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Dental Tribune Middle East & Africa Edition | 5/2017 ◊Page 20 RESTORATIVE 21 Fig. 18: Case 2. Internal pocket line curet- tage Fig. 19: Case 2. Second application of dox- ycycline 14% Fig. 20: Case 2. 12 months healing. PPD reduction and BOP absence are notice- able pendent of the surface characteris- tics.16 The downside is that sodium bicarbonate can be harmful for soft tissues and can increase roughness of smooth surfaces.16 This prob- lem has been overcome thanks to low-abrasiveness powders such as glycine and erythritol, proven to be respectful of oral soft tissues.5 Good in-vitro results are reported: glycine seems to be effective in removing bacteria from both smooth and rough surfaces.16 Repeated use of glycine powder was not associated with any surface alterations,16 mak- ing its use feasible for life-long im- plant maintenance. Schmage et al.28 proved glycine powder to be as effec- tive as ultrasonic instruments with PEEK tip in cleaning both smooth and structured surfaces. Drago et al.7 analysed the in-vitro effect of eryth- ritol powder fi nding that it shows even a stronger antimicrobial and antibacterial activity than glycine. The detoxifying. Erythritol powder has a lower granulometry although Fig. 21: Case 2. 12 months radiographic check the abrasive power is high. This may help reaching the micro-anfractuosi- ty of the implant and, in conjunction with the antimicrobial activity, help detoxifying the surface. Schmidt et al.29 analysed the ef- fects of different instrumentations (stainless steel and plastic curettes, ÿPage 22 Make Class II’s Count 1 Isolation & Contact Palodent® V3 Sectional Matrix System 2 S D R U 2 0 1 7 - 1 2 1109181 3 4 Strong Bond Cavity Adaptation Effi cient Esthetics Prime&Bond universal™ Universal Adhesive SDR® Posterior Bulk Fill Flowable Base ceram.x® SphereTEC™ one Universal Nano-Ceramic Restorative Our Class II Solution™ for a tight marginal seal and effi cient esthetics Class II restorations are more important to your practice that you may think – they account for nearly half of all direct restorations. Getting them right the fi rst time is the key to happy patients and profi tability. Dentsply Sirona’s Class II Solution™ off ers a portfolio of products designed to work together to deliver success at the most vulnerable interface – the fl oor of the proximal box – and achieve esthetic results. Make your Class II’s count with Dentsply Sirona’s Class II Solution™. www.dentsply.com Fig. 17: Case 2. Implant surface debrid- ment with piezo-ceramic device and PEEK tip debris have been described to be one of the responsible factors for aseptic loosening of orthopaedic implants.33 They can be phagocytized by mac- rophages, inducing the expression of pro-infl ammatory cytokines acti- vating osteoclasts maturation.19 On the surface of titanium implants we can fi nd a self-repairable layer of TiO2 that shows an high chemical stability and prevent the diffusion of metallic ions. Scratching of the implant or abutment surface could lead to the temporary removal of the TiO2 layer and to release of metal particles.3 Fretwurst et al.11 analysed bioptic samples of bone and soft tis- sues from patients with severe peri- implantitis. In 75% of the biopsies it was possible to detect titanium accompanied by pro-infl ammatory macrophages. Furthermore, the alteration of the oxide layer and the contamination of the surface by instrument’s debris result in a impaired cell adhesion and im- plant biocompatibility.10,17 In some in vitro studies, implant surfaces treated with stainless-steel curettes show a signifi cantly lower number of attached fi broblast compared to untreated controls.17 Ultrasonic scal- ers with metal tips are effective in removing plaque from implant sur- faces16 but cause damages mostly to the smooth surfaces, increasing the roughness and the possibility of new biofi lm formation.15 This is the reason why different ma- terials curettes made have been in- troduced to not damage the implant surface (titanium-coated, carbon fi - bre, tefl on, plastic). Same happened with ultrasonic devices: etherketone- coated tips have been proposed as an effi cient scaling mean. Fox et al.10 showed that plastic and titanium- allow curette produce signifi cantly lower roughness on titanium sur- face compared to steel ones. Un- fortunately, the softer the material, the more limited is the debridment power. Different non-metal curettes were found to be ineffective in re- moving bacteria and calcifi ed de- posits from smooth as well as rough titanium surfaces.16 They also show lack of fl exibility which prevents an adeguate cleaning of the threads. Ultrasonic scalers with non-metal tips seem to be effective in remov- ing bacteria from smooth surfaces but show controversial results with rough surfaces.16 In order to overcome these limita- tions, coadjuvants and new tech- nologies have been introduced and combined. Air-polishing devices aim to an easier and more effi cient biofi lm removal. Abrasive powders are expected to be more effi cient in reaching the inner part of the threads and the smallest anfractuos- ity other than being respectful of the metal surfaces.15 Sodium bicarbonate is proved to be highly effective in re- moving bacteria, in particular from rough implant surfaces16 and to be more effective than plastic manual and mechanical instruments, inde-