Antimicrobial efficiency and cytocompatibility of different decontamination methods on titanium and zirconium surfaces

Abstract

Objectives:The purpose of this study was to investigate the efficiency of different implant-decontamination methods regarding biofilm modification and potential cytotoxic effects. Therefore, the amount of biofilm reduction, cytocompatibility, and elementary surface alterations were evaluated after decontamination of titanium and zirconium surfaces.Material and Methods: Titanium and zirconium disks were contaminated with a newly developed high-adherence biofilm consisting of six microbial species.Decontaminations were performed using titanium curette, stainless steel ultrasonic scaler (US), glycine (GPAP) and erythritol (EPAP) powder air-polishing, Er:YAG laser, 1% chlorhexidine (CHX), 10% povidone-iodine (PVI), 14% doxycycline (doxy), and 0.95% NaOCl solution. Microbiologic analysis was done using real-time qPCR. For assessment of cytocompatibility, a multiplex assay for the detection of cytotoxicity, viability, and apoptosis on human gingival fibroblasts was performed. X-ray photoelectron spectroscopy (XPS) was used to evaluate chemical alterations on implant surfaces. Results:Compared with untreated control disks, only GPAP, EPAP, US, and Er:YAG laser significantly reduced rRNA counts (activity) on titanium and zirconium (p < .01), whereas NaOCl decreased rRNA count on titanium (p < .01). Genome count (bacterial presence) was significantly reduced by GPAP, EPAP, and US on zirconium only (p < .05). X-ray photoelectron spectroscopy analyses revealed relevant re-exposure of implant surface elements after GPAP, EPAP, and US treatment on both materials, however, not after Er:YAG laser application. Cytocompatibility was impaired by CHX, PVI, doxy, and NaOCl. CHX and PVI resulted in the lowest viability and doxy in the highest apoptosis.Conclusions: Within the limits of this in vitro study, air-polishing methods and ultrasonic device resulted in effective biofilm inactivation with surface re-exposure and favorable cytocompatibility on titanium and zirconium. Chemical agents, when applied on implant surfaces, may cause potential cytotoxic effects.

Decontamination of biofilm‐contaminated implant surfaces: An in vitro evaluation

“…The high cleaning efficacy of the two mechanical decontamination methods (rotating TiB and AP) observed in the present study is in agreement with results from previous in vitro studies (e.g., Al‐Hashedi et al, 2017; Dostie et al, 2017; Hui et al, 2021; Ichioka et al, 2022; Matthes et al, 2017; Stein et al, 2022). Toma et al (2018) showed that the reduction of a single‐bacterial biofilm by use of a TiB was similar to that achieved by AP.…”

“…The use of chemical agents (AEW and NAC) as adjuncts to the mechanical cleaning protocols provided no relevant overall benefit over saline. No treatment modality, however, resulted in complete biofilm removal.The high cleaning efficacy of the two mechanical decontamination methods (rotating TiB and AP) observed in the present study is in agreement with results from previous in vitro studies(e.g., Al-Hashedi et al, 2017;Dostie et al, 2017;Hui et al, 2021;Ichioka et al, 2022;Matthes et al, 2017;Stein et al, 2022) Toma et al (2018). showed that the reduction of a single-bacterial biofilm by use of a TiB was similar to that achieved by AP.…”

In vitro efficacy of non‐surgical and surgical implant surface decontamination methods in three different defect configurations in the presence or absence of a suprastructure

“…Tan et al found minimal surface alterations with the use of air‐powder abrasive devices and plastic curettes on zirconium surfaces and no difference in biofilm adhesion on biofilm‐contaminated titanium and zirconium discs for the following decontamination methods: titanium curette, plastic curette, air‐powder abrasion and ultrasonic scaler with a stainless steel tip 41 . On the other hand, Stein et al recently found a significant reduction in bacterial presence on zirconium surfaces compared with titanium surfaces after using an ultrasonic scaler with a stainless steel tip, glycine or erythritol air‐powder abrasion 42 . However, both studies did not investigate the effect of the presence or absence of a suprastructure on cleaning efficacy.…”

“…41 On the other hand, Stein et al recently found a significant reduction in bacterial presence on zirconium surfaces compared with titanium surfaces after using an ultrasonic scaler with a stainless steel tip, glycine or erythritol air-powder abrasion. 42 However, both studies did not investigate the effect of the presence or absence of a suprastructure on cleaning efficacy.…”

Efficacy of a novel three‐step decontamination protocol for titanium‐based dental implants: An in vitro and in vivo study

“…This finding can be associated with the direct preservation of the valleys region microstructure (Balderrama et al., 2020), which are the preferred cell adhesion sites on the surfaces, avoiding the peaks. This first phase determines the further behavior of the cells in contact with the implant surface (i.e., cell proliferation and differentiation), which could facilitate successful re‐osseointegration (Cao et al., 2018; Stein et al., 2023).…”