Ultrasonication-Assisted Sequential Chemical Removal of Mature Biofilm on Retrieved Titanium Healing Abutments

Potential effectiveness of ultrasonication (US) with different chemical solutions on the decontamination of titanium implant healing abutments (HAs) and their surface characteristics was investigated.

Ninety-five HAs, representing two distinct brands/designs, were retrieved from patients after 4-6 weeks for the present study. They were precleaned by immersing in enzymatic detergent (ED) and randomized into five groups: autoclaving only (control), US in 40°C tap water and autoclaving, US in 40°C 1% sodium hypochlorite (SH) and autoclaving, US in 80°C citric + maleic + lactic acid (CA) solution and autoclaving, US in 40°C ED and autoclaving. HAs were stained and photographed from lateral and occlusal aspects before and after decontamination. Stained areas were calculated and scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) analyses were conducted to assess surface morphology and elemental composition.

Control group showed the lowest debridement potential (mean 54.4%) and highest residual contamination. SH almost entirely removed the debris (mean 99.7%, Brand1: 99.6%, Brand2: 99.9%) showing an outperforming cleansing efficacy among all groups (p < 0.05). SEM and EDS analyses demonstrated that surface morphology and elemental composition of decontaminated surfaces in SH group was similar to that of unused HAs.

After precleaning HAs by soaking in ED, 1% SH, used in combination with US, can be preferred for decontaminating HAs due to its superior cleaning efficiency and minimal surface alteration regardless of HA macrogeometry. In cases where placing unused HAs is not feasible, this three-step protocol may present an efficient and cost-effective alternative for at least one reuse cycle.