The effect of chemotherapeutic agents on contaminated titanium surfaces: a systematic review

Objective: To systematically collect and evaluate the existing evidence for the abilities of different chemotherapeutic agents to decontaminate biofilm-contaminated titanium surfaces. Material and methods: PubMed-MEDLINE and the Cochrane-CENTRAL databases were searched, covering research published on or before June 2010, to identify appropriate studies. The eligible studies were controlled studies on the effects of chemical treatments on biofilm-contaminated titanium surfaces. Results: In total, 2425 unique papers were identified. Independent screening of the titles and abstracts resulted in only four publications that met all of the eligibility criteria. None of the in vivo studies assessed titanium surface decontamination in a controlled fashion. Three studies provided in vitro data, and one used an ex vivo protocol. Citric acid was found to be the most effective treatment in lipopolysaccharide removal as compared with an untreated control, although its effectiveness was equivalent to those of water and saline. In addition, citric acid demonstrated the greatest efficacy in cleaning the contaminated titanium surface, as evidenced by scanning electron microscopy. Conclusion: The data reported for the efficacy of chemotherapeutic agents in cleaning contaminated titanium surfaces are scarce, which precludes the generation of firm conclusions. Based on the lack of robust data, we cautiously conclude that citric acid is the chemotherapeutic agent with the highest potential for the removal of biofilms from contaminated titanium surfaces in vitro, although it does not achieve complete removal. To date, the killing effect of citric acid against biofilms has not been investigated on titanium surfaces.