Efficacy of Decontamination Methods for Biofilm Removal from Dental Implant Surfaces and Reosseointegration: An AAP/AO Systematic Review on Peri-implant Diseases and Conditions

Purpose: To evaluate the nonclinical evidence concerning the efficacy of different decontamination methods in facilitating reosseointegration, eliminating biofilm from implant surfaces, and their potential to induce adverse surface modifications and release of material remnants. Materials and Methods: Systematic electronic and manual searches were conducted to identify publications involving animal or human block biopsies, ex vivo/in situ studies, and in vitro studies. Mechanical, chemical, and electrolytic methods for implant decontamination were presented in a descriptive analysis. Results: A total of 121 studies were included, namely 46 involving animal/human biopsies, 39 ex vivo/in situ experiments, and 36 in vitro investigations. No modality demonstrated significant superiority in terms of reosseointegration outcomes. Ex vivo, in situ, and in vitro studies reported that greater biofilm removal from implant surfaces occurred with polyetheretherketone (PEEK) ultrasonic tips, air-powder abrasive (APA), erbium: yttrium-aluminum-garnet (Er:YAG) laser, and electrolytic cleaning. Minimal surface alterations were noted with soaked cotton pellets, APA, specific settings of Er:YAG laser, erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser, electrolytic treatment, and cold atmospheric plasma. Titanium or stainless steel curettes, ultrasonic tips, titanium brushes, and implantoplasty induced significant surface alterations and peak flattening of implant threads. Plastic and carbon curettes as well as PEEK ultrasonic tips and APA left material remnants. Conclusions: Implant reosseointegration is possible following appropriate surface decontamination. Application of Er:YAG laser, electrolytic cleaning, and APA stand out as the methods that most closely embody the ideal characteristics ofan effective decontamination protocol.