不同去污方法对种植体表面处理的体外研究

In vitro research of different decontamination methods for contaminated implant surfaces

目的评估不同去污方法对污染种植体的清洁效果和表面形态的影响,为临床中种植体表面清洁方案的选择提供依据。方法研究样本为收集自重度种植体周炎病例的8颗离体种植体,随机分为4组,每组2颗种植体,分别使用钛刮治器(刮治组)、钛刷(钛刷组)、喷砂(喷砂组)和铒激光(激光组)对种植体表面进行清洁并记录清洁时长,使用扫描电镜和X射线能谱仪对种植体表面进行成像和元素分析。结果清洁效果:(1)刮治组、钛刷组和喷砂组的组间清洁时长差异无统计学意义(均P>0.05),激光组用时明显高于刮治组(P<0.05);(2)低倍电镜图显示喷砂组与钛刷组的清洁程度相当,残留沉积物明显少于刮治组,而激光组去污前后沉积物量无明显变化;(3)元素分析显示仅喷砂组钛元素占比明显高于刮治组和基线(P<0.05)。表面形态:高倍电镜图显示激光去污和喷砂去污对蜂窝结构无影响,刮治组轻微改变,而钛刷组破坏严重。结论钛刮治器清洁污染种植体的能力有限,喷砂清洁有一定优势。目前单一的机械去污仍无法实现彻底清洁,需进一步探究更有效的去污方案。

Objective To evaluate the cleaning efficiency and the effects on implant surface morphology of different decontamination protocols,and to provide a reference for the selection of protocols to clinically clean contaminated implant surface.Methods The study samples were 8 isolated implants collected from cases of severe peri-implantitis, which were randomly divided into 4 groups of 2 implants in each group.The contaminated surface of the implants was cleaned in vitro by titanium curette,titanium brush,air-polishing or Er∶YAG laser,and the cleaning time was recorded.Scanning electron microscopy(SEM)and energy dispersive X-ray spectrometer(EDS)were used to evaluate the implant surface before and after cleaning.Results Cleaning effectiveness:(1)There was no significant difference in cleaning time among the curette group,the titanium brush group and the air-polishing group(P > 0.05),and the cleaning time of Er∶YAG laser group was significantly longer than that of the curette group(P < 0.05).(2)Low-fold SEM images showed that the cleanness of air-polishing group was equal to that of titanium brush group,while the amount of sediment in surface was significantly less than the currette group,but there was no significant change in the laser group.(3)The elemental analysis by EDS showed that the proportion of Ti in the air-polishing group was significantly higher than that in the curette group and the base line(P < 0.05).Surface morphology:High-fold SEM images showed that air-polishing decontamination and laser decontamination had no effect on the honeycomb-like microstructure,but the honeycomb-like structure was slightly changed by titanium curette and seriously damaged by titanium brush.Conclusion The cleaning ability of titanium curette is limited,but air-polishing decontamination has certain advantages in cleaning contaminated implant surface.The single mechanical decontamination method is still unable to realize thorough cleaning,and the more effective decontamination scheme needs to be further explored.