Mechanical Implant Surface Decontamination

Mechanical methods of surface decontamination include implantoplasty, use of hand or ultrasonic scalers, and the use of air powder abrasives.^104,106, Implantoplasty involves the use of rotary instruments to remove modified implant surfaces and to flatten or smooth threads on exposed implant surfaces.¹⁰⁶ Implantoplasty is often combined with resective approaches so that soft tissues are apically positioned and exposed implant surfaces demonstrate decreased plaque adherence.^107,108 Scaling with hand or ultrasonic scalers seeks to mechanically disrupt and remove biofilm deposits. The materials that the scalers and curettes consist of may influence both efficacy of biofilm removal and resultant damage and/or alterations to implant surfaces. Metal ultrasonic scaler tips and curettes are more efficient in removing biofilm and calculus, but alter implant surface topography.^109,110 It is often recommended that metals that are of equivalent or less hardness compared to the composition of dental implants (e.g. gold, titanium) should be use to minimize damage while maximizing biofilm removal.¹¹¹ Conversely, nonmetal curettes may be made of plastic, carbon, or resin. Such nonmetal curettes have demonstrated decreased effectiveness in biofilm removal and deposition of curette material on implant surfaces.^106,112 Air powder abrasives use an abrasive powder, including aluminum oxide, sodium bicarbonate, sodium hydrocarbonate, amino acid glycine, or erythritol, propelled by compressed air.¹¹² Effective biofilm and bacterial endotoxin removal has been demonstrated with minimal damage to implant surfaces.^109,113-115 However, some investigations have demonstrated that powder particles can stay attached to the implant surface after cleaning.¹¹⁵ It should also be noted that subcutaneous emphysema have been reported after air abrasives around teeth and implants and care should be taken to avoid forcibly direct compressed air into tissues.^116-117