摘要
PURPOSE: One of the most frequent complications related to dental implants is peri-implantitis, and the characteristics of implant surfaces are closely related to the progression and resolution of inflammation. Therefore, a technical modality that can effectively detoxify the implant surface without modification to the surface is needed. The purpose of this study was to evaluate the effect of erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser irradiation on the microstructural changes in double acid-etched implant surfaces according to the laser energy and the application duration. METHODS: The implant surface was irradiated using an Er:YAG laser with different application energy levels (100 mJ/pulse, 140 mJ/pulse, and 180 mJ/pulse) and time periods (1 minute, 1.5 minutes, and 2 minutes). We then examined the change in surface roughness value and microstructure. RESULTS: In a scanning electron microscopy evaluation, the double acid-etched implant surface was not altered by Er:YAG laser irradiation under the condition of 100 mJ/pulse at 10 Hz for any of the irradiation times. However, we investigated the reduced sharpness of the specific ridge microstructure that resulted under the 140 mJ/pulse and 180 mJ/pulse conditions. The reduction in sharpness became more severe as laser energy and application duration increased. In the roughness measurement, the double acid-etched implants showed a low roughness value on the valley area before the laser irradiation. Under all experimental conditions, Er:YAG laser irradiation led to a minor decrease in surface roughness, which was not statistically significant. CONCLUSIONS: The recommended application settings for Er:YAG laser irradiation on double acid-etched implant surface is less than a 100 mJ/pulse at 10 Hz, and for less than two minutes in order to detoxify the implant surface without causing surface modification.
Subject(s)
Dental Implants , Inflammation , Microscopy, Electron, Scanning , Peri-Implantitis , Yttrium摘要
PURPOSE: The aim of this study is to compare two different gingival depigmentation techniques using an erbium:yttrium-aluminum-garnet (Er:YAG) laser and rotary instruments. METHODS: Two patients with melanin pigmentation of gingiva were treated with different gingival depigmentation techniques. Ablation of the gingiva by Er:YAG laser was performed on the right side, and abrasion with a rotary round bur on the opposite side. RESULTS: The patients were satisfied with the esthetically significant improvement with each method. However, some pigment still remained on the marginal gingival and papilla. The visual analog scale did not yield much difference between the two methods, with slightly more pain on the Er:YAG laser treated site. CONCLUSIONS: The results of these cases suggest that ablation of the gingiva by an Er:YAG laser and abrasion with a rotary round bur is good enough to achieve esthetic satisfaction and fair wound healing without infection or severe pain. Prudent care about the gingival condition, such as the gingival thickness and degree of pigmentation along with appropriate assessment is needed in ablation by the Er:YAG laser procedure.
Subject(s)
Humans , Gingiva , Hyperpigmentation , Melanins , Pigmentation , Wound Healing摘要
PURPOSE: The objective of this study was to compare and evaluate the inflammatory responses of three widely used suture materials in the keratinized gingiva and buccal mucosa of beagle dogs. METHODS: Silk, polyglycolic acid, and nylon sutures were placed within the mandibular keratinized gingiva and maxillary buccal mucosa of four male beagle dogs. Biopsies were taken 3, 7, and 14 days after suturing. Specimens were prepared with hematoxylin-eosin stain for evaluation under a light microscope. RESULTS: The suture materials placed in the oral mucosa elicited more inflammatory reactions than did those placed in the keratinized gingiva. The multifilament suture materials caused more inflammatory tissue reactions than did the monofilament suture materials in the oral mucosa. CONCLUSIONS: If oral hygiene is well maintained and suture materials are placed in the keratinized gingiva, silk, nylon, and polyglycolic acid are considered to be proper suture materials for oral surgery. However, it is advisable to use monofilament suture materials if the suture site is within the oral mucosa.
Subject(s)
Animals , Dogs , Humans , Male , Biopsy , Gingiva , Keratins , Light , Mouth Mucosa , Nylons , Oral Hygiene , Polyglycolic Acid , Silk , Surgery, Oral , Sutures摘要
PURPOSE: The present study was performed to evaluate the effect of erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser irradiation on sand-blasted, large grit, acid-etched (SLA) implant surface microstructure according to varying energy levels and application times of the laser. METHODS: The implant surface was irradiated by the Er:YAG laser under combined conditions of 100, 140, or 180 mJ/pulse and an application time of 1 minute, 1.5 minutes, or 2 minutes. Scanning electron microscopy (SEM) was used to examine the surface roughness of the specimens. RESULTS: All experimental conditions of Er:YAG laser irradiation, except the power setting of 100 mJ/pulse for 1 minute and 1.5 minutes, led to an alteration in the implant surface. SEM evaluation showed a decrease in the surface roughness of the implants. However, the difference was not statistically significant. Alterations of implant surfaces included meltdown and flattening. More extensive alterations were present with increasing laser energy and application time. CONCLUSIONS: To ensure no damage to their surfaces, it is recommended that SLA implants be irradiated with an Er:YAG laser below 100 mJ/pulse and 1.5 minutes for detoxifying the implant surfaces.
Subject(s)
Dental Implants , Dietary Sucrose , Microscopy, Electron, Scanning , Yttrium摘要
PURPOSE: The aim of this study is to report a case of oral bisphosphonate-related osteonecrosis of the jaw (BRONJ) resulting in implant failure. METHODS: A patient suspected of having BRONJ was referred to the Department of Periodontology, Kyung Hee University School of Dentistry for the evaluation and treatment of exposed bone around implants. RESULTS: The patient, who had been taking oral bisphosphonates (BPs) for about a year, was successfully treated with systemic antibiotics, chlorhexidine mouth rinse, explantation, and surgical debridement of necrotic bone. CONCLUSIONS: The results of this case suggest that a patient taking BPs orally should be treated cautiously. Appropriate management including cessation of BPs and respective dental treatment may reduce the development of BRONJ.
Subject(s)
Humans , Anti-Bacterial Agents , Bisphosphonate-Associated Osteonecrosis of the Jaw , Chlorhexidine , Debridement , Dentistry , Diphosphonates , Mouth , Osteonecrosis , Osteoporosis摘要
PURPOSE: The aim of this case report is to present a case of incomplete bone formation after sinus augmentation. METHODS: A patient having alveolar bone resorption of the maxillary posterior edentulous region and advanced pneumatization of the maxillary sinus was treated with sinus elevation using deproteinized bovine bone in the Department of Periodontology, Kyung Hee University School of Dentistry and re-evaluated with computed tomography (CT) follow-up. RESULTS: Even though there were no significant findings or abnormal radiolucency on the panoramic radiograph, incomplete bone formation in the central portion of the augmented sinus was found fortuitously in the CT scan. The CT scan revealed peri-implant radiolucency in the apical portion of the implant placed in the augmented maxillary sinus. Nevertheless, the dental implants placed in the grafted sinus still functioned well at over 15 months follow-up. CONCLUSIONS: The result of this case suggests that patients who received maxillary sinus augmentation may experience incomplete bone formation. It is possible that 1) osteoconductive graft material with poor osteogenic potential, 2) overpacking of graft material that restricts the blood supply, and 3) bone microbial contamination may cause the appearance of incomplete bone formation after sinus augmentation. Further studies are needed to elucidate the mechanism of this unexpected result and care must be taken to prevent it.
Subject(s)
Humans , Bone Resorption , Dental Implants , Dentistry , Durapatite , Follow-Up Studies , Maxillary Sinus , Osteogenesis , Transplants摘要
PURPOSE: The present study was performed to evaluate the effect of erbium:yttrium-aluminium-garnet (Er:YAG) laser irradiation on the change of hydroxyapatite (HA)-coated implant surface microstructure according to the laser energy and the application time. METHODS: The implant surface was irradiated by Er:YAG laser under combination condition using the laser energy of 100 mJ/pulse, 140 mJ/pulse and 180 mJ/pulse and application time of 1 minute, 1.5 minutes and 2 minutes. The specimens were examined by surface roughness evaluation and scanning electron microscopic observation. RESULTS: In scanning electron microscope, HA-coated implant surface was not altered by Er:YAG laser irradiation under experimental condition on 100 mJ/pulse, 1 minute. Local areas with surface melting and cracks were founded on 100 mJ/pulse, 1.5 minutes and 2 minutes. One hundred forty mJ/pulse and 180 mJ/pulse group had surface melting and peeling area of HA particles, which condition was more severe depending on the increase of application time. Under all experimental condition, the difference of surface roughness value on implant surface was not statistically significant. CONCLUSIONS: Er:YAG laser on HA-coated implant surface is recommended to be irradiated below 100 mJ/pulse, 1 minute for detoxification of implant surface without surface alteration.
Subject(s)
Dental Implants , Durapatite , Electrons , Freezing摘要
PURPOSE: Pink gingival esthetic especially on the anterior teeth has been an important success criterion in implant-supported restoration. Inter-implant papillae are a critical factor for implant esthetics, and various techniques for inter-implant papilla reconstruction have been introduced. The aim of this study is to suggest and evaluate a surgical technique for reconstructing inter-implant papillae. METHODS: A 28-year-old man had an implant placed on the #13 and #14 area. Four months after implant placement, a second stage surgery was planned for inter-implant papilla reconstruction. At the time of the abutment connection, I-type incisions were performed on the #13i & #14i area followed by full-thickness flap elevation and connection of a healing abutment on underlying fixtures without suture. RESULTS: Two weeks after the second stage implant surgery, soft tissue augmentation between the two implants was achieved. CONCLUSIONS: I-shaped incisions for papilla reconstruction performed during the second stage implant surgery were useful for inter-implant papilla reconstruction and showed a good esthetic result.
Subject(s)
Adult , Humans , Dental Implants , Dental Papilla , Esthetics , Esthetics, Dental , Sutures , Tooth摘要
PURPOSE: The present study was performed to evaluate the effect of hydroxyapatite dental paste on tooth hypersensitivity compared to other materials. MATERIALS AND METHODS: In the general fluoride dental paste, strontium fluoride dental paste and hydroxyapatite dental paste, patient-performed VAS and VAS(ice test) were measured at baseline, 1weeks and 4weeks. RESULTS: 1. In patient-performed VAS, there were significant differences reducing of tooth hypersensitivity between general fluoride toothpaste and hydroxyapatite toothpaste. 2. In operator-performed VAS(ice test), there were significant differences reducing of tooth hypersensitivity among each group, between general fluoride toothpaste and hydroxyapatite toothpaste and between general fluoride toothpaste and strontium fluoride toothpaste. CONCLUSION: In conclusion, hydroxyapatite toothpaste can be applied for control of tooth hypersensitivity.
Subject(s)
Durapatite , Fluorides , Hypersensitivity , Strontium , Tooth , Toothpastes摘要
PURPOSE: The subepithelial connective tissue graft(SCTG) has been proven to be a highly predictable treatment modality for coverage of gingival recession. This case report was performed to evaluate the effect of various root coverage procedures using SCTG on gingival recession. MATERIALS AND METHODS: Three patients presents with Miller's class I recession defect on the maxillary canine. Each other SCTG(coronally advanced flap, Bruno's Tech., envelope Tech.) were performed for root coverage. Clinical parameters assessed included recession depth, recession width, and keratinized gingival width. Measurements were taken at baseline and 2 months and follow up end. RESULTS: The average of root coverage was 4 mm(100% of the pre-operative recession depth) at the 2, 5 months examination. The average increase of keratinized tissue between the baseline and the 2 months amounted to 3.2mm. CONCLUSION: Within the above results, various root coverage using SCTG is an effective procedure to Miller's class I recession defect and patient could be satisfied aesthetic requirement.
Subject(s)
Humans , Connective Tissue , Follow-Up Studies , Gingival Recession , Keratins , Transplants摘要
PURPOSE: In this study, the effect of micro-macroporous biphasic calcium phosphate(MBCP) incorporated with inorganic polyphosphate for bone regeneration in the calvaria of rabbit was evaluated. MATERIALS AND METHODS: The procedure of guided bone regeneration was performed with titanium reinforced expanded polytetrafluoroethylene(TR-ePTFE) membrane. Four animal groups were compared : 1) TR-ePTFE membrane for negative control group, 2) TR-ePTFE membrane filled with MBCP for positive control group, 3) TR-ePTFE membrane filled with MBCP soaked in 4% inorganic polyphosphate for experimental group I, and 4) TR-ePTFE membrane filled with MBCP soaked in 8% inorganic polyphosphate for experimental group II. RESULTS: 1. Negative control group showed the highest new bone formation at 16 weeks. 2. Positive control group showed the smallest new bone formation compared to other groups. 3. 8% inorganic polyphosphate induced more volume of bone formation, otherwise experimental group II did not show significant difference compared to negative control group. CONCLUSION: These results suggest that inorganic polyphosphate has a promoting effect on bone regeneration, possibly by enhancing osteoconductivity of the carrier and by increasing osteoinductivity of the defected alveolar bone tissue.
Subject(s)
Animals , Bone and Bones , Bone Regeneration , Calcium , Hydroxyapatites , Membranes , Osteogenesis , Skull , Titanium摘要
PURPOSE: The purpose of this study was to evaluate exophytically vertical bone formation in the mandibular premolar area of beagle dogs by the concept of guided bone regeneration with a titanium reinforced e-PTFE membrane combined with human demineralized freeze-dried bone. MATERIALS AND METHODS: Four one-year old beagle dogs were divided into control and experimental group. All mandibular premolars were extracted and surgical vertical defects of 5 mm in height were created in the extracted sockets. At 8 weeks after the extraction, TR e-PTFE membrane sized with 8 mm in length, 5 mm in width, and 4 mm in height was placed on the decorticated mandible, fixed with metal pins and covered with full-thickness flap and assigned as control group. In experimental group, decorticated mandibule was treated with TR e-PTFE membrane and human demineralized freeze-dried bone. The animals were sacrificed at 16 weeks after the regenerative surgery, and new bone formation was assessed by histomorphometric as well as statistical analysis. RESULTS: Average of new bone formation was 38% in the control group, whereas was 25% in the experimental group (p<0.05). Average of connective tissue formation was 42% in the experimental group, whereas was 30% in the control group (p<0.05). The lamellar bone formation with haversian canals was observed in the both groups. In the experimental group, the particles of human demineralized freeze-dried bone were observed after 16 weeks and complete resorption of graft was not observed. CONCLUSION: On the basis of these findings, we conclude that titanium reinforced e-PTFE membrane may be used alone for vertical guided bone regeneration, but demineralized freeze-dried bone has no additional effect on vertical guided bone regeneration.
Subject(s)
Animals , Dogs , Humans , Bicuspid , Bone Regeneration , Connective Tissue , Haversian System , Mandible , Membranes , Osteogenesis , Titanium , Transplantation, Heterologous , Transplants摘要
PURPOSE: The aim of this study was to evaluate the effect of Er:YAG laser on microstructure and roughness of TiO2 blasting implant surface. MATERIALS AND METHODS: Ten TiO2 blasting implant were used in this experiment. One implant was control group, and nine TiO2 blasting implant surfaces were irradiated with Er:YAG laser under 100 mJ/pulse, 140 mJ/pulse, and 180 mJ/pulse condition for 1 min, 1.5 min, and 2 min respectively. Optical interferometer and scanning electron microscopy was utilized to measure roughness and microstructure of specimens. RESULTS: The surface roughness was decreased after Er:YAG laser irradiation in all groups, but there was no significant difference. 100 mJ/pulse and 140 mJ/pulse group did not alter the TiO2 blasting implant surface in SEM study while 180 mJ/pulse group altered the TiO2 blasting implant surface. Implant surfaces showed melting, microfracture and smooth surface in 180 mJ/pulse group. CONCLUSION: Detoxification of implant surface using Er:YAG laser must be irradiated with proper energy output and irradiation time to prevent implant surface alteration.
Subject(s)
Freezing , Microscopy, Electron, Scanning摘要
PURPOSE: It has been shown that the inorganic polyphosphate is effective for the regeneration of bones through the preliminary animal test of rabbits. The most effective concentration of the polyphosphate, however, is not known yet. Moreover, the effectiveness of carriers inside human body is not confirmed.. MATERIALS AND METHODS: In this study, we examined the effect of the concentration of the inorganic polyphosphate on the process of the bone regeneration using the 6 weeks old rabbits with the weight of 2.0 kg in average. We performed the experiment using TR-ePTFE membrane(membrane) filled with collagen immersed in 4%, 8% of inorganic polyphosphate, respectively, following removal of the proper sized cortical bones from the rabbit calvaria. The experimental results were compared with the one of the following four groups: The negative control group for membrane only, the positive control group for membrane filled with collagen, the first experimental group for membrane filled with collagen immersed in 4% of inorganic polyphosphate, and the second experimental group for membrane filled with collagen immerse in 8% of inorganic polyphosphate. The fragments of the tissue with membrane obtained from each group of the sacrificed rabbits for 8 or 16 weeks sustained after surgery were then prestained by the Hematoxylin-Eosin stain and coated by resin to form non-decalcified specimens for the histologic examination and analysis. New bone formation was assessed by histomorphometric and statistical analysis. RESULTS: 1. All groups have shown better bone regeneration at 16weeks than 8weeks. 2. Negative control group has shown more bone regeneration relative to the other groups at 8 and 16 weeks. 3. All experimental groups have shown better bone regeneration relative to positive control group. 4. At 16 weeks, the first experimental group has shown more bone regeneration compared to the second experimental group. Exophytic bone formation is not good at the first and the second experimental groups compared with negative control group. But, the use of 4% inorganic polyphosphate was more effective to bone formation than the use of 8% inorganic polyphosphate. CONCLUSION: With above results, it is suggested the use of inorganic polyphosphate with vehicle under TR-ePTFE membrane.
Subject(s)
Animals , Rabbits , Bone Regeneration , Collagen , Human Body , Membranes , Osteogenesis , Regeneration , Skull摘要
PURPOSE: One of the main objectives of periodontal reconstructive surgery is the coverage of exposed roots that occur due to gingival recession. and Aestheic concerns are usually the reason to perform root coverage procedure. This case report was performed to evaluate the effect of root coverage using subepithelial connective tissue graft(SCTG) on Miller's Class I marginal tissue recession. MATERIALS AND METHODS: One patient, with two Miller's class I marginal tissue recession on both maxiallay canines, was treated with root coverage using SCTG (modified Nelson's technique). At baseline, the following measurements were recorded: 1) recession depth; 2) width of keratinized giniga. At 9, 10 months post-surgery, all clinical measurements were repeated. RESULT: 1) The mean root coverage from baseline to 9, 10 months post-surgery was 92.3%. 2) The mean recession depth decreased from 6.5 mm to 0.5 mm. 3) The mean width of keratinized gingiva increased from 1.25 mm to 3.5 mm. CONCLUSION: Within the above results, root coverage using SCTG is an effective procedure to cover Miller's class I marginal tissue recession defect. Also, patient with aesthetic concern could be satisfied with this result.
Subject(s)
Humans , Connective Tissue , Gingiva , Gingival Recession , Keratins , Transplants摘要
The present study was performed to evaluate the effect of Tetracycline-HCl on the change of implant surface microstructure according to application time. Implants with thermal dual acid etched surface were utilized. Implant surface was rubbed with 50mg/ml Tetracycline-HCl solution and sterilized saline for 0.5min, 1min, 1.5min, 2min, 2.5min and 3min. respectively in the test group. Then, specimens were processed for scanning electron microscopic observation and measured surface roughness by optical interferometer. The results of this study were as follows. 1. The thermal dual acid etched surfaces showed many small peaks and valleys distributed overall surface. 2. The surface conditioning with Tetracycline-HCl and saline didn't influence on its micromorphology. In conclusion, the implant with thermal dual acid etched surface has a protective micromorphology from the detoxification with 50mg/ml Tetracycline-HCl and a scrubbing with cotton pellet. Therefore, the detoxification with 50mg/ml Tetracycline-HCl is an effective method for peri-implantitis in case implants with thermal dual acid etched surface.
Subject(s)
Peri-Implantitis摘要
The present study was performed to evaluate the effects of Tetracycline-HCl on the microstructure change of SLA implant surface according to application time. In the Tetracycline-HCl group, 6 implants were rubbed with sponges soaked 50mg/ml Tetracycline-HCl solution for 0.5min., 1min., 1.5min., 2min., 2.5min. and 3min. In the saline group, another 6 implants conditioned with sponges soaked saline using same methods. One implant wasn't conditioned anything. Then, the changes of surface roughness values were evaluated by optical interferometer & specimens were processed for scanning electron microscopic observation. The results of this study were as follows: 1. In both Tetracycline-HCl group & saline group, there are no significant differences between surface roughness values before & after surface detoxification. And in scanning electron microscopic observation, there are slightl9y changes of implant surface structures but this changes were not significant by comparison with no treatment implant surface. 2. In the changes of surface roughness values & the scanning electron microscopic observation, there were no significant differences between saline & Tetracycline-HCl groups. In conclusion, the detoxification with 50mg/ml Tetracycline-HCl within 3 minutes can be applied for treatment of peri-implantitis in SLA surface implants, without surface microstructure changes.
Subject(s)
Peri-Implantitis , Porifera摘要
This study was performed to evaluate the effect of membrane exposure on new bone formation when guided bone regeneration with perforated titanium membrane on atrophic alveolar ridge. The present study attempted to establish a GBR model for four adult beagle dog premolar. Intra-marrow penetration defects were created on the alveolar ridge(twelve weeks after extraction) on the mandibular premolar teeth in the beagle dogs. Space providing perforated titanium membrane with various graft material were implanted to provide for GBR. The graft material were demineralized bovine bone(DBB), Irradiated cancellous bone(ICB) and demineralized human bone powder(DFDB). The gingival flap were advanced to cover the membranes and sutured. Seven sites experienced wound failure within 2-3weeks postsurgery resulting in membrane exposure. The animals were euthanized at 4 weeks postsurgery for histologic and histometric analysis.2) The results of this study were as follows: 1. There was little new bone formation at 4 weeks postsurgery, irrespectively of membrane exposure. 2. There was significant relationship between membrane exposure and bone graft resorption(P< 0.05), but no relation between membrane exposure and infiltrated connective tissue. 3. There was much bone graft resorption on DFDB than ICB and DBB. 4. The less exposure was on the perforated titanium membrane, the more dense infiltrated connective tissue was filled under the membrane when grafted with ICB and DBB. but there was no relationship between the rate of membrane exposure and the percentage of infiltrated connective tissue area and no relationship between the percentage of the area in the infiltrated connective tissue and in the residual bone graft. Within the above results, bone formation may be inhibited when membrane was exposed and ICB and DBB were more effective than DFDB as a bone graft material when guided bone regeneration.
Subject(s)
Adult , Animals , Dogs , Humans , Alveolar Process , Bicuspid , Bone Regeneration , Connective Tissue , Membranes , Osteogenesis , Titanium , Tooth , Transplants , Wounds and Injuries摘要
The present study was performed to evaluate the surface roughness and effect of Tetracycline-HCl on the change of implant surface microstructure according to application time. TiO2 surface Implant was utilized. Implant surface was rubbed with 50mg/ml Tetracycline-HCl solution for 0.5min, 1min, 1.5min, 2min, 2.5min and 3min respectively in the Tetracycline-HCl group. Then, specimens were measured surface roughness and processed for scanning electron microscopic observation. The results of this study were as follows. 1. TiO2 blast implant surface showed increased surface roughness 1.5 minute after treatment with Tetracycline-HCl. But, there were not significant differences in saline group after treatment. 2. Tetracycline-HCl group showed changed surface micro-morphology in SEM after 1.5 minute. There were not significant differences in saline group after treatment. 3. Between Tetracycline-HCl group and saline group, there were difference in surface roughness change and SEM micro-morphology. Tetracycline-HCl have influence on TiO2 blast implant surface. In conclusion, the detoxification with 50mg/ml Tetracycline-HCl must be applied respectively with different time according to various implant surfaces.
摘要
The present study was performed to evaluate the effect of Tetracycline-HCl and Saline on the change of implant surface microstructure and surface roughness according to application time. Implants with resorbable blasting media surface were utilized. Before test all 13 implants were measured surface roughness. Among them, 6 implants were rubbed with 50mg/ml Tetracycline-HCl solution and other 6 implants with saline for 1/2min., 1min., 1 1/2min., 2min., 2 1/2min and 3min. Then, specimens were processed for scanning electron microscopic observation and surface roughness after test. The results of this study were as follows. 1. Control group showed a few irregular, rough, uneven surface with crater-like depression. 2. The test group with Tetracycline-HCl conditioning showed an altered surface when Tetracycline-HCl was applied for 30secs, and showed a various surface alteration as application times go on. 3. The test group with Saline conditioning showed no significant surface differences and surface roughness. 4. The significant increase of Ra value was showed when Tetracycline-HCl was applied for 30secs. In conclusion, the 50mg/ml Tetracycline-HCl must not be applied for the RBM surface implant for surface treatment.