Among the chemicals tested, CA demonstrated the greatest decontamination capacity with respect to both the killing and the removal of biofilm cells. This combination of effects is clinically desirable because it promotes biocompatibility and healing around a previously contaminated implant surface. These results should, however, be validated in in vivo studies.
The data reported for the efficacy of chemotherapeutic agents in cleaning contaminated titanium surfaces are scarce, which precludes the generation of firm conclusions. Based on the lack of robust data, we cautiously conclude that citric acid is the chemotherapeutic agent with the highest potential for the removal of biofilms from contaminated titanium surfaces in vitro, although it does not achieve complete removal. To date, the killing effect of citric acid against biofilms has not been investigated on titanium surfaces.
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