Debridement Efficiency of Different Cleaning Modalities in a Peri-implantitis Model

Method: Implants (Straumann, Basel, Switzerland) were stained with permanent ink and placed into resin models simulating standardized peri-implantitis defects with different angulations (30°, 60° und 90°). Three different cleaning devices were applied by an experienced DH or a 2^nd year postgraduate student: (A) Gracey curettes (Deppeler, Rolle, Switzerland), an ultrasonic device with steel tip (ADS1, EMS, Nyon Switzerland) and an airflow device (Airflow Master, EMS) employing glycine powder (PerioFlow, EMS). After each run, implants were removed from the models and standardized photos were taken. Color remnants were detected using an image processing software (Adobe Photoshop Elements Vs. 9.0.3, Adobe Systems Inc., San José, CA) and the uncleaned surface was calculated planimetrically (ImageJ 1.45r). For each setting measurements were performed in 20 implants. After testing for normal distribution, means and standard deviations were calculated for each device, defect angulation and investigator and data were tested for statistical differences using one-way ANOVA. In addition, scanning electron microscopy (Supra 50 VP Scanning Electron Microscope, Carl Zeiss NTS, Oberkochen, Germany) was performed to assess the degree of surface alteration.

Result: The percentages of uncleaned surfaces (mean ± standard deviations) for curettes, ultrasonic tips and Airflow were 24.8 ± 8.2%^A, 18.5 ± 3.8^B and 11.3 ±5.4^C, respectively (different superscript capitals represent statistically significant differences; p<0.0001). Superior cleaning potential of the airflow device was pronounced in wide defects. However, the inter-examiner difference was also more distinct after treatment with the latter. The surface alterations were pronounced after instrumentation with steel tips whereas after glycine powder instrumentation no surface alteration was noticed at 10000-fold magnification.

Conclusion: Airflow devices with glycine powders might constitute an efficient therapeutic option for the debridement of implants in peri-implantitis defects, but some uncleaned areas remain.