Efficacy of calculus removal with hand and ultrasonic instruments on titanium surfaces

To evaluate the impact of different instruments on dental implants on titanium discs and simultaneously test how effective they were in removing calculus.

Artificial calculus was applied on 36 rectangular areas demarcated on titanium discs. Surface roughness was measured using a stylus profilometer. Calculus was then removed using six different hand or power-driven ultrasonic instruments. Surface roughness measurements D-Ra and D-Rz were then re-calculated. Cleaned distance was divided by total calculus to yield a cleaning ratio and the number of cleaning strokes required to remove the calculus was calculated. All measurements were statistically analyzed independently (two-way ANOVA, Holm-Sidak roughness and cleaning ratios Kruskal-Wallis one-way ANOVA on ranks, and Student-Newman-Keuls, α< 0.05).

Ultrasonic magnetostrictive instruments were most efficient in calculus removal and demonstrated a statistically high cleaning ratio percentage (P< 0.001) and required the least number of strokes compared to all the other groups. The resin curettes were the least effective in calculus removal and required the greatest number of strokes. When surface roughness values (D-Ra) were compared between different instruments, statistically significant differences were noted between the resin curettes and ultrasonic magnetostrictive groups, with the resin curette group showing lower values and the Ultrasonic magnetostrictive group showing greater values.

Current research on significance of titanium particles and their possible role in causing periimplantitis emphasizes the importance of using instruments that do not damage the implant surface. Instrumentation causing the least amount of surface roughness should be considered since the risk of damaging the surface outweighs the benefit.