801:Humans; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D013499:Surface Properties; D014025:Titanium
chemical_list: D015921:Dental Implants; D014025:Titanium
keywords: cleaning instruments; implant surfaces; low-vacuum SEM; surface roughness; white-light confocal profilometry