Cleaning, Disinfection, and Sterilization Protocols Employed for Customized Implant Abutments: An International Survey of 100 Universities Worldwide

Purpose: American and European standards recommend sterilization of customized abutments before connecting them to implants, as customized abutments are considered semi-critical medical devices. Since standardized procedures could not be identified in the literature on implantology, this survey evaluated the protocols employed at different universities worldwide to clean, disinfect, and/or sterilize customized abutments before their connection to bone-level implants. Materials and Methods: The survey took place between October 2015 and January 2016. A single question acquiring information on how customized abutments were treated prior to connection to the implants was sent by email to researchers affiliated at 100 universities worldwide. To avoid any bias, the survey was kept rigorously anonymous. A total of 100 universities from Europe (56), USA and Canada (25), Latin America (9), South Africa (1), Asia (6), and Australia and New Zealand (3) were invited to participate in the survey. Results: Altogether, 85 universities responded to the survey question, and 22 (25.9%) declared that no cleaning protocols were adopted. More than half of the respondents (n = 49, 57.6%) performed only one of the three procedures required by the standards (cleaning, disinfection, or sterilization). Twelve respondents (14.1%) adopted two procedures, and only two universities performed all three required procedures (2.4%). Conclusion: This survey indicated substantial heterogeneity in treating customized abutments before connecting them to implants. This study demonstrated that the majority of the universities applied either cleaning, disinfection, or sterilization which may not meet the prevailing standards. Keywords: customized abutments, disinfection, implant abutments, implant-abutment cleaning, oral implants, peri-implant tissues, sterilization, survey