Objectives

Cleaning instruments can negatively affect the implant surface and allow easier and faster bacterial attachment, which in turn can lead to periimplant diseases and eventually implant loss. However, regular maintenance is necessary. The purpose of this study was to evaluate various parameters before and 3 months after instrumentation with different treatment modalities on implant healing caps (HCs).

Material and Methods:

Following ethical approval, 18 participants each had 4 specially fabricated titanium HCs (CAMLOG, Wimsheim) attached to 4 newly inserted titanium implants (CAMLOG). After two months of healing each of the 4 HCs was randomly assigned to be treated with: (1) a titanium curette (TC; AESCULAP, Tuttlingen); (2) a stainless steel ultrasonic tip (PS; EMS, Munich) using an ultrasonic device; or (3) erythritol PLUS powder (EP) using an air polishing device (EMS). After instrumentation (2 min), HCs were rinsed with 5 ml 0.2% chlorhexidine (Chlorhexamed forte, GSK, Bühl). The fourth HC (control, CON) was polished and rinsed with 5 ml 0.9% NaCl. Before (T1) and 3 months after (T2) instrumentation peri-implant probing depths (PD) and bleeding on probing (BOP) were measured (mesiobuccal, buccal, distobuccal, mesiolingual, lingual and distolingual) using a pressure-sensitive probe (UNC 15, AESCULAP). Matrix metalloproteinase-8 (MMP-8) levels were measured at one predefined point at each implant (BIOSCIENTIA, Ingelheim).

Results:

Overall, no significant differences were evident before and after instrumentation for any of the clinical parameters, except TC showed a significant improvement in mean PD (p=0.049) and CON resulted in a significant decrease in mean BOP (p=0.024). MMP-8 significantly improved (*p<0.05) in all instrument groups except for EP. No significant differences were evident between any of the instrument types for any of the parameters measured (ANOVA).

Summary:

Within the limits of the study, it can be concluded that polishing and rinsing of implants with PD≤3mm and inflammation (mucositis) leads to similar results when compared to the three different instrumentation modalities. Longer term clinical results are being collected during regular preventive maintenance appointments following prosthodontic rehabilitation of the implants.