The Effect of Titanium-Based Instruments on the Surface Roughness of Moderately Rough Titanium Dental Implants: A Systematic Review

Abstract

Background: The survival rate of dental implants is increasing, which poses a higher risk of developing biological and technical complications. Peri-implantitis is considered one of the most encountered biological complications. Mechanical decontamination of the implant surface is an integral part of any surgical protocol for the management of peri-implantitis. The aim of this review is to systematically examine the current literature on the effects of titanium-based instruments on titanium dental implant surface roughness. Methodology: PubMed-MEDLINE and EMBASE databases were searched up to 30/10/2020 to identify appropriate studies. Eligible studies were controlled studies that investigated titanium surface roughness alteration following the instrumentation with titanium instruments. Results: 335 unique titles were identified; 9 in vitro studies met the inclusion criteria and included in this review. Two types of titanium instruments were identified: titanium curettes and brushes. The alteration in the titanium surface roughness was described qualitatively and quantitatively. The qualitative assessment revealed significant macroscopic and microscopic alteration in the surface roughness following the instrumentation. The surface alterations included flattening and smoothening of the peak structure with the formation of scratches, grooves, and pits. The quantitative assessment showed a significant reduction in surface roughness parameters values following the instrumentation. Among the titanium-based instruments, titanium brush is preferred over the titanium curette as it decontaminates the implant surface superiorly with relatively lower surface alterations. Conclusion: Significant surface alterations were observed following the instrumentation with titanium instruments. However, all of the titanium surfaces remained within the same roughness category. If peri-implantities management aims to create a smooth titanium surface that is less prone to bacterial attachment, then the use of titanium instruments is recommended. On the other hand, when preservation of surface topography is of importance, the use of titanium instruments during surface decontamination is not recommended.