Profilometric and Standard Error of the Mean Analysis of Rough Implant Surfaces Treated With Different Instrumentations Luca Ramaglia, MD, DDS,* Alessandro E. di Lauro, DDS, PhD,† Fabio Morgese, DDS,‡ and Antonino Squillace, PhD§ L ong-term clinical studies have shown that osseointegrated titanium dental implants are a successful and predictable treatment modality for both fully and partially edentulous patients. 1,2 Although favor- able clinical results have been re- ported, a small percentage of implants are lost after loading, and several fac- tors have been involved in the etio- pathogenesis of implant failures. Late failures, occurring after the osseointe- gration process, are basically caused by biomechanical and/or bacterial fac- tors. 3,4 The presence of pathogens around implant-supported prostheses may lead to peri-implantitis, an in- flammatory lesion involving both soft and hard tissues that form the bone- implant interface. 5 Several therapies have been pro- posed to treat peri-implant bony de- fects. 6 Such therapies consist of the removal of bacterial deposits from the exposed implant surface, which aims to resolve the resolution of the inflam- matory process. This procedure is performed using different cleaning in- strumentations in association with pharmacologic agents. 7-9 Titanium im- plants coated with hydroxyapatite or titanium plasma spray (TPS) are widely used in clinical practice. 10,11 The treatment of peri-implantitis around these implants seems to be more difficult compared to machined implants, and the related instrumenta- tions seem to cause detrimental effects on the treated implant surface. 12,8 The aim of this study was to analyze, in vitro, the effects of different instru- mentations used in the treatment of peri-implantitis on implant surfaces coated with hydroxyapatite or TPS. MATERIALS AND METHODS There were 14 cylindrical implants used, including 7 hydroxyapatite coated (Calcitek; Zimmer Dental, Carlsbad, CA) and 7 TPS (3i Implant Innovations, Inc., Biomet Co.,). One hydroxyapatite implant and 1 TPS implant were used as untreated controls. Each implant was split in 2 test areas, for a total of 24 experimental surfaces. Such surfaces were treated in vitro with 4 different instrumentations: a stainless-steel cu- rette (Gracey curette; Premier); plastic curette (Implant Scaler; Premier); ultra- sonic scaler tip (Suprasson; Satelect, France); and air-powder-water spray (Airflow, Siemens, Switzerland). Each treatment was performed on 3 hydroxy- apatite and 3 TPS surfaces. Regarding the procedure per- formed by the curettes, a custom-made device was used. It consisted of a hor- izontally movable slide to ensure a standardized treatment force (Fig. 1). This mechanical apparatus allowed, at 1 side, to secure the implant and, at the other side, to settle the curette at the end of a steel arm, which was free to swing around a fulcrum pin placed on a slide horizontally moved by a worm gear. The desired force was obtained as a reaction to the surface bearing (i.e., implant surface) versus the cu- *Associate Professor, Department of Dental and Maxillo-Facial Sciences, University of Naples “Federico II,” Naples, Italy. †Assistant Professor, Department of Dental and Maxillo-Facial Sciences, University of Naples “Federico II,” Naples, Italy. ‡Resident student in Oral Surgery, Department of Dental and Maxillo-Facial Sciences, University of Naples “Federico II,” Naples, Italy. §Assistant Professor, Department of Materials and Production Engineering, University of Naples “Federico II,” Naples, Italy. ISSN 1056-6163/06/01501-077 Implant Dentistry Volume 15 • Number 1 Copyright © 2006 by Lippincott Williams & Wilkins DOI: 10.1097/01.id.0000202425.35072.4e Purpose: This study evaluated, in vitro, the effects of different in- strumentations used in the treatment of peri-implantitis on implant sur- faces coated with hydroxyapatite or titanium plasma spray (TPS). Materials and Methods: There were 14 cylindrical rough implants used, including 7 hydroxyapatite and 7 TPS coated. Split in 2 parts for a total of 24 experimental surfaces, implants were treated with a stainless-steel curette, plastic curette, ultrasonic scaler tip, and air-powder-water spray. There was 1 hydroxyapatite and 1 TPS implant used as controls. Profilometry and scanning electron microscopy were used to examine instrumented surfaces for variations in surface topography. Results: All experimental pro- cedures determined changes on tested rough implant surfaces. Such alterations were related to the implant coating material, and the procedure consisting in coating removal and/or leveling of surface roughness. Conclusion: Although a plas- tic curette and air-powder-water spray induced less implant surface alterations, these instrumentations left deposits on the surface that may affect, in vivo, the tissue heal- ing process. (Implant Dent 2006; 15:77– 82) Key Words: implant surface, peri- implant instrumentation profilo- metric analysis IMPLANT DENTISTRY /VOLUME 15, NUMBER 1 2006 77