Influence of Different Decontamination Approaches on Bone Substitute Adhesion to Peri-Implantitis Affected Implant Surfaces: An SEM Proof of Principle Study

Abstract

Background: During healing, clot blended graft materials may retract away from implant surfaces creating microgaps that compromise re-osseointegration. The present study aimed to evaluate different surface decontamination materials’ effect on adhesion of the graft materials to peri-implantitis affected parts, a factor that can resist clot blended graft retraction improving re-osseointegration. Methods: Eighteen peri-implantitis affected implants diagnosed as hopeless and designated for removal contributed in this prospective, masked trial. Samples were randomly distributed into three groups, each of six implants. Group one (G1) was coated with hydroxyapatite of a micro particle size of 250 to 1000 µm after saline surface decontamination for two minutes. Group two (G2) peri-implantitis affected parts were treated with the graft material following two minutes of chlorhexidine gluconate 0.12% (CHX) surface treatment. Group three (G3) implants were coated with the graft material after citric acid (CA) (pH = 1) surface conditioning for two minutes. Implants in all groups were agitated in phosphate-buffered saline (PBS) by using an automatic tissue processor agitator for three minutes. Implants were prepared for surface scanning evaluation. Results: Scanning electron microscopy (SEM) observation of G1 saline treated control implants were devoid of bone particles adherent to peri-implantitis affected surfaces. The surface area covered by grafted particles in G2 was statistically higher than that of G1 (P<0.01). Group three (CA-treated) showed nearly complete coverage of peri-implantitis affected parts by the graft material covering 88.8% of examined surface areas which was statistically higher than that of G2 (P<0.05). Conclusion: Citric acid implant surface conditioning could improve implant re-osseointegration through enhancement of the graft adhesion to the implant surface. Smear layer barrier effect seemed to be the most important factor that compromised graft adhesion to preri-implantitis affected parts of the implant surfaces.