Mechanical Versus Laser Debridement of SLA Titanium Implants: An In Vitro Morphological and Elemental Analysis of Debris Removal and Surface Preservation.

Peri-implantitis treatment is challenging because of the complex micro- and nanostructured topography of implant surfaces. No standard debridement protocol exists. In this study, we compared five debridement methods used on heavily contaminated titanium implants that were explanted due to peri-implantitis. Twenty-five explanted implants (five per group) were treated with a carbon fiber ultrasonic insert, a polyetheretherketone (PEEK) ultrasonic insert, a rotating titanium brush, an erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser, or an erbium-doped yttrium, aluminum, and garnet (Er:YAG) laser. Five pristine implants were used as controls. Surface morphology was assessed by scanning electron microscopy (SEM). The Modified-Implant Debridement Visual Index (M-IDVI) was used to assess the debridement effectiveness according to SEM images. Surface elemental composition was assessed for atomic percentage (at. %) of carbon, titanium, oxygen and nitrogen using energy-dispersive X-ray spectroscopy (EDS). Mechanical methods were more effective at removing debris than laser methods. The titanium brush showed the lowest residual debris (2.33 ± 0.33) and the greatest reduction in surface carbon (Δ = -7.77 at. %). Surface titanium increased after debridement for all methods except for Er,Cr:YSGG (Δ = -5.9 at. %). Er:YAG best preserved SLA microtopography but exhibited a lower debridement efficacy (3.27 ± 0.83) than mechanical methods. No method resulted in a pristine surface.