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Impact of argon plasma treatment on microbiological surface receptivity of titanium implants: An in vitro study

September 21, 2016 / Categories: Digital Dentistry, Implant Dentistry

Annunziata, Marco

Galindo Moreno, Pablo

Donnarumma, Giovanna

Caputo, Pina

Nastri, Livia

Guida, Luigi

Pretreatment of dental implants by argon plasma has been suggested to increase their surface energy and enhance integration of both hard and soft periimplant tissue. However, no data are available on the risk of implant sterility loss after this process. This study aimed to test whether the treatment of implant fixtures by argon plasma in conditions compatible with clinical use produced an increased risk of microbiological contami- nation.

Introduction

Argon plasma is widely employed as the final step of the manufacturing process of titanium implant fixtures before their sterilization by gamma rays.

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With this treatment, a spray of argon under pressure at room temperature is used to clean implants and remove microbiological and organic contaminants from the metal surface. At the same time, however, the atomic bombardment to which the titanium surface is subjected, causes its activation, that is, a state of excitation of the electronic mantle and the modification of its physicochemical and biological features.1Aronsson BO, Lausmaa J, Kasemo B. Glow discharge plasma treatment for surface cleaning and modification of metallic biomaterials.
→ J Biomed Mater Res. 1997 Apr;35(1):49–73.

The activation obtained during the manufacturing phase is temporary and will have ceased once the implant fixture is used clinically. It has been suggested that the reactivation of the titanium surface by argon plasma immediately before the implant positioning in the oral cavity could be advantageous in terms of the integration of both hard and soft periimplant tissue.

In vitro and animal studies performed in sterile environments have shown an increased surface energy and an enhanced early biomechanical fixation of dental implants pretreated by argon plasma.2Coelho PG, Giro G, Teixeira HS, Marin C, Witek L, Thompson VP, Tovar N, Silva NR. Argonbased atmospheric pressure plasma enhances early bone response to rough titanium surfaces.
→ J Biomed Mater Res A. 2012 Jul;100A(7):1901–6.

3Teixeira HS, Marin C, Witek L, Freitas A Jr, Silva NR, Lilin T, Tovar N, Janal MN, Coelho PG. Assessment of a chairside argonbased nonthermal plasma treatment on the surface characteristics and integration of dental implants with textured surfaces.
→ J Mech Behav Biomed Mater.2012 May;9:45–9.
4Giro G, Tovar N, Witek L, Marin C, Silva NR, Bonfante EA, Coelho PG. Osseointegration assessment of chairside argon-based nonthermal plasma-treated Ca-P coated dental implants.
→ J Biomed Mater Res A. 2013 Jan;101A(1):98–103.
Furthermore, preliminary results have suggested that treatment of titanium abutments by argon plasma may enhance cell adhesion at the early stage of periimplant softtissue healing5Canullo L, PeñarrochaOltra D, Marchionni S, Bagán L, PeñarrochaDiago MA, Micarelli C. Soft tissue cell adhesion to titanium abutments after di erent cleaning procedures: preliminary results of a randomized clinical trial.
→ Med Oral Patol Oral Cir Bucal. 2014 Mar;19(2):e177–83.
and marginal bone preservation over time.6Canullo L, Peñarrocha D, Clementini M, Iannello G, Micarelli C. Impact of plasma
of argon cleaning treatment on implant abutments in patients with a history of periodontal disease and thin biotype: radiographic results at 24-month followup of a RCT.
→ Clin Oral Implants Res. 2015 Jan;26(1):8–14.
However, no data are available about the possible e ect of this treatment on the implant surface receptivity toward environmental bacteria and on the risk of sterility loss of the fixture just before its surgical placement. The aim of the present study was to test whether the treatment of implant fixtures by argon plasma in conditions compatible with clinical use produced an increased risk of microbiological contamination.

Materials and methods

Fig. 1
Test implants inserted into a metallic holder before pretreatment in the argon plasma chamber.

Fig. 2
Culture broths examined after the 72 h incubation. No traces of bacterial contamination were found for either controls or test implants.

Thirty (15 control and 15 test) sterile Grade 4 titanium implant fixtures with a sandblasted and acid-etched surface (ZirTi, average surface roughness of 1.3 μm; Sweden & Martina, Due Carrare, Padua, Italy) were used for this study. Control implants were directly transferred with sterile tweezers from their original packaging into test tubes containing 5 ml of Luria-Bertani broth (Oxoid, Basingstoke, UK) and incubated at 37 °C for 72 h. Test implants were inserted into a metallic holder (Fig. 1) and pretreated in an argon plasma chamber (Plasma R, Diener electronic, Ebhausen, Germany) for 12 min at room temperature and then transferred to culture broth. In order to simulate the clinical practice and environment, the time between the removal of each fixture from its sterile package, or from the argon plasma chamber, and its immersion in the culture broth was standardized at 60 s and the transfer was performed in a nonprotective environment. Three independent experiments were carried out under the same conditions.

Results

When the culture broths were examined after the 72 h incubation, no traces of bacterial contamination were found for either controls
or test implants (Fig. 2).

Conclusion

Within the limits of this study, the data reported suggest that argon plasma technology could be used to pretreat implant fixtures immediately before their surgical placement without increasing the risk of microbiological contamination. However, additional microbiological and preclinical studies should be performed to test the clinical applicability of this procedure.

Competing interests

The authors declare that they have no competing interests.

Dr Annunziata_Marco

Interview

with Dr. Marco Annunziata

Why did you conduct the research reported on in this paper?

The aim of this study was to demonstrate that the use of argon plasma technology to pretreat titanium implants before their clinical use has no impact on their receptivity to ambient microorganisms.

For what reasons could others cite your paper?

This is the only published paper to date that specifically deals with this topic.

How could your study’s findings have an impact on dentistry?

This study contributes to enlarging and supporting the applications of argon plasma technology in implant dentistry.

What is the relevance of your study’s findings to the daily practice of a dentist?

Dentists who wish to use argon plasma technology in their daily implant practice, for instance to activate implant fixtures before their surgical placement to enhance implant integration in hard and soft tissue, will find in this paper initial evidence supporting its safe use in terms of the risk of microbiological contamination of the treated implant surface.

What are your recommendations for further investigation of the topic of your article?

Further studies are needed to confirm the study findings and to expand the investigation to implants with a different geometry and surface topography in order to confirm the validity and expand the applicability of argon plasma technology.

References   [ + ]

1. Aronsson BO, Lausmaa J, Kasemo B. Glow discharge plasma treatment for surface cleaning and modification of metallic biomaterials.
→ J Biomed Mater Res. 1997 Apr;35(1):49–73.
2. Coelho PG, Giro G, Teixeira HS, Marin C, Witek L, Thompson VP, Tovar N, Silva NR. Argonbased atmospheric pressure plasma enhances early bone response to rough titanium surfaces.
→ J Biomed Mater Res A. 2012 Jul;100A(7):1901–6.
3. Teixeira HS, Marin C, Witek L, Freitas A Jr, Silva NR, Lilin T, Tovar N, Janal MN, Coelho PG. Assessment of a chairside argonbased nonthermal plasma treatment on the surface characteristics and integration of dental implants with textured surfaces.
→ J Mech Behav Biomed Mater.2012 May;9:45–9.
4. Giro G, Tovar N, Witek L, Marin C, Silva NR, Bonfante EA, Coelho PG. Osseointegration assessment of chairside argon-based nonthermal plasma-treated Ca-P coated dental implants.
→ J Biomed Mater Res A. 2013 Jan;101A(1):98–103.
5. Canullo L, PeñarrochaOltra D, Marchionni S, Bagán L, PeñarrochaDiago MA, Micarelli C. Soft tissue cell adhesion to titanium abutments after di erent cleaning procedures: preliminary results of a randomized clinical trial.
→ Med Oral Patol Oral Cir Bucal. 2014 Mar;19(2):e177–83.
6. Canullo L, Peñarrocha D, Clementini M, Iannello G, Micarelli C. Impact of plasma
of argon cleaning treatment on implant abutments in patients with a history of periodontal disease and thin biotype: radiographic results at 24-month followup of a RCT.
→ Clin Oral Implants Res. 2015 Jan;26(1):8–14.

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