Characteristics of Particles and Debris Released after Implantoplasty: A Comparative Study

Abstract

Titanium particles embedded on peri-implant tissues are associated with a variety of detrimental effects. Given that the characteristics of these detached fragments (size, concentration, etc.) dictate the potential cytotoxicity and biological repercussions exerted, it is of paramount importance to investigate the properties of these debris. This study compares the characteristics of particles released among different implant systems (Group A: Straumann, Group B: BioHorizons and Group C: Zimmer) during implantoplasty. A novel experimental system was utilized for measuring and collecting particles generated from implantoplasty. A scanning mobility particle sizer, aerodynamic particle sizer, nano micro-orifice uniform deposit impactor, and scanning electron microscope were used to collect and analyze the particles by size. The chemical composition of the particles was analyzed by highly sensitive microanalysis, microstructures by scanning electron microscope and the mechanical properties by nanoindentation equipment. Particles released by implantoplasty showed bimodal size distributions, with the majority of particles in the ultrafine size range (<100 nm) for all groups. Statistical analysis indicated a significant difference among all implant systems in terms of the particle number size distribution (p < 0.0001), with the highest concentration in Group B and lowest in Group C, in both fine and ultrafine modes. Significant differences among all groups (p < 0.0001) were also observed for the other two metrics, with the highest concentration of particle mass and surface area in Group B and lowest in Group C, in both fine and ultrafine modes. For coarse particles (>1 µm), no significant difference was detected among groups in terms of particle number or mass, but a significantly smaller surface area was found in Group A as compared to Group B (p = 0.02) and Group C (p = 0.005). The 1 first minute of procedures had a higher number concentration compared to the second and third minutes. SEM-EDS analysis showed different morphologies for various implant systems. These results can be explained by the differences in the chemical composition and microstructures of the different dental implants. Group B is softer than Groups A and C due to the laser treatment in the neck producing an increase of the grain size. The hardest implants were those of Group C due to the cold-strained titanium alloy, and consequently they displayed lower release than Groups A and B. Implantoplasty was associated with debris particle release, with the majority of particles at nanometric dimensions. BioHorizons implants released more particles compared to Straumann and Zimmer. Due to the widespread use of implantoplasty, it is of key importance to understand the characteristics of the generated debris. This is the first study to detect, quantify and analyze the debris/particles released from dental implants during implantoplasty including the full range of particle sizes, including both micro- and nano-scales.

The Role of Titanium Particles and Ions in the Pathogenesis of Peri-Implantitis

“…[ 17 , 23 , 24 ] Nonetheless, some instruments employed in this decontamination procedure appear to promote a large-scale release of metal particles into the surrounding tissues. [ 17 , 26 , 27 ] For example, Eger et al [ 37 ] demonstrated that the treatment of peri-implantitis using ultrasonic metal tips promoted the release of Ti particles from different implant surfaces. Moreover, the authors reported that these particles significantly increased the inflammatory and osteoclastogenic responses in vitro and in vivo , suggesting the possibility of aggravation of peri-implantitis, in short-term follow-ups (24–48 hr) and indicating the necessity of long-term examination in further studies to investigate the chronic effects of this exposure.…”

“…[23][24][25] However, different studies have demonstrated that decontamination techniques using burs or metal instruments, i.e., implantoplasty, generate Ti particles around the implant, which could have negative effects on bone regeneration. [26,27] As such, it must be highlighted that the concentration and size of these released particles during implantoplasty treatments are dependent on the implant chemical composition and implant surface modifications. [27] To date, the role of the released Ti particles/ions in the pathogenesis and progression of peri-implantitis is still not fully understood.…”

“…[26,27] As such, it must be highlighted that the concentration and size of these released particles during implantoplasty treatments are dependent on the implant chemical composition and implant surface modifications. [27] To date, the role of the released Ti particles/ions in the pathogenesis and progression of peri-implantitis is still not fully understood. The aim of this concise narrative review is to highlight the effect of Ti particles/ions released into periimplant tissues on the cellular and tissue responses, which might result in the pathogenesis and/or progression of periimplantitis.…”

“…[ 26 , 27 ] As such, it must be highlighted that the concentration and size of these released particles during implantoplasty treatments are dependent on the implant chemical composition and implant surface modifications. [ 27 ]…”

Effect of the Size of Titanium Particles Released from Dental Implants on Immunological Response

“…Another case leading to a large release of titanium particles into the oral environment is the technique of implantoplasty for cases of peri-implantitis. This technique consists of the mechanization of the surface of the dental implant on which a bacterial biofilm is created, whereby the mechanical removal of the infected implant surface causes a large release of particles into the oral environment [13][14][15][16]. This technique avoids the replacement of the osseointegrated implant by eliminating the infection.…”