Effects of ultrasonic scaler tips and toothbrush on titanium disc surfaces evaluated with confocal microscopy

Instrumentation to remove plaque from dental implants may cause damage to the implant surface, and previous studies that have evaluated the effects of the ultrasonic scalers and brushing in experimental settings reported that substantial changes were seen on implant surfaces after mechanical plaque removal. There is limited information on changes of the surface profile and roughness of sandblasted acid-etched (SLA) and machined titanium surfaces after treatment with different instruments in simulated clinical situations. The purpose of this study was to evaluate the effects of oral hygiene instruments including various types of ultrasonic tips in simulated clinical settings and brushing with dentifrice on machined and SLA titanium surface with confocal microscopy.

Both SLA and machined discs were treated with various ultrasonic scaler tips and brushing. Discs were either instrumented with 4 different ultrasonic scaler tips or brushed with dentifrice. The entire top surface of the discs was instrumented for a total of 40 seconds (20 seconds, 2 cycles). Brushing with dentifrice was done for 40 seconds. Roughness measurements were performed using a confocal microscope.

The change of surface structure after different treatment modalities could be observed with the naked eye when compared with the untreated surface (SLA and machined groups). In case of SLA surfaces, the 2 metal tips produced greater changes on the titanium surfaces when compared with the plastic ultrasonic tips and brushing. On the machined discs, scratch lines over the original surfaces could be observed from all ultrasonic metal and plastic tips, but 2 metal tips produced significant and definite scratches on the original disc surfaces.

This study showed the effects of different types of ultrasonic tips and brushing with dentifrice on both SLA and machined titanium surfaces in simulated clinical setting. Within the limits of our study, we suggest that metal or plastic ultrasonic scaler tips may be applied as usual to treat the SLA surface of dental abutment or fixture surfaces without increasing the irregularities on the titanium surfaces. However, in case of machined surfaces, ultrasonic metal tips cannot be recommended because the surface becomes rougher after treatment. In addition, brushing of titanium, regardless of surface treatment (SLA and machined surfaces), resulted in reduction of surface roughness. Meticulous oral hygiene with brushing must be reinforced for the patients with dental implants to maintain the exposed implant surface clean. Brushing with dentifrice may facilitate maintaining the exposed fixture surface clean by smoothening the surface.