Clinical and laboratory evaluation of the effects of different treatment modalities on titanium healing caps: a randomized, controlled clinical trial
The objective of this study is to evaluate the effects of treatment modalities on titanium surface characteristics and surrounding tissues.
Materials and methods
Eighteen participants each had four titanium healing caps (HC) attached to four newly inserted implants. After healing, each HC was randomly assigned to either (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) only rubber cup polishing (CON). Probing depths (PD), bleeding on probing (BOP), matrix metalloproteinase 8 (MMP-8), and periopathogens were recorded before and 3 months following instrumentation. After final assessments, HCs were removed, cleaned, and subjected to (a) bacterial colonization (Streptococcus gordonii, 24 h; mixed culture, 24 h) and (b) gingival fibroblasts (5 days). HC surfaces were analyzed with a scanning electron microscope (SEM).
No significant differences between the groups were evident before or after instrumentation for PD and BOP (except TC showed a significant decrease in PD; p = 0.049). MMP-8 levels and bacterial loads were always very low. MMP-8 decreased further after instrumentation, while bacteria levels showed no change. No significant differences (p > 0.05) were evident in bacterial colonization or fibroblast attachment. A comparison of the overall mean SEM surface roughness scores showed a significant difference between all groups (p < 0.0001) with the lowest roughness after EP.
All treatments performed yielded comparable outcomes and may be implemented safely.
Clinicians may fear implant surface damage, but all instrumentation types are safe and non-damaging. They can be implemented as needed upon considering the presence of staining and soft and hard deposits.
KeywordsTitanium dental implants Healing caps Instrumentation Probing depths Bleeding on probing Matrix metalloproteinase-8 Biofilm formation Attachment of fibroblasts Surface roughness Biocompatibility
Special thanks to Dr. Ralf Rössler for inserting the dental implants.
This study was partially supported by an unrestricted grant from the Oral Reconstruction Foundation (previously Camlog Foundation), Basel, Switzerland (Grant CF41203), who also provided the dental implants and the specially constructed titanium healing caps for the experimental investigation. The design, documentation, and analyses of this study were carried out independently.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The protocol of the study was reviewed and approved by the Medical Ethics Committee, Philipps-University Marburg in Germany (no. 159/12). The study was conducted in accordance with the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and Good Clinical Practice guidelines as well as the Declaration of Helsinki.
All participants gave their informed consent prior to their inclusion in the study.
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