Effects of Mechanical Instrumentation with Commercially Available Instruments Used in Supportive Peri-implant Therapy: An In Vitro Study

Purpose: To evaluate topographic changes and effectiveness of mechanical instrumentation upon machined (MA) and roughened (RG) surfaces of dental implants. Materials and Methods: The coronal one-third of seven RG and seven MA implants was coated with a mixture of cyanoacrylate and toluidine blue dye to resemble calculus. Implants were cleaned with three curettes (SS: stainless steel, PT: plastic, TI: titanium), two ultrasonic tips (UM: metal tip, UP: plastic tip), a titanium brush (TB), and an air-polishing device (AA) until visibly clean. Additionally, a simulation of 1- and 5-year supportive peri-implant therapy (SPT) was performed on 14 implants using the aforementioned instruments with 20 strokes/40 s (T1) or 100 strokes/200 s (T5). Each implant was evaluated using stereomicroscopy, atomic force microscopy, and scanning electron microscopy. Results: UM was the most effective instrument, with 0% average percentage of residual artificial calculus (RAC), followed by TB (2.89%) and UP (4.90%). SS was more effective than TI (15.43% vs 20.12% RAC, respectively), while PT failed to remove any deposit (100% RAC). AA completely removed deposits on RG surfaces but not MA surfaces (26.61% RAC). Noticeable topographic changes were observed between both implant surfaces. RG surfaces became less rough, whereas MA surfaces became rougher at both T1 and T5 with the exception of AA. Plastic- and titanium-like remnants were noted after debridement with PT, SS, and TI, respectively. Conclusion: Artificial calculus removal by mechanical instrumentation, with the exception of PT, was proven to be clinically effective. All instruments induced minor to major topographic changes upon dental implant surfaces. AA did not remarkably change MA and RG surfaces at both micrometer and nanometer levels. Findings from this study may impact the selection of instruments or devices used during SPT protocols. Keywords: maintenance, mechanical instrumentation, microtexture, peri-implant disease