纯钛种植体激光-微弧氧化表面处理对早期骨结合的影响

目的:对比机械光滑表面和经激光-微弧氧化处理表面的纯钛种植体的理化性能,及其对早期骨结合的影响。方法:将纯钛棒加工制作成16颗螺纹柱形种植体,对照组(光滑组)为机械加工光滑表面种植体8颗,实验组(激光-微弧氧化组)为经激光-微弧氧化处理种植体8颗。通过能谱分析仪(EDX)和扫描电镜(SEM)分析种植体表面性质,Veeco粗糙仪检测其粗糙度(Ra)。分别将16颗种植体随机植入新西兰兔的胫骨,4周后处死取样,处死前第13天和第14天皮下注射四环素,处死前第3和第4天皮下注射钙黄绿素,通过四环素-钙黄绿素双色标记示踪检测其矿化速率。将标本通过塑料包埋制作成不脱钙含种植体骨切片,观察种植体-骨界面的骨结合情况。结果:实验组表面可见较大级别微孔,基本与激光处理后一致,孔径约100μm,孔深40⁸0μm。种植体表面微弧氧化膜具有多微孔结构,微孔孔径约180μm。种植体表面微弧氧化膜具有多微孔结构,微孔孔径约1⁵μm,微孔内还可见更小级别微孔,孔径小于1μm。对照组种植体表面Ra值为0.179μm,实验组表面的微弧氧化膜Ra值为1.55μm。对照组只检测到Ti元素,实验组钛表面氧化膜层中含Ti、O、Ca、P元素。实验组的矿化速率和种植体与骨接触的百分率(OI值)均显著高于对照组(P<0.05)。结论:通过激光-微弧氧化表面处理,纯钛种植体表面形成多层次多微孔的微弧氧化膜,具有良好的生物相容性和骨引导性,能促进种植体骨结合。     

种植体表面去污联合手术疗法治疗种植体周围炎

种植体周围炎是种植义齿常见的并发症,是导致种植义齿失败的主要原因。种植体表面去污会影响种植体周围炎手术治疗的疗效,是种植体周围骨缺损重建前的必要处理步骤。由于良好的杀菌和去污能力,激光疗法和光动力学疗法在处理污染种植体表面上拥有良好的应用前景。本文就不同种植体表面去污的方法及其联合手术疗法治疗种植体周围炎的效果作一归纳总结。     

不同去污方法对种植体表面处理的体外研究

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。     

不同功率He:Ne激光对种植体骨结合面积影响的动物实验研究

目的:探索不同功率He:Ne激光对种植体骨结合面积的影响。方法:选取成年雄性Beagle犬6只,每只犬每侧胫骨植入4枚种植体,种植体随机编入A、B、C、D组,A、B、C组为实验组,D组为对照组,每组12枚,共48枚。实验组术后立即采用不同功率He:Ne激光垂直照射种植体对应体表,A组15.9J/cm2、B组26.5J/cm2、C组37.1J/cm2,20min/次,1次/d,持续2周。术后1、2、3个月分别处死2只犬,取标本制作种植体骨磨片,Goldner’s三色法染色后测量种植体骨接触率,所得数据采用统计学处理。结果:种植体骨接触率:术后1、2个月A、B、C、D组间无显著差异,术后3个月A与B及C与D组间无显著差异,A、B组明显高于C、D组(P<0.05)。结论:术后持续照射低功率He:Ne激光2周,能明显增加种植体骨结合的面积,以15.9J/cm2或26.5J/cm2照射效果最佳。     

种植体周围牙槽骨对表面单纯切削与氧化处理的钛种植体反应的比较

本研究采用两种不同表面处理的钛种植体进行体内自身对照实验来评估钛种植体表面氧化处理对种植体骨接触率及种植体螺纹附近的骨密度率的影响。     

不同表面形貌掺锶羟基磷灰石涂层钛种植体的体内实验研究

目的:观察不同微弧氧化时间处理对纯钛表面形成的掺锶羟基磷灰石涂层表面形貌的影响,以及不同表面形貌特征对其表面成骨特性的影响。方法:经5、10、15 min 3种微弧氧化时间在钛表形成3组掺锶羟基磷灰石涂层,分别采用扫描电镜观察表面形貌;采用表面粗糙度仪测量涂层表面粗糙度数值。然后再将3种钛种植体植入新西兰兔体内,术后4、12周取材,采用组织染色法观察植入体表面骨形成情况和骨接触率(Bone Implant Contact,BIC)。结果:随着微弧氧化时间的延长,涂层表面形貌成多孔状且越加不规则,粗糙度增加;丽春红染色显示4周时植入体表面有新骨形成,12周时转化为成熟的骨组织并与涂层形成紧密的骨结合。随植入时间的延长种植体表面骨接触率逐渐增加,而且15 min组和10 min组的骨接触率在第4周和12周均高于5 min组。结论:不同微弧氧化时间可以改变掺锶羟基磷灰石涂层的表面特性,而粗化的的涂层表面结构有利于骨组织的形成。     

正畸微种植体表面阳极氧化处理对周围骨组织的影响

目的通过组织形态学及组织形态测量学评价正畸微螺旋种植体表面阳极氧化处理对周围骨组织愈合情况的影响。方法24枚钛合金正畸用微螺旋种植体种植于两只新西兰大白兔的后腿,在闭合环境下生长6周。12枚微种植体经过表面阳极氧化处理作为研究组;另外12枚表面没有经过任何处理作为对照组。兔处死后,部分微种植体及周围骨组织进行组织学苏木精-伊红染色（hematoxylin-eosin staining,HE）处理,每组有4枚微种植体及周围骨组织块采用维拉努埃瓦（Villanueva）染色。光学显微镜评价种植体的组织学变化并计算种植体的骨结合率。结果两组种植体均与周围骨组织有一定的结合,其间无结缔组织可见。螺旋区骨纤维走向紊乱,表面阳极氧化组微种植体周围有较多的骨组织可见。阳极氧化组微种植体的骨结合率略高于对照组。结论阳极氧化处理可能促进钛合金微种植体与周围骨组织的结合。     

与牙种植体有关的表面处理技术

本文对牙种植体表面处理的常见方法进行了综述。常见的牙种植体的表面处理主要为氧化膜形成,表面粗糙化和表面涂层3种类型。钛种植体的生物相容性与钛氧化膜的特殊性质有关;种植体表面 一定的粗糙度将有利于骨细胞的早期附着;溶胶-凝胶法和碱处理法有可能成为未来种植体表面处理的新方法。     

Nd: YAG激光对牙根面结构及变异链球菌黏附的影响

目的 研究不同功率的水冷Nd: YAG激光照射治疗对牙根面结构及变异链球菌黏附的影响。方法 将因重度慢性牙周炎拔除的离体牙分为4组,均进行手工刮治和根面平整,制备牙根片,激光1、2、3组分别用功率为4、6、8 W的水冷Nd: YAG激光照射处理60 s,对照组不作处理。用扫描电子显微镜（SEM）观察各组根片的表面结构。将变异链球菌接种于各组牙根片表面并进行培养,计数各组根片表面细菌的黏附量（CFU·mL-1）;同时用SEM观察对照组及激光2组根面的细菌黏附情况。结果 SEM观察根片表面结构,激光组较对照组牙根表面的玷污层、碎屑及菌斑样物质附着减少,但裂隙增多。3个激光组牙根表面的细菌黏附量均少于对照组（P<0.05）,而不同功率的激光组之间的差异无统计学意义（P>0.05）。SEM观察细菌黏附情况,激光2组表面的细菌黏附量明显少于对照组。结论 与单纯刮治相比,刮治后进行水冷Nd: YAG激光治疗能清除牙根表面的玷污层、碎屑及菌斑样物质,并能减少变异链球菌的黏附,但激光会导致牙根表面出现裂隙。本实验中,6 W为激光最佳功率,既能较好地去除牙根表面的玷污层和碎屑等,又能较好地控制激光对根面的热损害程度。     

表面氧化处理钛合金种植体骨界面血小板源性生长因子的表达变化

目的通过检测血小板源性生长因子(PDGF)在种植体-骨界面骨组织中的表达,评价表面氧化处理钛合金种植体的生物相容性。方法分别设计经表面氧化处理的Ti-6Al-4V组、未经处理的Ti-6Al-4V组以及316L不锈钢组,将种植体材料制成直径3mm、厚1mm圆柱体,植入大鼠的下颌骨内,于术后第1、2、3、4、6周取材进行HE染色观察及PDGF免疫组化染色分析。结果 HE染色显示:氧化处理钛合金种植体成骨细胞排列紧密,新生骨较致密。比较PDGF免疫组化染色灰度值可见:表面氧化处理钛合金组高于未处理钛合金组,未处理钛合金组高于不锈钢组(P<0.05)。结论表面氧化处理可以增强钛合金骨界面PDGF的表达,提高其生物相容性。     

Temperature increases during surface decontamination of titanium implants using CO2 laser

The purpose of the present in vitro investigation was to measure temperature changes at the implant surface when using pulsed CO2 laser in a simulated implant surface decontamination protocol. Six threaded titanium implants were placed in a fresh resected pig mandible. A 4 x 4 mm defect was created buccally to each implant in order to expose the implant head and approximately 5 threads. Temperature changes were monitored by two thermocouples placed near the dehiscence and at the apical part of the implant. Several setting combinations of the CO2 laser with regard to output power, pulse width, pulse repetition rate and irradiation time were tested on dry and wet (distilled water) surfaces. Only minor temperature increases were measured when lasing wet titanium surfaces, while the temperature at dry surfaces exceeded the proposed thresholds for bone damage at clinically relevant settings. It is concluded that the CO2 laser when used on a wet implant surface in a pulsed mode at 8 W/10 ms/20 hz during 5 s induces a temperature increase of less than 3 degrees C. This would minimize the risk of temperature induced tissue damage as a result of lasing implant surfaces.     

Surface properties of endosseous dental implants after NdYAG and CO2 laser treatment at various energies.

OBJECTIVES: Dental lasers have been used for uncovering submerged implants as well as decontaminating implant surfaces when treating peri-implantitis. The objective of this study was to compare the possible alterations of the smooth surface and resorbable blast material (RBM) surface implants after using NdYAG and CO(2) lasers at various energies. MATERIALS AND METHODS: Ten smooth surface implants and 10 RBM surface implants were used. Two smooth surface implants and 2 RBM surface implants served as a control group that was not lased. The remaining implants were treated using NdYAG and CO(2) lasers. The surface of each implant was treated for 10 seconds on the second and third threads. The smooth surface implants (group 1) were treated using a pulsed contact NdYAG laser at power settings of 1, 2, 3.5, and 5 W, which are commonly used for soft tissue surgery; the corresponding energy and frequency were 50 mJ and 20 Hz, 100 mJ and 20 Hz, 350 mJ and 10 Hz, and 250 mJ and 20 Hz, respectively. The group 2 RBM implants were treated using a pulsed contact NdYAG laser. The group 3 smooth surface implants were treated using a pulsed wave non-contact CO(2) laser at 1, 2, 3.5, and 5 W, and the group 4 RBM implants were treated using a pulsed wave non-contact CO(2) laser. Data were analyzed using scanning electron microscopy. RESULTS: The control surface was very regular and smooth. After NdYAG laser treatment, the implant surface showed alterations of all the surfaces. The amount of damage was proportional to the power. A remarkable finding was the similarity of the lased areas on the smooth and RBM surfaces. CO(2) laser at power settings of 1.0 or 2.0 W did not alter the implant surface, regardless of implant type. At settings of 3.5 and 5 W, there was destruction of the micromachined groove and gas formation. CONCLUSION: This study supports that CO(2) laser treatment appears more useful than NdYAG laser treatment and CO(2) laser does not damage titanium implant surface, which should be of value when uncovering submerged implants and treating peri-implantitis.     

Effect of Nd:YAG, Ho:YAG, Er:YAG, CO2, and GaAIAs laser irradiation on surface properties of endosseous dental implants

PURPOSE: To analyze potential surface alterations in endosseous dental implants induced by irradiation with common dental lasers. MATERIALS AND METHODS: Sandblasted and acid-etched, plasma-sprayed, hydroxyapatite-coated, and smooth titanium discs were irradiated using Nd:YAG, Ho:YAG, Er:YAG, CO2, and GaAIAs lasers at various power settings. The specimens were examined by scanning electron microscopy and energy dispersive spectroscopy. Results: In an energy-dependent manner, the pulsed YAG lasers induced partial melting, cracking, and crater formation on all 4 surfaces. Within the energy range applied, the CO2 laser caused surface alterations on the hydroxyapatite and plasma coatings as well as in the acid-etched surface. GaAIAs laser irradiation did not damage any of the surfaces. Energy dispersive spectroscopy revealed an altered chemical compound of the surfaces with regard to titanium, oxygen, and silicon. DISCUSSION: The clinical application of most common dental laser systems can induce implant surface alterations. Relevant factors are not only the laser system and power setting, but also the application system. CONCLUSION: The results of the study indicate that Nd:YAG and Ho:YAG lasers are not suitable for use in decontamination of implant surfaces, irrespective of the power output. With the Er:YAG and CO2 laser, the power output must be limited so as to avoid surface damage. The GaAIAs laser seems to be safe as far as possible surface alterations are concerned.     

Temperature changes induced by 809-nm GaAlAs laser at the implant-bone interface during simulated surface decontamination

The aim of the study was to investigate temperature changes at the implant-bone interface during simulated implant surface decontamination with a 809-nm gallium-aluminium-arsenid (GaAlAs) semiconductor laser. Stepped cylinder implants with a diameter of 3.8 mm and a length of 11 mm with two different surfaces (sand-blasted and acid etched, and hydroxyapatite-coated) were inserted into bone blocks cut from freshly resected pig femurs. Access holes of 0.5 mm were drilled into the bone, to allow K-type thermocouples to contact periimplant bone in different parts of the cavity. An artificial periimplant bone defect provided access for laser irradiation in the coronal third. A 600-micrometer optic fiber was used at a distance of 0.5 mm from the implant surface. Power output varied between 0.5 and 2.5 W in the continuous wave mode. The bone block was placed into a 37 degrees C water bath in order to simulate in vivo thermal conductivity and diffusitivity of heat. Temperature elevations during irradiation were registered for a period of 120 s. In mean, the critical threshold of 47 degrees C was exceeded after 9.0 s at 2.5 W, 12.5 s at 2.0 W, 18.0 s at 1.5 W and 30.5 s at 1.0 W. Surface characteristics did not have a significant effect on temperature elevations. In an energy-dependent manner, implant surface decontamination with an 809-nm GaAlAs laser must be limited in time to allow the implant and bone to cool down. Clinical guidelines are presented to avoid tissue damage.     

Effect of plastic-covered ultrasonic scalers on titanium implant surfaces

Objectives: Maintaining oral health around titanium implants is essential. The formation of a biofilm on the titanium surface will influence the continuing success of the implant. These concerns have led to modified ultrasonic scaler instruments that look to reduce implant damage while maximising the cleaning effect. This study aimed to assess the effect of instrumentation, with traditional and modified ultrasonic scalers, on titanium implant surfaces and to correlate this with the oscillations of the instruments. Materials and methods: Two ultrasonic insert designs (metallic TFI‐10 and a plastic‐tipped implant insert) were selected. Each scaler probe was scanned using a scanning laser vibrometer, under loaded and unloaded conditions, to determine their oscillation characteristics. Loads were applied against a titanium implant (100g and 200 g) for 10 s. The resulting implant surfaces were then scanned using laser profilometry and scanning electron microscopy (SEM). Results: Insert probes oscillated with an elliptical motion with the maximum amplitude at the probe tip. Laser profilometry detected defects in the titanium surface only for the metallic scaler insert. Defect widths at 200 g high power were significantly larger than all other load/power conditions (P<0.02). Using SEM, it was observed that modifications to the implant surface had occurred following instrumentation with the plastic‐tipped insert. Debris was also visible around the defects. Conclusions: Metal scalers produce defects in titanium implant surfaces and load and power are important factors in the damage caused. Plastic‐coated scaler probes cause minimal damage to implant surfaces and have a polishing action but can leave plastic deposits behind on the implant surface. To cite this article:
Mann M, Parmar D, Walmsley AD and Lea SC. Effect of plastic covered ultrasonic scalers on titanium implant surfaces.
Clin. Oral Impl. Res. 23 , 2012; 76–82
doi: 10.1111/j.1600‐0501.2011.02186.x     

Effects of diode and Nd:YAG laser irradiation on titanium discs: a scanning electron microscope examination

BACKGROUND: Dental lasers have been recommended for uncovering submerged implants as well as decontaminating implant surfaces when treating peri-implantitis. The aim of this study was to show the possible alterations in titanium disc surfaces using an Nd:YAG or a diode laser. METHODS: Three different titanium discs were used (sandblasted, titanium plasma-sprayed [TPS], and hydroxyapatite [HA] coated) to determine the effects of laser irradiation on these surfaces using a scanning electron microscope (SEM). The discs were either irradiated with a pulsed Nd:YAG laser with a contact handpiece and power settings of 2.0, 4.0, and 6.0 W or with a diode laser at 5.0, 10.0, and 15.0 W power settings and continuous wave (cw) in the contact handpiece. Irradiated areas were compared with control titanium sites which were not lased. The specimens were prepared for SEM examination after the disc irradiation. RESULTS: The SEM examination demonstrated extensive melting in all of the Nd:YAG laser irradiated areas. Damage was seen in all TPS- and HA-coated discs even at the lowest power setting. Loss of porosity, coating microfractures, and a relatively smooth surface were observed. In contrast, the diode laser did not cause any damage or modify the disc surface. Regardless of the power setting, there was no visible difference between lased and non-lased surfaces after cw irradiation with the diode laser. CONCLUSIONS: From these findings, it was concluded that the diode laser (980 nm) does not damage titanium surfaces, which should be of value when uncovering submerged implants and treating peri-implantitis.     

The effect of CO(2) laser irradiation on failed implant surfaces

The aim of this investigation was to evaluate the cleaning effect of CO(2) on surface topography and composition of failed dental implant surfaces. Ten failed dental implants were retrieved from nine patients (mean age, 46.33 +/- 5.81 years) as a result of early or late failure. The implants were divided into two parts: one side of the implant was irradiated with a CO(2) laser (test side), while the other side did not receive irradiation (control side). The CO(2) laser was operated at 1.2 W in a continuous wave for 40 seconds (40 J energy). The handpiece of the CO(2) laser was kept at a distance of 30 mm from the implant surface, resulting in a spot area of 0.031415 cm (38.20 W/cm; 1559 J/cm) in scanning mode (cervical-apical). One unused dental implant was used as a negative control for both groups. All implant surfaces were examined by scanning electron microscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) for element analysis. SEM showed that the surface of the test sides consisted of different degrees of organic residues, appearing mainly as dark stains similar to those observed on the control sides. None of the test surfaces presented alterations such as crater-like alterations, lava-like layers, or melting compared with the nonirradiated surfaces. Foreign elements such as carbon, oxygen, sodium, calcium, and aluminum were detected on both sides. These results suggest that CO(2) laser irradiation does not modify the implant surface, although the cleaning effect was not satisfactory.     

Antimicrobial efficacy of semiconductor laser irradiation on implant surfaces

PURPOSE: This study was conducted to investigate the antimicrobial effect of an 809-nm semiconductor laser on common dental implant surfaces. MATERIALS AND METHODS: Sandblasted and acid-etched (SA), plasma-sprayed (TPS), and hydroxyapatite-coated (HA) titanium disks were incubated with a suspension of S. sanguinis (ATCC 10556) and subsequently irradiated with a gallium-aluminum-arsenide (GaAlAs) laser using a 600-microm optical fiber with a power output of 0.5 to 2.5 W, corresponding to power densities of 176.9 to 884.6 W/cm2. Bacterial reduction was calculated by counting colony-forming units on blood agar plates. Cell numbers were compared to untreated control samples and to samples treated with chlorhexidine digluconate (CHX). Heat development during irradiation of the implants placed in bone blocks was visualized by means of shortwave thermography. RESULTS: In TPS and SA specimens, laser irradiation led to a significant bacterial reduction at all power settings. In an energy-dependent manner, the number of viable bacteria was reduced by 45.0% to 99.4% in TPS specimens and 57.6% to 99.9% in SA specimens. On HA-coated disks, a significant bacterial kill was achieved at 2.0 W (98.2%) and 2.5 W (99.3%) only (t test, P < .05). For specimens treated with CHX, the bacterial counts were reduced by 99.99% in TPS and HA-coated samples and by 99.89% in SA samples. DISCUSSION: The results of the study indicate that the 809-nm semiconductor laser is capable of decontaminating implant surfaces. Surface characteristics determine the necessary power density to achieve a sufficient bactericidal effect. The bactericidal effect, however, was lower than that achieved by a 1-minute treatment with 0.2% CHX. The rapid heat generation during laser irradiation requires special consideration of thermal damage to adjacent tissues. CONCLUSION: No obvious advantage of semiconductor laser treatment over conventional methods of disinfection could be detected in vitro.     

Effects of the Nd:YAG dental laser on plasma-sprayed and hydroxyapatite-coated titanium dental implants: surface alteration and attempted sterilization.

The Nd:YAG dental laser has been recommended for a number of applications, including the decontamination or sterilization of surfaces of dental implants that are diseased or failing. The effects of laser irradiation in vitro (1) on the surface properties of plasma-sprayed titanium and plasma-sprayed hydroxyapatite-coated titanium dental implants, and (2) on the potential to sterilize those surfaces after contamination with spores of Bacillus subtilis have been examined. Surface effects were examined by scanning electron microscopy, energy dispersive spectroscopy, and x-ray diffraction after laser irradiation at 0.3, 2.0, and 3.0 W using either contact or noncontact handpieces. Controls received no laser irradiation. Melting, loss of porosity, and other surface alterations were observed on both types of implants, even with the lowest power setting. For the sterilization study, both types of implants were first sterilized by exposure to ethylene oxide and then contaminated with spores of B subtilis. After laser irradiation, the implants were transferred to sterile growth medium and incubated. Laser irradiation did not sterilize either type of implant. The spore-contaminated implants in the control group were successfully sterilized with ethylene oxide.     

Erbium,Chromium:Yttrium‐Scandium‐Gallium‐Garnet Laser Effectively Ablates Single‐Species Biofilms on Titanium Disks Without Detectable Surface Damage

Background: Increasing evidence implicates biofilms, consisting of species such as Porphyromonas gingivalis (Pg), in the etiology of peri‐implantitis. Multiple approaches to ablate biofilms on failing implants have been proposed and include use of lasers, most recently the erbium, chromium:yttrium‐scandium‐gallium‐garnet (Er,Cr:YSGG) laser. The purpose of this study is to establish an in vitro single‐species biofilm model on implant surfaces and determine power settings of the Er,Cr:YSGG laser that remove biofilm without causing physical damage to disks. Methods: Single‐species biofilms consisting of Pg strain 381 were grown on titanium disks, including: 1) sandblasted, large‐grit, acid‐etched (SLA); 2) calcium phosphate nano‐coated (CaP); 3) anodized; or 4) machined surfaces. Power settings from 0 to 1.5 W using an Er,Cr:YSGG laser equipped with radial firing tip were used. Biofilm formation/removal was quantitated using confocal and scanning electron microscopy. Surface changes in temperature, microroughness, and water contact angle were analyzed. Results: Results show confluent Pg biofilm coating all disk surfaces. The laser removed biofilms from all surfaces, with CaP and SLA surfaces requiring power setting of 1.0 to 1.5 W for ablation of bacteria coating the disks. Within this power range, and with water spray, there were no changes in surface temperature, surface roughness, or contact angle on any surfaces tested. Conclusion: The Er,Cr:YSGG laser with radial firing tip and water spray was able to effectively ablate ≥95% of biofilm on all types of tested titanium surfaces, using clinically relevant power settings, without causing measurable physical changes to surfaces.