Clin Oral Invest (2017) 21:2355–2361
DOI 10.1007/s00784-016-2030-x
ORIGINAL ARTICLE
The influence of implantoplasty on the diameter, chemical surface
composition, and biocompatibility of titanium implants
Frank Schwarz 1 & Gordon John 1 & Jürgen Becker 1
Received: 18 March 2016 / Accepted: 6 December 2016 / Published online: 24 December 2016
# Springer-Verlag Berlin Heidelberg 2016
Abstract
Objectives The objective of the study was to assess the influ-
ence of implantoplasty (IP) on the diameter, chemical surface
composition, and biocompatibility of titanium implants
in vitro.
Material and methods Twenty soft tissue-level (TL; ma-
chined transmucosal—M and rough endosseous part—SLA)
and 20 bone-level (BL; SLA) implants were allocated to IP
covering 3 or 6 mm of the structured surface (SLA) area. The
samples were subjected to diameter, energy-dispersive X-ray
spectroscopy (EDX), and cell viability (ginigval fibroblasts,
6 days) assessments.
Results Median diameter reductions varied between 0.1 (TL
3 mm) and 0.2 mm (TL 6 mm). EDX analysis revealed that IP
and M surfaces were characterized by a comparable quantity
(Wt%) of elements C, O, Na, Cl, K, and Si, but a significantly
different quantity of elements Ti and Al. When compared to
SLA surfaces, significant differences were noted for elements
C, O, Na, Ti, and Al. At BL implants, the extension of IP (i.e.,
3 to 6 mm) was associated with a significant increase in cell
viability.
Conclusions IP applied to SLA implants was associated with
(i) a minimal diameter reduction, (ii) an undisturbed cell via-
bility, and (iii) a chemical elemental composition comparable
to M surfaces.
* Gordon John
Gordon.John@med.uni-duesseldorf.de
1
Department of Oral Surgery, Universitätsklinikum Düsseldorf,
40225 Düsseldorf, Germany
Clinical relevance This specific IP procedure appears to be
suitable for the management of exposed SLA implant
surfaces.
Keywords Dental implants . Implant surface .
Implantoplasty . Cell culture
Introduction
Surgical treatment of peri-implantitis commonly involves
open flap debridement including a thorough granulation tissue
removal from the defect area and a decontamination of the
exposed implant surface areas [1]. This basic procedure may
either be combined with augmentative (e.g., bone fillers/auto-
grafts, guided bone regeneration) or resective (e.g., pocket
elimination, bone recontouring, implantoplasty) approaches
[2].
In particular, implantoplasty (IP) has been proposed as a
procedure to smoothen endosseous implant parts passing the
bony envelope, with the aim to render those surfaces less
attractive for plaque biofilm formation [3–5]. Indeed, when
used as an adjunct to open flap debridement + bone re-
contouring + apical flap re-positioning, IP was associated with
a significantly higher resolution of peri-implant mucosal in-
flammation than the control treatment [4]. Moreover, while
the test sites were associated with stable interproximal bone
levels at 3 years, the radiographic bone loss at control sites
amounted to 1.45–1.54 mm [6].
Preclinical animal and human re-entry data provide some
evidence that these restructured surfaces supported the adhe-
sion of peri-implant soft tissues, thus establishing a more fa-
vorable transmucosal area [7, 8]. When considering surface
roughness, treatment time, and pollution of the surgical site, IP
using a sequence of diamant burs in decreasing roughness and
2356
arkansas stones has been reported to be the most optimal pro-
cedure [9].
In a series of clinical trials, the latter protocol had also been
successfully employed to smoothen buccally and
supracrestally (>1 mm) exposed implant parts, which was
combined with augmentative therapy at the intrabony defect
components (refers to combined surgical resective/
regenerative therapy) [3, 8, 10–13].
The aim of the present in vitro study was to further analyze
the influence of this specific IP protocol on the diameter,
chemical surface composition, and biocompatibility of titani-
um implants.
Material and methods
Titanium implants
Commercially available one-piece (20 Straumann Soft Tissue
Level, Standard Plus SLActive, Ø 3.3 mm RN, length 10 mm,
Institut Straumann AG, Basel, Switzerland) (TL) and two-
piece (20 Straumann Bone Level, SLActive, Ø 4.1 mm RN,
length 10 mm, Institut Straumann AG) (BL) titanium implants
were used for the present analysis.
Both TL and BL implants were subdivided into groups
receiving either IP at the coronal 3 mm (10 TL/10 BL) or
6 mm (10 TL/10 BL) of their endosseous surface (coronal
reference points: TL—smooth-rough border; BL—implant
shoulder). The TL macrodesign was chosen as narrow diam-
eter implant, due to its thinner wall thickness in the designated
area, thus being more critical (i.e., perforation) for IP than BL.
Implantoplasty
In all groups (TL 3 mm; TL 6 mm; BL 3 mm; BL 6 mm), the
respective threatened and structured surface areas were demar-
cated (caliper measurements) and completely planished and
smoothened using a sequence of egg/football fine (grit size
46 μm) and extra-fine (grit size 25 μm) grit diamant burs
(8379 314.021; 379EF 314.023, Gebr. Brasseler GmbH &
Co. KG, Lemgo, Germany) and round arkansas stones
(601.314, extra fine, grit 420; Gebr. Brasseler GmbH & Co.
KG) (IP) (Fig. 1) in a red contra-angle at about 120 000/60
000 rpm under copious irrigation with sterile saline. All pro-
cedures were performed by the same experienced and calibrat-
ed operator (D.M.). Surface treatment was provided until the
operator felt that the exposed threatened and structured areas
were adequately planished and smoothened.
Diameter assessments
From all implants, standardized digital intraoral X-rays
(60 kV, 0.12 s.) (Sirona XiosPlus, CMOS-APS Sensor 20 ×
Clin Oral Invest (2017) 21:2355–2361
Fig. 1 IP was performed using a sequency of egg/football fine (red ring)
and extra-fine grit (yellow ring) diamant burs and round arkansas stones
30 mm, Sirona, Bensheim Germany) were obtained be-
fore and after IP. Digital images were used to assess the im-
plant diameter at predefined horizontal reference points (R)
(Image J, National Institutes of Health, Bethesda, MA,
USA). In particular, starting at the level of the respective cor-
onal reference points, R1-6 were drawn perpendicularly to the
implant axis at distances of 1.5 mm in apical direction.
Analysis of groups TL/BL 3 mm and TL/BL 6 mm considered
diameter assessments between R1-3 and R1-6, respectively
(Fig. 2a). All measurements were performed by the same pre-
viously calibrated examiner (F.S.).
Scanning electron microscopy and energy-dispersive
X-ray spectroscopy
After IP, the samples were gently rinsed with sterile water and
subjected to scanning electron microscopy (SEM) and energy-
dispersive X-ray spectroscopy (EDX) (S-3000 N, Hitachi,
Pleaston, USA). The transmucosal machined part of TL im-
plants (M) and the endosseous structured part (SLA) of TL/BL
implants served as positive and negative controls, respective-
ly. The localized chemical compositions of these surface areas
were detected, and elements were stated in weight percentage
(Wt%).
Cell viability assay
Human gingival fibroblasts (HFIB-G, Provitro GmbH, Berlin,
Germany) (fifth passage, 5000 cells suspended in 2 ml of
Dulbecco’s modified Eagle Medium/well, DMEM high glu-
cose, Glutamax; Sigma Aldrich, Schnelldorf supplemented
with 1% penicillin/streptomycin and 15% fetal bovine serum)
were seeded on the M, IP, and SLA surface areas of respective
BL and TL implants (n = 8 specimens per subgroup) that were
horizontally positioned in non-binding 24-well plates (Ø
15.6 mm per single well). The medium was exchanged after
3 days. At 6 days after incubation (5% CO2 at 37 °C) and
Clin Oral Invest (2017) 21:2355–2361 2357

Fig. 2 Standardized intraoral

radiographs to assess implant
diameters before and after IP.
Reference points (R’s) 1–3 and 1–
6 served for the assessments in
groups TL/BL 3 mm and TL/BL
6 mm, respectively. a TL pre. b
TL 3 mm. c TL 6 mm. d BL pre. e
BL 3 mm. f BL 6 mm

washing off (i.e., medium exchange) non-adherent cells from
the well bottom, the biocompatibility was assessed by the use
of a cell viability assay, which quantifies the key energy me-
tabolite adenosine triphosphate (CellTiter-Glo®, Promega,
Mannheim, Germany) in a luminometer (Victor 2030,
PerkinElmer, Rodgau, Germany). The signal was assessed in
counts per second (CPS). After cell lysis induced by the
CellTiter-Glo® reagent, the titanium implants were removed
from the wells.
The non-parametric Wilcoxon test was used for within
group comparisons of implant diameter reductions (R1-R3/
R6). Between group comparisons of mean EDX and CPS
values were accomplished using analysis of variance
(ANOVA, post-hoc testing using Bonferroni’s correction)
and the unpaired t test, respectively. Results were considered
statistically significant at p ≤ 0.05.

Statistical analysis Results

A commercially available software package (IBM SPSS Diameter assessments

Statistics 24.0, IBM Deutschland GmbH, Ehningen,
Germany) was used for the statistical analysis. Mean values,
medians, and standard deviations were calculated for R1-R3/
R6, EDX, and CPS values in each group.
The data rows were examined with the Shapiro-Wilk test
for normal distribution.
The mean and median reductions in implant diameters after IP
are summarized in Table 1. In all groups investigated, the
procedure was associated with a comparable and statistically
significant (p = 0.001, respectively; Wilcoxon test) diameter
reduction at R1-3/R1-6.
2358 Clin Oral Invest (2017) 21:2355–2361

Table 1 Reduction (Δ) in implant

diameter after implantoplasty Pre Post Δ
(n = 40 implants)
Group Mean SD Median Mean SD Median Mean SD Median

TL 3 mm 3.05 0.05 3.05 2.94 0.07 2.95 0.10*** 0.07 0.10

TL 6 mm 3.04 0.05 3.00 2.89 0.07 2.90 0.15*** 0.06 0.20
BL 3 mm 3.90 0.16 3.9 3.76 0.24 3.75 0.13*** 0.12 0.10
BL 6 mm 3.83 0.20 3.80 3.74 0.26 3.70 0.09*** 0.07 0.10
***
p ≤ 0.001; Wilcoxon test, respectively

In particular, median implant diameters in the TL 3 mm/
6 mm groups changed from 3.05/3.00 mm by 0.10/0.20 mm to
2.95/2.90 mm, respectively. Similarly, median implant diam-
eters in the BL 3 mm/6 mm groups changed from 3.90/
3.80 mm by 0.10/0.10 mm to 3.75/3.70 mm, respectively
(Table 1). Perforations of the implant walls were not observed.
SEM and EDX analyses
Representative SEM views of IP, M, and SLA surface areas
are presented in Fig. 3a–c.
IP commonly resulted in a smoothing of the sharp-edged
SLA microstructure. However, the procedure was associated
with the presence of irregular grooves and flat pits, which
appeared to be more uneven than the structure noted for M
surfaces.
The quantification (Wt%) of chemical elements at IP, M,
and SLA surfaces is summarized in Table 2. Basically, EDX
analysis revealed that titanium (Ti) was the predominant
element at all surface areas investigated. However, its quantity
and the presence of other elements varied considerably be-
tween groups (Fig. 3d–f). In particular, IP and M surfaces
were characterized by a comparable quantity (Wt%) of ele-
ments carbon (C), oxygen (O), sodium (Na), chloride (Cl),
potassium (K), and silicon (Si), but a significantly different
quantity of elements nitrogen (N), Ti, and aluminum (Al). In
particular, mean Wt% values for element N was 6.3 ± 6.2 in
the M group, but amounted to 13.9 ± 5.3 at IP surfaces (p =
0.001, ANOVA). Conversely, mean Wt% for element Ti de-
creased from 84.8 ± 12.4 in the M group to 76.7 ± 10.0 at IP
surfaces (p = 0.023, ANOVA). At some specimens of the IP
group, EDX analysis has also pointed to the presence of ele-
ment Al, thus reaching statistical significance over the M
group (p = 0.001, ANOVA) (Table 2).
When compared to SLA surfaces, significant differences
were noted for elements C, O, Na, Ti, and Al. In particular,
mean Wt% values for element Ti was 55.0 ± 10.8 in the SLA
group, but amounted to 76.7 ± 10.0 at IP surfaces (p = 0.001).

Fig. 3 Representative SEM views (original magnification ×1000) and EDX—IP. e EDX—TL transmucosal machined. f EDX—TL
EDX quantification reports for different surface areas. a SEM—IP. b endosseous SLA
SEM—TL transmucosal machined. c SEM—TL endosseous SLA. d
Clin Oral Invest (2017) 21:2355–2361 2359

Table 2 EDX quantification

(Wt%) of elements at IP, M, and IP M SLA
SLA surfaces (n = 40 implants)
Element Mean SD Median Mean SD Median Mean SD Median

C 6.8 5.8 8.5 7.4 10.4 0.0 16.8*** 5.1 15.7

***
N 13.9 5.3 14.7 6.3 6.2 4.9 11.3 6.2 14.0
O 2.0 3.9 0.0 1.3 2.7 0.0 14.6*** 6.1 15.5
Na 0.0 0.0 0.0 0.0 0.0 0.0 1.03* 2.9 0.0
Cl 0.0 0.0 0.0 0.0 0.0 0.0 0.3 1.1 0.0
Ti 76.7 10.0 75.7 84.8* 12.4 85.6 55.0*** 10.8 53.5
Al 0.7 1.0 0.0 0.0** 0.0 0.0 0.1** 0.4 0.0
K 0.1 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Si 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.0

M refers to the the transmucosal machined part of TL implants and SLA to the endosseous structured part of TL
and BL implants
Comparisons to IP surfaces: *p < 0.05, ** p < 0.01, *** p < 0.001; ANOVA, respectively

Conversely, mean Wt% for elements C and O decreased from
16.8 ± 5.1 and 14.6 ± 6.1 in the SLA group to 6.8 ± 5.8 and 2.0
± 3.9 at IP surfaces (p = 0.001; p = 0.001, ANOVA), respec-
tively. Some specimens in the SLA group were associated
with the presence of elements Na and Al, thus reaching statis-
tical significance (p = 0.04; p = 0.01, ANOVA) over respective
IP surfaces (Table 2).
Cell viability assay
Cell viability measurements after 6 days of incubation,
expressed as mean CPS values, are presented in Table 3. In
both TL and BL groups, the extension of IP from 3 to 6 mm
was associated with an increase in the luminescence signal. In
particular, mean CPS values increased from 255.25 ± 128.36
to 263.50 ± 84.64 in the TL 3/6 mm groups and from 155.25
± 71.82 to 437.25 ± 289.21 in the BL 3/6 mm groups, respec-
tively. In the BL group, mean CPS changes reached statistical
significance (p = 0.029, unpaired t test).
Discussion
of the implants. These outcomes were neither influenced
by the extend of the procedure (i.e., 3 or 6 mm) nor the
macrodesign of the implant (i.e., BL or TL). In this con-
text, it must be emphasized that a potential drawback of the
present study was the lack of further analyses to evaluate
the mechanical strength of the smoothened implants.
However, recent in vitro data employing implants with a
tapered design have indicated that IP may weaken the
strength of narrow-diameter specimens [14]. In particular,
the bending strength was significantly reduced from 613.9
± 42.8 N (untreated control) to 511.4 ± 55.9 N (5 mm IP
using 30/15-μm egg-shaped diamond burs, arkansas
stones, and fine silicon polishers), thus resulting in a body
fracture of all 3.75-mm diameter implants. In contrast, at
4.7-mm implants, the fractures solely occurred at the level
of the abutment screws [14]. When interpreting the results
of the latter study, however, one has to keep in mind that
the authors did not assess the diameter reductions, and
therefore, it is impossible to estimate to what extend a
variation in the final thickness of the implant walls may
have influenced the measurements in respective groups.
Moreover, since the aforementioned study employed ta-
pered implants with different size parameters, it is

The aim of the present in vitro study was to further analyze the
influence of a specific IP protocol, which had been success-
Table 3 Cell viability at 6 days after seeding of gingival fibroblasts on
fully used in a series of clinical trials (i.e., combined surgical the M, IP, and SLA surface areas of BL and TL implants (n = 32 implants,
resective/regenerative therapy of peri-implantitis) [3, 8, horizontally positioned in non-binding 24-well plates)
10–13], on the diameter, chemical surface composition, and
Group Mean SD Median
biocompatibility of titanium implants.
Basically, it was observed that the reduction in implant TL 3 mm 255.25 128.36 192.0
diameter after a careful application of fine/extra-fine dia- TL 6 mm 263.50 84.64 269.0
mond burs and arkansas stones was commonly considered BL 3 mm 155.25 71.82 134.0
as minimal. As evidenced by the radiographic examina- BL 6 mm 437.25** 289.21 374.0
tions, the smoothing procedure was mainly restricted to
the threads and did obviously not affect the core diameter Compared to BL 3 mm: ** p < 0.05; unpaired t test
2360
impossible to estimate to what extend these results obtain-
ed under different experimental conditions may be applied
to either BL or TL implants. Nevertheless, the clinician
should be cautious when applying this procedure to
narrow-diameter implants.
When further analyzing the results of the present study, it
was noted that IP resulted in a smoothing of the sharp-edged
SLA microstructure, but still revealed the presence of irregular
grooves and flat pits. In this context, it must be emphasized
that another drawback of the present analysis was a lack of
surface roughness measurements. However, the Ra value
resulting from a similar sequence of diamond (106, 40,
4 μm) and arkansas burs applied at SLA surfaced TL implants
has recently been reported to be within the range of 0.39 ±
0.13 μm [9]. These outcomes were slightly improved to 0.32
± 0.14 μm, when the diamond burs were combined with sili-
cone polishers. In contrast, the Ra value assessed at the ma-
chined neck of TL implants was 0.10 ± 0.01 μm and
amounted to 1.94 ± 0.47 μm at SLA surfaces [9].
Since silicone polishers are commonly associated with a
pronounced pollution of the surgical site, one has to question
their slight beneficial influence on surface roughness over
arkansas stones. Even though a further Ra reduction, at least
to a threshold level of 0.2 μm, appears to be desirable to limit
plaque biofilm formation [15], the surface characteristics at
the transmucosal aspect of titanium implants had obviously
no effect on the development of peri-implant soft tissue in-
flammation [16–18].
Moreover, the results of a previous experimental animal
study employing the ligature-induced peri-implantitis de-
fect model have indicated that this specific IP procedure
(i.e., fine/extra-fine diamond burs and arkansas stones) re-
sulted in a smooth transmucosal area at SLA-surfaced im-
plants, which in turn supported a close adhesion of the
subepithelial connective tissue. The formation of a new
bone to implant contact after IP could not be identified in
any of the specimens investigated, thus indicating that
these surfaces do obviously not attract osteoblasts [7]. A
positive effect of an extension of IP (i.e., 3 to 6 mm) on the
cell viability of gingival fibroblasts has, at least in part
(refers to the BL group), also been confirmed by the pres-
ent study. In this context, it must be emphasized that the
spreading and proliferation of fibroblast are commonly
pronounced at smooth when compared with rough titanium
surfaces [19, 20]. However, in addition to the microstruc-
ture, cellular interactions may also be influenced by the
chemical elemental composition of the implant surface.
This mainly refers to the presence of potential contami-
nants from the atmosphere, such as hydrocarbons and C,
which have been shown to reduce the surface free energy
and subsequently cell adhesion [21]. The present EDX
Clin Oral Invest (2017) 21:2355–2361
profiles noted for M and SLA areas basically corroborate
a recent elemental analysis of the same surfaces [20].
When comparing these data with the specific characteris-
tics obtained after IP, it was apparent that smoothened and
M surfaces revealed a comparable quantity (Wt%) of ele-
ments C, O, Na, Cl, K, and Si, but a significantly different
quantity of elements Ti and Al. However, when compared
with SLA surfaces, IP resulted in a significantly different
quantity of elements C, O, Na, Ti, and Al. Similar EDX
profiles were also reported subsequent to IP using 30-mm
particle size egg-shaped burs [22]. In particular, the analy-
sis (refers to mass%) of elements Ti, O, Al, and C for SLA-
surfaced implants was 67.5, 26.75, 8.23, and 3.01. After
surface treatment, these values were 92.28, 1.59, 3.3, and
1.73 [22]. All these data taken together with the results of
the present analysis seem to indicate that the elemental
composition of IP-modified surfaces closely resembles that
of conventional M surfaces. In this context, however, one
has to keep in mind that the titanium implants/discs as used
in the present or latter study were unworn and the intraoral
contamination of commercially pure titanium foils was as-
sociated with an increase in C from 48 to 70% [23]. Since
biofilm removal alone did not result in a reestablishment of
the biocompatibility of contaminated titanium surfaces
[24], one might hypothesize that the effects of IP on the
elemental composition and cell to implant interactions be-
come even more relevant at diseased implant sites. These
issues need to be carefully addressed in future studies.
In conclusion, the present analysis has indicated that IP
applied to SLA implants was associated with (i) a minimal
diameter reduction, (ii) an undisturbed cell viability, and (iii)
a chemical elemental composition comparable to that noted
for M surfaces.
Acknowledgements The authors kindly appreciate the skills and com-
mitment of Dr. Daniel Martens (performing the implantoplasty) and Ms
Tina Hagena (in vitro analyses) (both Department of Oral Surgery,
Universitätsklinikum Düsseldorf, Düsseldorf, Germany).
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Funding The study was self-funded by the Department of Oral
Surgery, Universitätsklinikum Düsseldorf, Germany. The titanium im-
plants were kindly provided by the Institut Straumann AG, Basel,
Switzerland.
Ethical approval This article does not contain any studies with human
participants or animals performed by any of the authors.
Informed consent For this type of study, formal consent is not required.
Clin Oral Invest (2017) 21:2355–2361
References
1. Heitz-Mayfield LJ, Salvi GE, Mombelli A, Faddy M, Lang NP,
Implant Complication Research G (2012) Anti-infective surgical
therapy of peri-implantitis. A 12-month prospective clinical study.
Clin Oral Implants Res 23:205–210
2. Schwarz F, Schmucker A, Becker J (2015) Efficacy of alternative or
adjunctive measures to conventional treatment of peri-implant mu-
cositis and peri-implantitis: a systematic review and meta-analysis.
Int J Implant Dent 1:22
3. Schwarz F, Sahm N, Iglhaut G, Becker J (2011) Impact of the
method of surface debridement and decontamination on the clinical
outcome following combined surgical therapy of peri-implantitis: a
randomized controlled clinical study. J Clin Periodontol 38:276–84
4. Romeo E, Ghisolfi M, Murgolo N, Chiapasco M, Lops D, Vogel G
(2005) Therapy of peri-implantitis with resective surgery. A 3-year
clinical trial on rough screw-shaped oral implants. Part I: clinical
outcome. Clin Oral Implants Res 16:9–18
5. Matarasso S, Iorio Siciliano V, Aglietta M, Andreuccetti G, Salvi
GE (2013) Clinical and radiographic outcomes of a combined
resective and regenerative approach in the treatment of peri-
implantitis: a prospective case series. Clin Oral Implants Res 25:
761–767
6. Romeo E, Lops D, Chiapasco M, Ghisolfi M, Vogel G (2007)
Therapy of peri-implantitis with resective surgery. A 3-year clinical
trial on rough screw-shaped oral implants. Part II: radiographic
outcome. Clin Oral Implants Res 18:179–187
7. Schwarz F, Sahm N, Mihatovic I, Golubovic V, Becker J (2011)
Surgical therapy of advanced ligature-induced peri-implantitis de-
fects: cone-beam computed tomographic and histological analysis.
J Clin Periodontol 38:939–949
8. Schwarz F, John G, Becker J (2015) Reentry after combined surgi-
cal resective and regenerative therapy of advanced peri-implantitis:
a retrospective analysis of five cases. Int J Periodontics Restorative
Dent 35:647–653
9. Ramel CF, Lussi A, Ozcan M, Jung RE, Hämmerle CH, Thoma DS
(2015) Surface roughness of dental implants and treatment time
using six different implantoplasty procedures. Clin Oral Implants
Res doi: 10.1111/clr.12682
10. Schwarz F, John G, Mainusch S, Sahm N, Becker J (2012)
Combined surgical therapy of peri-implantitis evaluating two
methods of surface debridement and decontamination. A two-year
clinical follow up report. J Clin Periodontol 39:789–797
11. Schwarz F, Hegewald A, John G, Sahm N, Becker J (2013) Four-
year follow-up of combined surgical therapy of advanced peri-
implantitis evaluating two methods of surface decontamination. J
Clin Periodontol 40:962–967
12. Schwarz F, John G, Sahm N, Becker J (2014) Combined surgical
resective and regenerative therapy for advanced peri-implantitis
2361
with concomitant soft tissue volume augmentation: a case report.
Int J Periodontics Restorative Dent 34:489–495
13. Schwarz F, Sahm N, Becker J (2014) Combined surgical therapy of
advanced peri-implantitis lesions with concomitant soft tissue vol-
ume augmentation. A case series. Clin Oral Implants Res 25:132–
136
14. Chan HL, Oh WS, Ong HS, Fu JH, Steigmann M, Sierraalta M,
Wang HL (2013) Impact of implantoplasty on strength of the
implant-abutment complex. Int J Oral Maxillofac Implants 28:
1530–1535
15. Bollen CM, Papaioanno W, Van Eldere J, Schepers E, Quirynen M,
van Steenberghe D (1996) The influence of abutment surface
roughness on plaque accumulation and peri-implant mucositis.
Clin Oral Implants Res 7:201–211
16. Jepsen S, Berglundh T, Genco R, Aass AM, Demirel K, Derks J,
Figuero E, Giovannoli JL, Goldstein M, Lambert F, Ortiz-Vigon A,
Polyzois I, Salvi GE, Schwarz F, Serino G, Tomasi C, Zitzmann NU
(2015) Primary prevention of peri-implantitis: managing peri-
implant mucositis. J Clin Periodontol 42(Suppl 16):152–157
17. Schwarz F, Mihatovic I, Becker J, Bormann KH, Keeve PL,
Friedmann A (2013) Histological evaluation of different abutments
in the posterior maxilla and mandible: an experimental study in
humans. J Clin Periodontol 40:807–815
18. Schwarz F, Mihatovic I, Golubovic V, Eick S, Iglhaut T, Becker J
(2014) Experimental peri-implant mucositis at different implant
surfaces. J Clin Periodontol 41:513–520
19. Nothdurft FP, Fontana D, Ruppenthal S, May A, Aktas C, Mehraein
Y, Lipp P, Kaestner L (2015) Differential behavior of fibroblasts and
epithelial cells on structured implant abutment materials: a compar-
ison of materials and surface topographies. Clin Implant Dent Relat
Res 17:1237–1249
20. John G, Becker J, Schwarz F (2015) Modified implant surface with
slower and less initial biofilm formation. Clin Implant Dent Relat
Res 17:461–468
21. Rupp F, Scheideler L, Olshanska N, de Wild M, Wieland M, Geis-
Gerstorfer J (2006) Enhancing surface free energy and hydrophilic-
ity through chemical modification of microstructured titanium im-
plant surfaces. J Biomed Mater Res A 76:323–334
22. Toma S, Lasserre J, Brecx MC and Nyssen-Behets C (2015) In vitro
evaluation of peri-implantitis treatment modalities on Saos-2osteo-
blasts. Clin Oral Implants Res doi: 10.1111/clr.12686
23. Mouhyi J, Sennerby L, Wennerberg A, Louette P, Dourov N, van
Reck J (2000) Re-establishment of the atomic composition and the
oxide structure of contaminated titanium surfaces by means of car-
bon dioxide laser and hydrogen peroxide: an in vitro study. Clin
Implant Dent Relat Res 2:190–202
24. Schwarz F, Papanicolau P, Rothamel D, Beck B, Herten M, Becker
J (2006) Influence of plaque biofilm removal on reestablishment of
the biocompatibility of contaminated titanium surfaces. J Biomed
Mater Res Part A 77:437–444