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Louropoulou A, Slot DE et al. Clin Oral Impl Res 2014; 25: 1149–1160

It is a balance; on one hand it has been reported that 'Non-metal instruments and rubber cups were found to cause minimal or no damage to smooth implant surfaces', yet can these be used to debride contaminated titanium implant surfaces, particularly when trying to salvage an implant with peri-implantitis? In this systematic review, 14 studies met inclusion criteria. Most were in vitro studies employing titanium strips, discs and cylinders. Of the three in situ studies, two employed an animal model. Statistical analysis of the data was not possible because of study heterogeneity. It would appear that the use of ultrasonics, metal curettes, rotating titanium brushes and air abrasion all disrupt the biofilm (usually a monoculture). No methods were shown to remove consistently calcified deposits. The use of non-metal curettes, even when used in combination with chlorhexidine, and rubber cups were ineffective. It was shown that the use of ultrasonic scalers with metal tips caused damage to titanium surfaces.