Scanning Electron Microscopic Study of the Effects of Citric Acid on the Change of Implant Surface According to Application Time

구연산의 적용시간에 따른 임플란트 표면변화에 대한 주사전자현미경적 연구

  • Song, Woo-Seok (Department of Periodontology, College of Dentistry, Kyung Hee University) ;
  • Kwon, Young-Hyuk (Department of Periodontology, College of Dentistry, Kyung Hee University) ;
  • Lee, Man-Sup (Department of Periodontology, College of Dentistry, Kyung Hee University) ;
  • Park, Joon-Bong (Department of Periodontology, College of Dentistry, Kyung Hee University) ;
  • Herr, Yeek (Department of Periodontology, College of Dentistry, Kyung Hee University)
  • 송우석 (경희대학교 치과대학 치주과학교실) ;
  • 권영혁 (경희대학교 치과대학 치주과학교실) ;
  • 이만섭 (경희대학교 치과대학 치주과학교실) ;
  • 박준봉 (경희대학교 치과대학 치주과학교실) ;
  • 허익 (경희대학교 치과대학 치주과학교실)
  • Published : 2002.12.31


The present study was performed to evaluate the effect of citric acid on the change of implant surface microstructure according to application time. Implants with pure titanium machined surface, titanium plasma-sprayed surface, and sand-blasted, large grit, acid etched surface were utilized. Implant surface was rubbed with pH 1 citric acid for $\frac{1}{2}$ min., 1 min., 1 $\frac{1}{2}$ min., 2 min., and 3min, respeaively in the test group and implant surface was not treated in the control group. Then, the specimens were processed for scanning electron microscopic observation. The following results were obtained. 1. Both test and control group showed a few shallow grooves and ridges in pure titanium machined surface implants. There were not significant differences between two groups. 2. In titanium plasma-sprayed surfaces, round or amorphous particles were deposited irregularly. The irregularity of titanium plasma-sprayed surfaces conditioned with pH 1 citric acid was lessened and the cracks were increased relative to the application time of pH 1 citric acid. 3. Sand-blasted, large grit, acid etched surfaces showed the macro/micro double roughness. The application of pH 1 citric acid didn't change the characteristics of the sand-blasted, large grit, acid etched surfaces. In conclusion, the application of pH 1 citric acid to titanium plasma-sprayed surface is improper. And pure titanium machined surface implants and sand-blasted, large grit, acid etched surface implants can he treated with pH 1 citric acid for peri-implantitis treatment if the detoxification of these surfaces could be evaluated.



  1. Branemark, P.I., Hansson, B.O., Adell, R., Breine, U., Lindstrom, J., Hallen, O. and Ohman, A. : Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-years period. Scand. J. Plast. Recontr. Surg., 11(suppl, 16): 1-132,1977
  2. Adell, R., Lekholm, U., Rockier, B., and Branemark, P.I. : A 15-year study of osseointegrated implants in the treatment of edentulous jaw. Int. J. Oral Surg., 10:387-416, 1981
  3. Zarb, G.A., and Schmitt, A. : The longitudinal clinical effectiveness of osseointegrated dental implants. The Toronto study: part I, surgical results, J. Prosthet, Dent, 63: 451-457, 1990
  4. Ericsson, I., Lekholm, U., Branernark, P.I., Lindhe, J., Glantz, P.O., and Nyman, S. : A clinical evaluation of fixed bridge restorations supported by the combination of tooth and osseoinregrated titanium implants. J. Clin, Periodontol., 13: 307-312, 1986
  5. Meffert. R.M., Langer, B., and Fritz, M.E. : Dental Implants : A Review. J. Periodontol, 63: 859-870, 1992
  6. Albreksson, T., Zarb, G.A., Worthinton, P., and Ericsson, R.A. : The long-term efficacy of currently used dental implants : A review and prognosis criteria for success. Int. J. Oral Maxillofac. Implants., 1: 11-25, 1986
  7. Albreksson, T., Dahl, E., and Enbom, L. : Osseointegrated oral implants. A Swedish multicenter study of 8,139 consecutively inserted Nobelpharma implants, J. Periodontol., 59: 287-296, 1988
  8. Quirynen, M., Naert, I., and Van Steenberghe, D. : Fixture design and overload influence marginal bone loss and fixture success in the Branemark system. Clin, Oral Impl. Res., 3: 104-111, 1992
  9. Isidor, F. : Loss of osseointegration caused by occlusal load of ordl implants. Clin, Oral Impl, Res., 7: 143-152, 1996
  10. Mombelli, A., Van Oosten, M.A.C., Schurch, E.J., and Lang, N.P. : The microbiota associated with successful or failing osseointegrated titanium implants, Oral Microbiol. Immunol., 2: 145-151, 1987
  11. Hickey, J.S., O'Neal, R.B., Scheidt, M.J., Strong, S.L., Yurgeon, D., and Van Dyke, T.E. : Microbiologic characterization of ligatureinduced peri-implantitis in the microswine model. J. Periodontol., 62(9): 548-553, 1991
  12. Lekholm, U., Ericsson, I., Adell, R., and Slots, J. : The conditions of the soft tissues at tooth and fixture abutments supporting fixed bridge. A microbiological and histological study. J. Clin. Periodontol., 13: 558-562, 1986
  13. Holt, R., Newman, M., and Kratochvil, F. : The clinical and microbial characterization of periimplant environment. J. Dent. Res., 65(spec. Issue): 257, 1986
  14. Ericsson, I., Berglundh, T., Marinello, C.P., Liljenberg, B., and Lindhe, J. : Long standing plaque and gingivitis at implants and teeth in dog. Clin. Oral Impl, Res., 3: 99-103, 1992
  15. Berglundh, T., Lindhe, J., Ericsson, I., Marinello, C.P., Liljenberg, B., and Thomsen, P. : The soft tissue barrier at implants and teeth. Clin, Oral Impl. Res., 2: 81-90, 1991
  16. Berglundh, T., Lindhe, J., Ericsson, I., Marinello, C.P. and Liljenberg, B. : Soft tissue reactions to de novo plaque formation on implants and teeth. An experimental study in the dogs. Clin, Oral Impl, Res., 3: 1-8, 1992
  17. Mombelli, A. and Lang, N.P. : The diagnosis and treatment of peri-implantitis, Periodontol, 2000, 63-76, 1998
  18. Thomson-Neal, D., Evans, G. and Meffert, R. : Effect of various prophylactic treatments on titanium, sapphire, and hydroxyapatite-coated implants : An SEM study. Int. J. Periodontics Restorative Dent., 9: 301-311, 1989
  19. Chairay, J.P,, Boulekbache, H., Jean, A., Soyer, A. and Bouchard, P, : Scanning electron microscopic evaluation of the effects of an air-abrasive system on dental implants : A comparative in vitro study between machined and plasmasprayed titanium surfaces. J. Periodontol., 68: 1215-1222, 1997
  20. Meffert. R.M. : How to Treat Ailing and Failing Implants. Implant Dentistry, 1: 25-33, 1992
  21. Meffert, R.M. : Periodontitis and peri-implantitis : One and the same? Pract, Periodont, Aesthet, Dent., 5: 79-82, 1993
  22. Muller, E., Gonzaliz, Y.M., and Andreana, S. : Treatment of peri-implantitis : Longitudinal clinical and microbiological findings - A case report. Implant Dent., 8(3): 247-254, 1999
  23. Mellonig, J. T., Griffiths, G., Mathys, E., and Spitznagel, J. : Treatment of the failing implant : A case reports. Int. J. Periodontics Restorative Dent., 15: 385-395, 1995
  24. Somerman, M.J., Foster, R.A., Vorsteg, G., Progebin, K., and Wynn, R.L. : Effects of minocy- cline on fibroblast attachment and spreading. J. Periodontol., 23: 154-159, 1988
  25. AI-Ali, W., Bissada, N.F., and Greenwell, H. : The effect of local doxycycline with and without tricalcium phosphate on the regenerative healing potential of periodontal osseous defects in dogs. J. Periodontol., 60: 582-590, 1989
  26. Pepelassi, E.M., Bissada, N.F., Greenwell, H., and Farah, C.F. : Doxycycline-tricalcium phosphate composite graft facilitates osseous healing in advanced periodontal furcation defects. J. Perio- dontol., 62: 106-115, 1991
  27. Wielder, R., Newman, H., and Strahan, J. : Stannous fluoride and subgingival chlorhexidine irrigation in the control of plaque and chronic periodontitis, J. Clin, Periodontol.. 10: 172-181, 1983
  28. Daly, C.G. : Anti-bacterial effects of citric acid treatment of periodontally diseased root surfaces in vitro. J. Clin, Periodontol., 9: 386, 1982
  29. Tanaka, K., O'Leary, T.J., and Kafrawy, A.H. : The effect of citric acid on retained plaque and calculus. J. Periodontol., 60(2): 81-83, 1989
  30. Larjava, H., Salonen, J., Hakkinen, L., and Narhi, T. : Effect of citric acid treatment on the migration of epithelium on root surfaces in vitro. J. Periodontol., 59(2): 95-99, 1988
  31. Register, A.A., and Burdick, F.A. : Accelerated reattachment with cementogenesis to dentin, demineralized in situ. I. Optimum range. J. Periodontol., 46(1): 646-655, 1975
  32. Register, A.A., and Burdick, F.A. : Accelerated reattachment with cementogenesis to dentin, demineralized in situ. II. Defect repair. J. Periodontol., 47(9): 497-505, 1976
  33. Zablotsky, M.H., Diedrich, D.L., and Meffert, R.M. : Detoxification of endotoxin-contaminated tita- nium and hydroxyapatite-coated surfaces utiliz- ing various chemotherapeutic and mechanical modalities. Implant Dent., 1: 154-158, 1992
  34. Zablotsky, M.H., Diedrich, D.L., Meffert, R.M., and Wittrig, E. : The ability of various chemotherapeutic agents to detoxify the endotoxin infected HA-coated implant surface, Int. J. Oral Implant, 8: 45-51, 1991
  35. Parham, P.L., Cobb, C,M., French, A.A., Love, J.W., Drisko, C.L. and Killoy, W.J. : Effects of an air-powder abrasive system on plasma-sprayed titanium implant surfaces : An in vitro Evaluation. J. Oral Implantol., 15:78-86, 1989
  36. Albreksson, T., Branemark, P.I., Hansson, H.A., and Lindstrom, J. : Osseointegrated titanium implants, Acta. Orthop. Scand., 52: 155-170, 1981
  37. Jaffin, R.A., and Berman, C.L.: The excessive loss of Branemark fixtures in type IV bone: a 5 year analysis. J. Periodontol, 62: 2-4, 1991
  38. Jemt, T, : Implant treatment in resorbed edentulous upper jaw. A three-year follow-up study in 70 patients. Clin, Oral Impl, Res., 4: 187-194, 1993
  39. Jemt, T., Chai, J., Harnett, J., Heath, M.R., Hutton, J.E., Johns, R. B., McKenna, S., McNamara, D.C., van Steenberghe, D., Taylor, R., Watson, R.M., and Hermann, I. : A 5-year prospective multi- center follow-up report on overdentures supported by osseointegrated implants. Int. J. Oral Maxillofac, Implants., 11: 291-298, 1996
  40. Schroeder, A., Pohler, O., and Sutter, F. : Gewebereaktion auf ein Titan-Hohlzylinderim-platat mit Titan-Spritzschichtoberflache, Schweiz Monatsschr Zahnheilkd, 86: 713-727, 1976
  41. Babbush, C.A., Kent, J.N., and Misiek, D.J. : Titanium plasma-sprayed(TPS) screw implants for the reconstruction of the edentulous mandible. J. Oral Maxillofac. Surg, 44: 274-282, 1986
  42. Scacchi, M., Merz, B.R., and Schar, A.R. : The development of the $ITI^{\circledR}$ DENTAL IMPLANT SYSTEM. Part 2: 1998-2000: Steps into the next millenium. Clin. Oral Impl. Res., 11(Suppl.): 22-32, 2000
  43. Dennison, D.K., Huerzeler, M.B., Quinones, C., and Caffesse, R.G. : Contaminated Implant Surfaces : An In Vitro Comparison of Implant Surface Coating and Treatment Modalities for Decontamination. J. Periodontol., 65: 942-948, 1994
  44. Augthun, M., Tinschert, J., and Huber, A. : In vitro studies on the effect of cleaning methods on different implant surfaces. J. Periodontol., 69: 857-864, 1998
  45. Rapley, J.W., Swan, R.H., Hallmon, W.W. and Mills, M.P. : The surface characteristics produced by various oral hygiene instruments and materials on titanium implant abutments. Int. J. Oral Maxillofac. Implant, 5: 47-52, 1990
  46. Lozada, J.L., James, R.A., and Boskovic, M. : Surgical repair of peri-implant defects, J. Oral Implantol., 16: 42-46, 1990
  47. Hurzeler, M.B., Quinones, C.R., Morrison, E.C. and Caffesse, R.G. : Treatment of periimplantitis using guided bone regeneration and bone grafts, alone or in combination, in beagle dogs. part I : clinical findings and histologic observations. Int. J. Oral Maxillofac, Implants, 10: 474-484, 1995
  48. Hurzeler, M.B., Quinones, C.R., Schupbach, P., Morrison, E.C. and Caffesse, R.G. : Treatment of peri-implantitis using guided bone regeneration and bone grafts, alone or in combination, in beagle dogs. part II : histologic finding. Int. J. Oral Maxillofac, Implants, 12: 168-175, 1997
  49. Mellonig, J.T., Griffiths, G., Mathys, E. and Spitznagel, J. : Treatment of the failing implant: A case reports. Int. J. Periodontics Restorative Dent., 15: 385-395, 1995
  50. Wetzel, A.C., Vlassis, J., Caffesse, R.G., Hammerle, C.H. and Lang, N.P. : Attempts to obtain reosseointegration following experimental peri-implantitis in dogs. Clin, Oral Impl, Res., 10(2): 111-119, 1999
  51. Persson, L.G., Araujo, M.G., Berglundh, T., Grondahl, K., and Lindhe. J, : Resolution of peri-implantitis following treatment. An experimental study in the dog. Clin, Oral Impl, Res., 10: 195-203, 1999
  52. Baron, M., Haas, R., Dortbudak, O., and Watzek, G. : Experimentally induced peri-implantitis: A review of different treatment methods described in the literature. Int. J. Oral Maxillofac. Implants, 15: 533-544, 2000
  53. Persson, L. G., Ericsson, I., Berglundh, T., and Lindhe, J. : Osseointegration following treatment of peri-implantitis and replacement of implant components. An Experimental study in the dog. J. Clin. Periodontol., 28: 253-263, 2001