الفهرس 
Review of literatureOnly 14 pages are availabe for public view
 |  | from | 172 |  |  |
| | | from | 172 | | |
Abstract
Soft and hard tissue integration is a prerequisite for implants success. The peri-implant soft tissues became a major concern in recent years as the presence of an effective mucosal attachment seal at the trans-mucosal part of the implant will provide the implant with protection of the peri-implant bone from bacterial contamination, oral environment and preventing peri-implant pathologies.
The presence of contaminants at the implant-platform abutment level has been suggested to be associated with tissue damage, inflammation and titanium wear. Different modalities for surface decontamination for implant abutments were recommended such as laser, plasma spray, acid etching and steaming.
Er: YAG laser has been extensively investigated clinically for applications for treating periimplantitis either independently or in combination with other techniques, showing favorable outcomes.
Plasma spray treatment can decontaminate surfaces without modifying their topography. It is also able to increase the surface energy by obtaining more hydrophilic surfaces, which may increase the capacity of the titanium oxide layer to interact with cells and proteins of surrounding tissue improving cell adhesion to the treated surface.
To our knowledge, no previous study has compared the effect of both laser and plasma spray for surface treatment of implant healing abutments. Accordingly, this study was conducted to evaluate and compare the effect of cold plasma versus ER: YAG laser treatment on titanium healing abutments, and their effect on the surrounding peri-implant soft tissue clinically, histologically and by using SEM analysis for the healing abutment surface.
This study was conducted on 24 patients seeking implant placement. A total number of 33 healing abutments were included in this study, they were divided into 3 groups. group 1 (Laser group): 8 patients in this group received 11 healing abutments treated with Er:YAG laser, group 2 (Plasma group): 8 patients in this group received 11 healing abutments treated with plasma spray and group 3 (control group): 8 patients in this group received 11 healing abutments with no surface treatment.
Three months after implants placement, patients included in the study were randomly assigned to one of the three study groups, second stage surgery was performed and patients received healing abutments without surface treatment in control group, surface treatment was performed in plasma and laser groups. After two weeks, clinical assessment was done using PI and GI before taking biopsies from peri-implant soft tissue for histological assessment. H&E stain was used for measuring inflammatory cells count and Masson’s Trichrome stains for measuring collagen fibers area fraction. Analysis of the abutments surface was done using SEM.
Clinically, mean PI values measured at 2 weeks after second stage surgery showed statistically significant difference between study groups, the lowest mean value was in plasma group followed by laser group, while the highest values were recorded in the control group. Control group showed a significantly higher value than plasma group. However, the difference was not statistically significant when comparing laser group with control or plasma group. After 3 months, there was no significant difference between different groups.
Mean GI values measured at 2 weeks after second stage surgery showed statistically significant difference between study groups. The control group demonstrated the highest value, followed by laser group, while the lowest value was found in plasma group. Control group showed a statistically significant higher value than plasma group, while there was no statistically significant difference when comparing laser group with control or plasma group. After 3 months, there was no significant difference between study groups.
Regarding the histological results, the inflammatory cells count mean values showed a significant difference between study groups, the least value was in the plasma group. However, the mean value in the control group was higher than the other two groups. In laser group, the value was lower than the control group but higher than plasma group.
The mean area fraction of collagen fibers showed statistically significant differences between the study groups. The highest value was found in plasma group, followed by laser group, while the lowest value was found in control group.
SEM analysis of healing abutments showed the presence of different types of cells like keratinocytes, fibroblasts like-cells and erythrocytes in all study groups however, fibroblast like-cells were more developed with more spread and extended shape compared to the other two groups. In addition, these cells were more numerous and attached to the surface than the other groups. Collagen fibers were detected in plasma group, while they were fewer in the laser group and no fibers were detected in control group.