Patent Publication Number: US-2023149144-A1

Title: Electrode applicators for conjunctive use in a dental implant treatment system

Description:
CROSS REFERENCE TO PRIOR APPLICATIONS 
     This application is a national stage application under 35 U.S.C. §371 of International Application No. PCT/US2020/041022, filed Jul. 7, 2020, which claims priority under applicable portions of 35 U.S.C. §§119 and 120 to U.S. Pat. Application Serial No. 16/884,664, filed on May 27, 2020 and U.S. Pat. Application Serial No. 62/984,332, filed Mar. 3, 2020, the entire contents of each application being herein incorporated by reference. 
    
    
     TECHNICAL FIELD 
     The application is directed generally to the field of treatment systems used to disrupt bacteria from surgically implanted devices, and more specifically to supporting and configuring electrodes used in systems for treating infected metal dental implants. 
     BACKGROUND 
     Metal implants are used in patients with many different injuries or medical problems. For example, various orthopedic devices such as knee, hip or shoulder joint replacements can be surgically implanted. Similarly, metal implants may be used for any individual that needs to replace a tooth in a dental procedure. Dental implants are commonly used to completely replace a tooth. More specifically, dental implants are made up of three (3) components; namely, a metallic post that is osseointegrated to the jaw bone of the patient, an abutment extending from the metallic post, and a prosthetic tooth (a dental crown), in which the latter can be made from an electrically non-conductive material, which is disposed over the abutment. 
     One potential problem with metal implants in general is that they tend to allow for the growth of bacteria on the surface. This may increase the patient’s risk for an infection. This issue is especially prevalent in the mouth due to a large bacterial presence. As bacteria colonize upon foreign surfaces such as metal, biofilms are formed. Biofilms are protective extracellular matrix materials that encapsulate bacterial colonies onto a surface and protect them. Biofilms can be 500-5000 times more resistant to antibiotics than common planktonic bacteria because the antibiotics cannot penetrate the biofilm. Statistically, a significant percentage (greater than 14 percent) of dental implants acquire periimplantitis, or bacterial infection of the implant that can cause complications with implant loosening, gum and bone loss. 
     To decrease the risk of infection, electrodes can provide electrical stimulation to disrupt the growth of bacteria. It has been shown in scientific literature that the application of a suitable cathodic current to metal samples create chemical reactions at the surface of the implant that can disrupt and kill bacterial biofilms that exist on the metal. 
     For electrochemical processes to occur, there must be an anode and a cathode within an electrolyte solution. The anode is a metallic surface where oxidative reactions occur, and the cathode is another metallic surface where reduction reactions occur. A reduction reaction is essentially when the material of interest gains electrons and thereby decreases the oxidation state of the molecules. The electrolyte that the electrodes each reside in provides the electrical connection by facilitating the flow of electrons shuttled by ion carriers such as sodium or potassium ions. Electrons are driven from the anode to the cathode through the electrical path via a potentiostat. A potentiostat is an instrument used to drive current from a counter electrode to a working electrode in order to keep the voltage on the working electrode at a constant value compared to a stable reference electrode. A treatment technique based on cathodic voltage controlled electrical stimulation (CVCES) is described in U.S. Pat. No. 9,616,142, herein incorporated in its entirety by reference. In this treatment technique, the anode represents the counter electrode and the cathode represents the working electrode. Using a potentiostat, a user can dictate which electrochemical process is occurring on the working electrode and at what rate it occurs simply by adjusting the applied voltage parameters with respect to a separate reference electrode. The cathodic reactions occurring at the working electrode produce hydroxide ions, resulting in an alkaline pH at on the implant surface while also producing different reactive oxidative chemical species that are bactericidal for existing biofilms. 
     In a research setting, the above treatment technique has been shown as a way to fight bacterial biofilm infections on metallic implants in the most minimally invasive way possible. In this setting, the patient’s bodies can act as an electrochemical cell by using the metal implant as the cathode and the counter electrode as the anode. The treatment system uses the electrochemical properties of the two electrodes in a DC circuit to chemically kill the biofilm, which means the electrodes must be submersed or contacting an electrolyte that transports the electrical energy through chemical reactions to the other electrode. Human bone and soft tissue provide this electrolyte media for conduction, and thus the complete surface area of the dental implant embedded in the bone receives treatment. Full surface treatment optimizes effectiveness against biofilm infections. 
     For dental implants in particular, an electrical connection to the implant can be difficult due to the non-conductive crown or crown coating that sits on top of the metal post and abutment, and above the gum line. Various approaches to electrically connect to the metal post for treatment include removing the crown or using a needle to pierce through the gum. Each of these approaches are impractical and inconvenient, as well as uncomfortable for the patient. Moreover, the design of any dental apparatus or medical device must highly consider patient safety and comfort. The treatment device must be both efficient and non-toxic relative to the patient. 
     BRIEF DESCRIPTION 
     As described above, it has been demonstrated that applying cathodic voltages to a metallic material kills any form of bacterial biofilm that exists on the metal. When applying this therapy to an infected dental implant, it is preferable to keep the prosthetic crown attached, as opposed to alternative attachment mechanisms that need to connect to the implant abutment directly with no crown. The disclosed apparatus provides means of contact to exposed portions of the abutment, or specialized electrical contact points provide on a specialized crown, such as that described in U.S. Pat. Application No. 16/884,664, herein incorporated by reference or other variants. The apparatus and related method of the present invention also involves novel features that optimize the cathodic voltage system for patient safety in the oral cavity. 
     The disclosed invention presents a novel apparatus to both make electrical contact with an exposed dental abutment or a specialized crown with exposed metal, as well as novel embodiments of the application of the counter electrode (anode) and the reference electrode within the mouth. Optimal application of the implant (working electrode) connector, the counter electrode, and the reference electrode allows for efficient and concise connection to an external voltage source. This system and related method allows the physician to treat the fully bone-embedded implant surface, while still maintaining patient safety parameters and its minimally invasive profile. 
     The present invention relates to the use of voltage controlled electrical treatment to metallic surfaces as a method to prevent and eradicate microbial colonization on the surface, such as in the case of periimplantitis, common to dental implants. This invention is implemented when a DC electrical current is applied to a metallic implant. The system requires at least two (2) electrodes, but can also utilize three (3) or more electrodes. Specifically and in the case of three (3) electrodes, a counter electrode, a working electrode, and a reference electrode are provided in which the counter electrode delivers the current to the working electrode in order to maintain a steady DC potential with respect to the stable reference electrode. In the case of a dental implant, the metallic surface of the implant post and abutment act as the working electrode. 
     Novel mechanisms are disclosed to reliably attach electrodes to the dental implant and the tissue within the mouth to enable the chemical reaction for biofilm treatment to proceed safely and effectively. The herein disclosed apparatus provides a novel way of incorporating all elements necessary to provide an effective cathodic voltage electrical stimulation to a dental implant while maintaining patient safety and optimizing the treatment of the biofilm infection. These elements include the various electrodes of the treatment system, as well as physical applicator apparatus as described herein. 
     Therefore and according to one aspect, there is provided an apparatus for use with a treatment system that disrupts bacteria from a metallic dental implant, the treatment system comprising a device capable of producing a stimulation voltage, a counter electrode, and a working electrode each coupled to the device capable of producing the stimulation voltage. The apparatus comprises a connective body configured for connection to the device capable of producing a stimulation voltage and having at least one feature configured for attachment to the mouth of a patient, the body including at least one metal contact configured for electrical contact with an exposed metal area of the metallic dental implant as the working electrode. 
     The connective body according to at least one embodiment can comprise a mouth guard, which is shaped and configured to fit over the teeth and gums of a patient. In at least one version, the at least one metal contact is integrated into a wall of the mouth guard. In another version, the at least one metal contact can be releasably attached to a wall of the mouth guard. 
     The mouth guard can include a grounding plate imbedded in the wall of the mouth guard, wherein the at least one metal contact is formed on a clip member that is releasably attachable to the mouth guard. According to at least one version, the apparatus can comprise two or more clip members that can be releasably disposed on the mouth guard. 
     In an embodiment, the at least one metal contact of the mouth guard is biased into contact with an exposed metal area of at least one dental implant when attached to the mouth of a patient. The biasing can occur in a number of ways. For example and according to one version, the at least one metal contact can comprise a section of a conductive sponge or steel wool. According to another version, the at least one metal contact comprises a spring section of steel or other conductive material. 
     According to at least one other version, the connective body comprises at least one clip member configured for direct attachment to at least one tooth of a patient. The at least one clip member can include a torsional spring configured to bias the at least metal contact into contact with an exposed metal area of at least one dental implant when attached. The at least one clip member can further comprise a soft pad opposite the at least one metal contact configured for contacting the tooth of a patient when attached. 
     According to another aspect of the invention, there is described an apparatus for use with a treatment system that disrupts bacteria from a metallic dental implant, the treatment system comprising a device capable of producing a stimulation voltage, a counter electrode, and a working electrode each coupled to the device capable of producing the stimulation voltage, the working electrode comprising the metallic dental implant, the apparatus comprising the counter electrode including a connective body adapted for attachment to the gum line of the patient. 
     According to at least one version, the connective body comprises a flexible member configured to wrap about the teeth and gums of at least a portion of the mouth of a patient, the flexible member comprising a conductive anodic layer. 
     According to another version, the apparatus comprises a conductive member disposed within a container external to the mouth of the patient, the container containing a conductive fluid that is fluidically connected to an applicator disposed within the mouth of the patient. The conductive fluid is preferably neutral to basic in pH, wherein the container is configured to deliver conductive fluid to the connective body. In at least one version, the connective body supports at least one cotton roll that is saturated by the conductive fluid wherein the conductive fluid is transferred using a hollow tube disposed between the container and at least one cotton roll. 
     According to yet another aspect, there is provided a treatment system to disrupt bacteria from a metallic dental implant comprising a device capable of producing a cathodic stimulation voltage, a working electrode that comprises the metallic dental implant and a counter electrode. Each of the counter electrode and working electrode are connected via a circuit to the device capable of producing a stimulation voltage. The counter electrode comprises a container retaining a conductive fluid and an electrically conductive member, the container being connected to the device capable of producing the stimulation voltage. The system further comprises a connective body fluidically coupled to the container and the gum interface of a patient in relation to the metallic dental implant, the connective body being configured to receive conductive fluid and current created by the device capable of producing the stimulation voltage. 
     According to another aspect, there is provided an apparatus for use with a treatment system that disrupts bacteria from a metallic dental implant, the treatment system comprising a device capable of producing a stimulation voltage, a counter electrode, and a working electrode each coupled to the device capable of producing the stimulation voltage, the apparatus comprising a mouth guard configured for attachment to the mouth of a patient and having at least one metal contact configured for electrical contact with an exposed metal area of the metallic dental implant as the working electrode. 
     According to yet another aspect, there is provided an apparatus for use with a treatment system that disrupts bacteria from a metallic dental implant, the treatment system comprising a device capable of producing a stimulation voltage, a counter electrode, and a working electrode each coupled to the device capable of producing the stimulation voltage, the apparatus comprising at least one clip member configured for attachment to at least one tooth of a patient. 
     According to yet another aspect, there is provided a treatment system for disrupting bacteria from a metallic dental implant, the system comprising a device capable of providing a cathodic stimulation voltage, a working electrode capable of making electrical contact with at least one metallic dental implant; and a counter electrode electrically coupled with the gum line of a patient in proximity to the at least one metallic dental implant, each of the working and counter electrode being coupled in a circuit. 
     In at least one embodiment, the treatment system further comprises a reference electrode coupled to the circuit, the reference electrode being configured for monitoring treatment of the at least metallic dental implant. 
     According to at least one embodiment, the working electrode further comprises a connective body configured for attachment to the mouth of a patient, the connective body including at least one metal contact for engaging an exposed metal area of the at least one metallic dental implant. In at least one version, the connective body comprises a mouth guard shaped and configured to fit over the teeth and gums of a patient in which the at least one metal contact is integrated into a wall of the mouth guard or alternatively the least one metal contact is releasably attachable to a wall of the mouth guard. 
     A grounding plate is imbedded in the wall of the mouth guard wherein the at least one metal contact can be formed on a clip member that is releasably attachable to the mouth guard. According to at least one version, two or more clip members are configured to be releasably disposed on the mouth guard. 
     In at least one embodiment, the connective body comprises at least one clip member configured for attachment to at least one tooth of a patient. Means are provided for biasing the at least one metal contact into contact with the exposed metal area of at least one dental implant when the connective body is attached to the mouth of a patient. In one version, the at least one metal contact can comprise a section of conductive sponge or steel wool. In another version, the at least one metal contact can comprise a spring section made from conductive material. 
     In at least one version, the clip member can comprise a torsional spring configured to bias the at least metal contact into contact with an exposed metal area of at least one dental implant when attached. The at least one clip member can further comprise a soft pad opposite the at least one metal contact configured for contacting the tooth of a patient when attached. 
     The metallic dental implant comprises a crown disposed over a post, wherein the crown includes a metallic core having an exposed end in electrical contact with a metallic post fused to the jaw of the patient. 
     According to another embodiment, the connective body can comprise a flexible member configured to wrap about the teeth and gums of at least a portion of the mouth of a patient, the flexible member comprising a conductive anodic layer. The flexible member can further comprise a conductive mesh layer disposed between the conductive anodic layer and an exterior adhesive layer. In addition, a hydrogel layer having a buffered agent is disposed between the conductive anodic layer and exterior adhesive layer. 
     According to another embodiment, the counter electrode comprises at least one conductive member disposed within a container external to the mouth of the patient, the container containing a conductive fluid that is fluidically connected to the connective body disposed within the mouth of the patient. In some versions, the conductive fluid is neutral to basic in pH. 
     The container is configured to deliver conductive fluid to the connective body in which conductive fluid can be delivered to the connective body by at least one hollow tube and wherein the connective body includes at least cotton roll configured to receive conductive fluid from the container. 
     An advantage is that the herein described apparatus provides alternative means for dentists to treat infections that statistically affect roughly 14% of all people who receive a dental implant in a manner that is very minimally invasive. 
     The novel embodiments of the herein described dental implant treatment system that include abutment and crown contact mechanisms, as well as novel counter electrode embodiments give the physician optimal ability to apply a cathodic voltage system that can effectively disrupt and eliminate biofilm from a dental implant without removing the crown. A distinct differentiator from alternative dental treatment techniques is that this system promotes conduction over the entire bone-embedded surface of the dental implant, not just within the abscess pocket. This is key, especially in regard to dental implant posts. The posts are manufactured to have a very rough, coarse microsurface to promote osseointegration. One issue this surface can create is that bacteria are able to “hide” within the crevices of the microstructure, even when bone matrix are apparently grown into the surface. The approach and design of this novel system allows for thorough treatment of all microstructures in the metal, even with bone present, to eliminate all bacteria from those location. It has been found in scientific literature that at optimizes treatment parameters, matrix embedded bone cells that are local to the reaction are not affected to a high degree. 
     These and other technical features and advantages will be readily apparent from the following Detailed Description, which should be read in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1  ( a )  is a side elevational view of a dental implant that enables access by a treatment system without removal of the crown; 
         FIG.  1 ( b )  is a sectioned view of the dental implant of  FIG.  1 ( a )  taken through Section A-A; 
         FIG.  1  ( c )  is a partially exploded view of the dental implant of  FIGS.  1 ( a ) and  1 ( b ) ; 
         FIG.  2  ( a )  is schematic diagram of an exemplary CVCES treatment system; 
         FIG.  2 ( b )  is a schematic diagram of another exemplary CVCES treatment system that includes working, counter and reference electrodes; 
         FIG.  2 ( c )  is a schematic diagram of yet another CVCES treatment system incorporating a plurality of electrodes; 
         FIG.  3  ( a )  is a top perspective view of an apparatus for use in a CVCES treatment system, including but not limited to those shown in  FIGS.  2 ( a ) -  2 ( c ) , which is made in accordance with aspects of the invention; 
         FIG.  3 ( b )  is a top perspective view of the apparatus of  FIG.  3 ( a ) , including a contact portion made in accordance with aspects of the invention; 
         FIGS.  3 ( c ) and  3 ( d )  are top perspective views of the apparatus of  FIG.  3 ( a ) , including contact portions made in accordance with alternative aspects of the invention; 
         FIG.  4 ( a )  depicts a top perspective view of an apparatus in accordance with an exemplary embodiment, including one or more releasably attachable contacts, according to one configuration; 
         FIG.  4 ( b )  depicts the top perspective view of the apparatus of  FIG.  4 ( a ) , including the one or more releasable contacts as disposed in another configuration; 
         FIG.  4 ( c )  is a partial sectioned view depicting the attachment of a releasable contact to the apparatus of  FIGS.  4 ( a ) and  4 ( b ) ; 
         FIG.  4 ( d )  depicts an enlarged view of the releasable contact attachment of  FIG.  4 ( c ) ; 
         FIG.  4 ( e )  is a partial perspective view of the apparatus of  FIGS.  4 ( a ) -  4 ( d ) , depicting another alternative placement of the releasable contacts; 
         FIG.  4 ( f )  is a perspective view of the apparatus of  FIGS.  4 ( a ) -  4 ( e ) , depicting the releasable attachability of the contacts; 
         FIG.  5 ( a )  is a perspective view of an apparatus made in accordance with other aspects of the invention and as attached to a patient; 
         FIG.  5 ( b )  is an elevational view of the apparatus of  FIG.  5 ( a ) , showing a contact portion made in accordance with an exemplary embodiment; 
         FIG.  5 ( c )  is a top perspective view of the apparatus of  FIGS.  5 ( a ) and  5 ( b ) ; 
         FIGS.  5 ( d ) and  5 ( e )  are perspective view of the apparatus of  FIGS.  5 ( a ) - ( c ) , showing alternative contact portions made in accordance with aspects of the invention; 
         FIG.  6 ( a )  is a perspective view of an apparatus made in accordance with another exemplary embodiment; 
         FIG.  6 ( b )  is an exploded view of an electrode made for use in the apparatus of  FIG.  6 ( a ) ; 
         FIGS.  7  and  8    are schematic views of an external electrolytic delivery system in accordance with aspects of the invention; and 
         FIGS.  9 ( a ) -  9 ( c )  are views of the placement of cotton or similar material into the oral cavity of a patient for use with the external electrolytic delivery system of  FIGS.  7  and  8   . 
     
    
    
     DETAILED DESCRIPTION 
     The present disclosure provides several novel embodiments of apparatus used in conjunction with treatment systems in order to disrupt and remove biofilms from a metallic dental implant. The treatment systems discussed utilize electrochemical stimulation therapy through an established electrical connection to the metallic dental implant and application of a suitable cathodic voltage. Connection is described in the following embodiments to a specific form of dental implant that enables treatment without requiring removal of the crown portion. It will be readily apparent, however, that this implant is an example and the herein described apparatus can be adapted for use with other types of dental implants. The novel apparatus designs that are discussed improve the overall ease and efficiency of treating metallic dental implants with suitable cathodic stimulation voltages. 
     As a matter of background and when a patient has a tooth that needs to be removed, the standard procedure is to replace that tooth with a dental implant. The dental implant typically is made up of three (3) main components that include a metallic post that is osseointegated to the jaw bone of a patient and a prosthetic tooth (crown) that is placed over an abutment of the metallic post. The tooth and roots are extracted and the bone is reamed to properly fit the metal post. A healing abutment is placed until the site is sufficiently healed. The healing abutment is then removed, and another metal abutment is screwed onto the post. The prosthetic crown can then be adjoined to the abutment. The crown typically has a hollowed core that allows the abutment to be press fit inside. It is also common to have an abutment that screws into the crown itself. The screw hole is typically at the top of the tooth and then is filled once the complete implant is in place. In many cases of this implantation, especially if there is an infection present that causes recession of tissue, the metal abutment is visibly exposed at the base. This situation provides a means of directly contacting with the abutment via a working electrode connection in order to provide cathodic stimulation for treatment of the infection and to disrupt biofilm layers. 
     The herein described system and method relies upon the introduction of an electrical current to an electrochemical cell. As a matter of background and for electrochemical (redox) processes to occur, there must be an anode and a cathode within an electrolyte solution. The anode is a metallic surface where oxidative reactions occur, and the cathode is another metallic surface where reduction reactions occur. A reduction reaction occurs when the material of interest gains electrons and thereby decreases the oxidation state of the molecules. The electrolyte that the electrodes each reside in provides the electrical connection by facilitating the flow of electrons shuttled by ion carriers, such as electrolytic sodium or potassium ions. Electrons are driven from the anode to the cathode through the electrical path via a potentiostat or similar device. More specifically, a potentiostat is an instrument used to drive current from a counter electrode to a working electrode in order to keep the voltage on the working electrode at a constant value compared to a stable reference electrode. One such procedure used for the treatment of biofilms on a metallic implant is described in U.S. Pat. No. 9,616,142, the entire contents of which are herein incorporated by reference. 
     According to this treatment procedure, the anode represents the counter electrode and the cathode represents the working electrode. Using a potentiostat, a user can dictate which electrochemical process is occurring on the working electrode and at what rate the process occurs simply by adjusting the applied voltage parameters with respect to a separate reference electrode. The cathodic reactions occurring at the working electrode produce hydroxide ions, resulting in an alkaline pH at on the implant surface, while also producing different reactive oxidative chemical species that are bactericidal for existing biofilms. 
     In a research setting, the above-noted technique has been shown as a way to fight bacterial biofilm infections on metallic implants in the most minimally invasive way possible. In this setting, the patient’s body can act as an electrochemical cell by using the metal implant as the cathode and the counter electrode as the anode. It has been shown that the above techniques can be used for the treatment of various orthopedic implants, including metallic dental implants. 
     Referring to  FIGS.  1 ( a ) -  1 ( c ) , an exemplary dental implant  200  includes a metal abutment  208  and a dental crown  220 , the latter being made from a non-conductive material such as ceramic, porcelain or a suitable polymer having an open end and an enclosed hollow cavity  224  that is suitably sized and shaped to be fitted over the metal abutment  208 . The abutment  208  is tied to a metallic post  210 , the latter component being shown more clearly in  FIGS.  2 ( a ) -  2 ( c ) , wherein the metallic post  210  is implanted directly into the jawbone  240  of the patient. According to this embodiment, the metal abutment  208  is press fit into the crown  220 , the latter having an integrated metallic core  230  made in accordance with a specialized embodiment. The metallic core  230  is made from a suitable metallic material that enables and facilitates electrical conduction. In a preferred embodiment, the metallic core  230  is composed of a biocompatible metal commonly used in dentistry, such as but not limited to titanium, stainless steel and/or their alloys. When the metal abutment  208  is surgically implanted, the abutment  208  is placed into direct physical contact with a distal end of the metallic core  230 , thereby creating an electrical connection. The metallic core  230  can alternatively be made integral with the abutment  208  (or can be formed as part of the crown  230 ), according to this embodiment. 
     More specifically and according to this specific embodiment, the metallic core  230  extends upwardly, as shown more specifically in  FIG.  1 ( b ) , through the hollow cavity  224  of the dental crown  220 , including a transverse portion of the core  230  that further extends to an opening formed in a side wall of the dental crown  220 . A proximal end of the metallic core  230  is preferably flush with the side wall of the dental crown  220 , thereby exposing a small metallic surface zone  234  on the dental crown  220 , as shown. The shape of the exposed metallic surface zone  234  is circular according to this specific embodiment, but it will be understood that the shape of the defined zone  234  and the metallic core  230  can be suitably varied. Making the proximal end of the core  230  flush to the surface of the crown  220  is preferable so not to produce an overhang or create sharp edges. According to one version, the exposed surface area  234  of the metallic core  230  may be dimpled to allow for better mating with the crown attachment mechanism. In a preferred embodiment, the exposed metallic surface zone  234  resides on the inner facing wall of the crown  220  relative to the patient, such that the exposed metallic surface zone  234  is not visible. 
     The overall shape and configuration of the metallic core  230  can be suitably varied provided that the dental crown  220  can adequately and structurally function primarily as a prosthetic tooth. For example and in lieu of extending transversely as shown, the proximal end of the metallic core  230  can extend vertically through the hollow cavity  224  until exposed at a top surface of the crown  220 . Other similarly based versions of implants that enable access to the metallic abutment and post, but without requiring removal of the crown are described in U.S. Pat. Application No. 16/884,664, which is incorporated herein by reference. As noted, this implant design provides a great advantage, when compared to other technologies, because the crown does not have to be removed in order to perform treatment. 
     Various systems are shown schematically in  FIGS.  2 ( a ) -  2 ( c )  that can be utilized for treatment of an infected dental implant, such as implant  200 , based on the application of a suitable cathodic stimulation voltage to the exposed metal surface area  234  without having to first remove the crown  220  to disrupt biofilm layers on the implant. The overall principles of this form (CVCES) of treatment are described in U.S. Pat. No. 9,616,142, previously incorporated herein in its entirety. As shown in  FIGS.  2 ( a ) -  2 ( c ) , the herein described dental implant  200  or other dental implants can be treated in conjunction with various CVCES treatment configurations or systems, herein labeled  400 ,  500 , and  600 , respectively. For purposes of this discussion, the dental implant  200  is shown schematically in use with each treatment system  400 ,  500 , and  600 . It will be understood that other metallic dental implants can be similarly treated using any of these exemplary treatment systems. 
     Each CVCES treatment system  400 ,  500  and  600 , as shown diagrammatically in  FIGS.  2 ( a ) -  2 ( c ) , respectively, commonly includes a potentiostat  404  or similar device that is capable of generating an electrical potential as well as a number of electrodes, minimally including a working electrode and a counter electrode. The minimal configuration is shown with reference to  FIG.  2 ( a ) , for a first exemplary CVCES treatment system  400 , employing a pair of electrodes; namely, a working electrode and a counter electrode  420 . The working electrode is the dental implant  200  based on the availability of the exposed metallic surface area  234  of the crown  230 , while the counter electrode  420  is preferably made up of carbon, although other materials can be used. The counter electrode  420  is attached to the gum/jawbone  240  area of the patient via an electrical lead or wire  412  coupled to the potentiostat  404 . An electrical lead  408  is further provided extending to a conductive member that is placed into contact with the exposed metallic area  234  of the crown  230 . Electrochemical current is caused to flow based on voltages applied by the potentiostat  404  via an electrochemical circuit being formed between the working electrode  200  and the counter electrode  420 . Due to the exposure area  234 , the potentiostat  404  is electrically connected to the metal abutment  208 , and thus the entire post-abutment-core system is electrically connected. However, the only metallic materials that are in contact with a conductive electrolyte (bone and soft tissue) are the metal abutment  208  and the post  210 . Because the metallic core  230  is encapsulated by the non-conductive crown material, the metal core  230  essentially acts as an electrical wire or lead capable of transferring electrical energy (i.e., current) from the potentiostat lead to the dental implant  200 . This system  400  provides a significant advantage, when compared to other comparable potentiometric treatment systems or techniques, because the dental crown  220  does not have to be first removed in order to perform treatment. 
       FIG.  2 ( b )  diagrammatically illustrates a three (3) electrode system  500  that includes the working electrode (the implant  200 ), as well as a counter electrode  520  functioning in the same manner as that of the prior system  400 . Each electrode  200 ,  520  is coupled to the potentiostat  404  via electrical leads  508  and  512 , respectively. A third (reference) electrode  524  is applied along with the counter electrode  520  to the gums/jawbone area  240  of the subject and is electrically coupled to the potentiostat  404  via a corresponding lead  516 . The reference electrode  524  permits greater electrochemical control for the treatment system  500 . In a preferred embodiment, the reference electrode  524  is made from silver/silver chloride, thus producing a stable electrochemical biopotential for the working electrode (implant  200 ). Further details relating to the functioning of the potentiostat and counter and reference electrodes of this system  500  are described in greater detail in U.S. Pat. No. 9,616,142, previously incorporated by reference in its entirety. 
       FIG.  2 ( c )  diagrammatically illustrates yet another version of a CVCES treatment configuration  600  that employs four (4) electrodes. As in the preceding, the dental implant  200  due to the exposed metallic area  234  acts a working electrode as electrically coupled to the potentiostat  404  by electrical lead  608 . A counter electrode  620  and reference electrode  624  are attached to the gum/jawbone area  240  of the patient as connected to the potentiostat  404  by leads  612  and  616 , respectively. Each of the electrodes  620  and  624  operate in the same manner as those previously described. In addition, this treatment system  600  is further equipped with a working sense electrode  632 , similarly attached to the gum/jawbone  240  area of the patient and coupled to the potentiostat  404  by electrical lead  618 . The working sense electrode  632  enables further control and data feedback of the working electrode (implant  200 ). Other suitable cathodic voltage treatment configurations or systems can also be utilized. In addition and though the counter, reference and working sense electrodes are shown according to this embodiment being attached to the jawbone/gum area  240 ,  FIGS.  2 ( a ) -  2 ( c ) , of the patient, other suitable positioning of these electrodes is permitted. For example, any or all of these electrodes could also be located outside the mouth on the face or completely external to the body and connected via a salt bridge. 
     Advantageously, each of the above systems/configurations permit reliable treatment of the dental implant  200 , but without requiring removal of the crown. The exposed metallic surface area  234  of the crown permits electrical conduction to the remainder of the dental implant. Exposed metal surfaces are both safe and cosmetically acceptable when applying these designs and embodiments. A distinct differentiator from alternative dental treatment techniques is that the herein described implant promotes conduction over the entire bone-embedded surface of the dental implant, and not just conduction, for example, within the abscess pocket. This differentiator is a significant advance, especially in regard to dental implant posts. Implant posts are typically manufactured with a very rough, coarse microsurface to promote osseointegration. One issue this microsurface can create is that bacteria are able to “hide” within the crevices of the microstructure, even when bone matrix are apparently grown into the surface. The approach and design of herein described apparatus allows for thorough treatment of all microstructures in the metal, even with bone present, to eliminate all bacteria from those locations. It has been found and substantiated in scientific literature that at optimized treatment parameters, matrix embedded bone cells that are local to the reaction are not affected to a high degree. 
     Apparatus are now described in accordance with a number of embodiments according to various aspects of the present invention for use in a treatment system. More specifically, the following described apparatus can be used in connection with treatment systems for enabling electrical contact with the working electrode (metallic dental implant) and/or retaining the counter and/or reference electrode. 
     With reference to  FIGS.  3 ( a ) -  3 ( d ) , there is shown a first embodiment of an apparatus  700  that can used in conjunction with the CVCES treatment systems  400 ,  500 ,  600 ,  FIGS.  2 ( a ) -  2 ( c ) , as well as other systems designed to remove biofilms from metallic surfaces. The herein described apparatus  700  is described by way of example for use with the dental implant  200 ,  FIGS.  1 ( a ) -  1 ( c ) , having the exposed metallic surface area  234 ,  FIGS.  1 ( a ) -  1 ( c ) , on the crown  220  to enable direct electrical connection to the metal abutment/post of the dental implant  200 . It will be understood, however, that the specialized dental implant  200  is merely discussed as an example wherein the described apparatus  700  is suitable for use with other dental implant designs. 
     As previously described and in a CVCES treatment system such as system  500 ,  FIG.  2 ( b ) , the dental implant  200  is employed as the working electrode and the cathode of the formed electrochemical cell. The herein described apparatus  700  is a connective body that is configured to provide electrical engagement between an external electrical source such as a potentiostat  404 ,  FIG.  2 ( b ) , and the dental implant  200 . More specifically and according to this embodiment, the herein described apparatus  700  is defined by a semi-circularly shaped mouth guard  720 . The mouth guard  720  is made from a moldable biofriendly thermoplastic or other suitable structural material that is sized and configured to fit within the mouth of a patient. More specifically and according to this embodiment, the mouth guard  720  includes an outer side or surface  722  and an opposing inner side or surface  723 . A front or outer circumferential section  728  and a rear or inner circumferential section  732  each project from the inner surface  723 , each of the front and rear circumferential sections  728 ,  732  being separated by an open-ended circumferential recess  736 . The recess  736  is defined by a height and width dimension enabling the mouth guard  720  to be placed over the teeth (not shown) of a patient in either the entire upper or lower portion of the mouth. Alternative mouth guard designs are contemplated for purposes of this invention. For example, a single mouth guard can be sized and configured to cover both the upper and lower sets of teeth of a patient at the same time. 
     According to this embodiment and as shown in  FIG.  3 ( b ) , the mouth guard  720  is custom formfitted to the patient and includes at least one metal contact  752  integrated in a wall of at least one of the front and rear circumferential sections  728 ,  732 . The location of the at least one metal contact can be determined during the manufacturing process of the mouth guard  720  and is patient specific, depending on the location of the implant(s). Since the apparatus  700  is patient specific, a single metal contact can be provided or the apparatus  700  can include two (2) or more metal contacts for use with patients having multiple infected dental implants. 
     In terms of electrical connection and still referring to  FIG.  3 ( b ) , the at least one metal contact  752  is coupled to a grounding plate  744  imbedded within the wall of the mouth guard  720 , the latter grounding plate  744  being coupled by to an imbedded wire  748  that extends to an extending electrical lead  740  at one end of the mouth guard  720 . The extending electrical lead  740  is preferably coated with a polymer or other insulating material and configured for attachment to an external electrical supply, such as a potentiostat  404 ,  FIGS.  2 ( a ) -  2 ( c ) . 
     According to at least one version, the mouth guard  720  may be reusable or alternatively could be designed as a single patient or single use apparatus. According to a preferred embodiment, the at least one metal contact  752  is biasedly positioned on the interior surface (i.e., the surface facing the circumferential recess  736 ) of either the outer or inner circumferential sections  728 ,  732  of the mouth guard  720  to promote electrical contact with the exposed metal area  234 ,  FIG.  1 ( b ) , of the dental implant  200 . 
     Various means for biasing the at least one metal contact  752  of the mouth guard  720  can be employed. For example, the at least one metal contact  752  can be spring loaded relative to one of the circumferential sections  728 ,  732  of the mouth guard  720 . Alternatively, biasing can be provided by manufacturing the at least one metal contact  752  from a section of a spring steel, as shown in  FIG.  3 ( b ) . 
     Alternatively and as shown in  FIGS.  3 ( c ) and  3 ( d ) , the at least one metal contact can be made from a conductive sponge  756  or a section of steel wool  760 , each of the latter materials inherently providing a spring-like quality, albeit a weaker one than those provided by either spring loading or manufacturing the at least one metal contact from a section of spring steel. Each of the foregoing contacts  752 ,  756 ,  760  are electrically coupled to the grounding plate  744 ,  FIG.  3 ( b ) , and imbedded wire  748 ,  FIG.  3 ( b ) , disposed within the mouth guard  720  wherein each or any of the foregoing techniques can be used for insuring that the at least one spring contact  752 ,  756 ,  760  is biased into contact with the exposed metal area  234 ,  FIG.  1 ( b ) , of the dental implant  200 ,  FIGS.  1 ( a ) -  1 ( c ) . As noted, the grounding plate  744  and imbedded wire  748  provides a suitable electrical connection to the coated electrical lead  740 , partially shown, leading to an external voltage supply of a treatment system, for example CVCES treatment systems  400 ,  500 ,  600 ,  FIGS.  2 ( a ) -  2 ( c ) , each having a potentiostat  404  or other suitable device that is capable of providing a cathodic stimulation voltage. 
     When using a conductive sponge or steel wool  756 ,  760  as a metal contact as shown in  FIGS.  3 ( c ) and ( d ) , respectively, the contact components should be made as condensed as much as possible within the defined recess  736  without sacrificing contactability to the abutment or crown of the dental implant in order to reduce extra metallic surface area involved in the working electrode reaction. In addition, all of the contact components described according to this embodiment may be coated with an insulating polymer that exposes only the points of contact needed for electrical connection in order to reduce extraneous metal surface area. 
     The at least one electrical contact, as described according to this embodiment and having embedded contact points, allows for treatment of a dental implant without having to remove the crown. As previously discussed, removing the crown is an option that many dentists prefer not to perform because the dental crown may break or cause extra trauma to the afflicted tissue. In the case where a biofilm exists on the post and abutment, the flow of electrons into the bulk metal, out the metal surface, and into the electrolytic environment, will create bactericidal chemical species that attack the biofilm from the metal surface outwards. pH is also a large factor in the bactericidal effect as laboratory testing has shown that microenvironment pH levels microns away from the surface can reach an alkaline level of 12 within minutes of electrical stimulation. 
     Alternatively and for dental implants in which the abutment of the dental implant is not exposed or the crown does not provide an exposed electrical contact point, the contact mechanism embedded in the mouth guard  720  may alternatively include a needle (not shown), the latter being appropriately sized and configured to pierce the tissue and contact the abutment of a metal dental implant directly. 
     With reference to  FIGS.  4 ( a ) -  4 ( f ) , another exemplary apparatus  800  is described. The apparatus  800  according to this embodiment is defined by another connective body and more specifically by a generic mouth guard  824 , which like the preceding described custom or formfitted version  700 ,  FIGS.  3 ( a ) -  3 ( d ) , has a semicircular shape or configuration. The mouth guard  820  includes an outer facing side or surface  821 , an opposing inner side or surface  823 , as well as an outer or front circumferential section  826 , an inner or rear circumferential section  830 , and an open-ended circumferential recess  834 , each extending from the inner surface  823 . The recess  834  has a width and height dimension that enables the mouth guard  820  to be placed over the teeth and gums of the patient. Preferably, the mouth guard  820  is made from a moldable thermoplastic material. According to one version, the apparatus  800  can be cleaned or recycled for reuse. In another version, the apparatus  800  is designed for single patient or single use. 
     As shown in  FIGS.  4 ( a ),  4 ( c ) and  4 ( d ) , the herein described apparatus  800  further contains a metal grounding plate  844 , preferably made from sheet metal, which is embedded within the mouth guard  820 , as well as an embedded wire  848  further extending to an electrical lead  840 , the latter extending from the mouth guard  820  to an external voltage supply  404 ,  FIGS.  2 ( a ) - ( c ) , of a CVCES implant treatment system  400 ,  500 ,  600 ,  FIGS.  2 ( a ) - ( c ) . Preferably, the extending electrical lead  840  is coated with a protective polymeric or other suitable insulating layer. 
     According to this specific embodiment and rather than specifically integrating at least one electrical contact, at least one releasably attachable contact  850  is configured for placement over one of the inner and outer circumferential sections  826 ,  830  of the mouth guard  820 . As shown in  FIGS.  4 ( c ) and  4 ( d ) , the at least one releasably attachable contact  850  is fabricated in the form of a clip-like member defined by a base portion  854 , as well as pair of arm portions  860 ,  864  extending in parallel relation from the base portion  854  with a spacing  858  being defined between the arm portions  860 ,  864  that is sized to seat the releasable attached contact  850  over the outer or inner circumferential portion  826 ,  830  of the mouth guard  820 . More specifically, the arm portion  864  is longer than the other arm portion  860  and further configured, when attached, to extend into the recess  834  of the mouth guard  820 . The exterior side of the arm portion  864  is further configured with a contact portion, the latter being configured for engaging the dental implant. 
     As further shown in  FIG.  4 ( d ) , the releasably attachable contact  850  according to this embodiment has embedded metal on the interior surfaces of each of the arm portions  860 ,  864  to “bite” into the sheet metal of the grounding plate  844  imbedded in the mouth guard  820 . 
     Advantageously and according to this embodiment, the number and location of releasably attachable contacts  850  can be varied as needed in order to create alignment with an implant, irrespective of the implant’s location in the mouth of the patient. Again referring to  FIGS.  3 ( a ) - ( c ) , the contact mechanism according to this embodiment may be spring loaded, spring steel/leaf-spring, or comprise a section of a conductive sponge or steel wool to create biasing, each enabling electrical contact with the exposed metal area  234 ,  FIGS.  1 ( a ) -  1 ( c ) , of the dental implant  200 . Alternatively and in lieu of a contact, the leg portion  864  can be separately provided with a needle (not shown) extending therefrom and configured and positioned to directly engage the tissue below the gum line for contact with the abutment/post of the implant. 
     The ability to attach the herein releasable attachable contact(s)  850  to one of the wall sections  826 ,  830  of the mouth guard  820  provides considerable versatility, enabling placement of the contact(s) in literally any portion of the mouth of a patient as shown in  FIGS.  4 ( a ), ( b ) and ( e ) , without the need for pre-molding a custom guard. However, in the case in which the dentist wishes to have no mouth guard in order to use conjunctive irrigational therapies to disrupt the biofilm, alternative embodiments of the working electrode contact are described that attach directly to the crown and without the need for a fitted mouth guard. 
       FIGS.  5 ( a ) -  5 ( e )  illustrates an apparatus  900  made in accordance with aspects of the invention to a connective body that can be used without an intermediate mouth guard. More specifically, the apparatus  900  is a spring loaded clip  920  having first and second half portions  924 ,  928 . Each of the half portions  924 ,  928  commonly include a leg portion  932 ,  936 , respectively, vertically extending from a distal end of each half portion  924 ,  928 . An arm portion  940 ,  944  outwardly and transversely extends from an upper end of each leg portion  932 ,  936  in a curved configuration wherein each of the arm portions  940 ,  944  inwardly extend and then cross with one of the arm portions  944  being configured beneath the other arm portion  940 . A torsional spring  950  provided on the upper arm portion  940  is coupled to the remaining lower arm portion  944  at the junction between the curved arm portions  940 ,  944 . The torsional spring  950  according to this embodiment biases the leg portions  932 ,  936  of the apparatus  900  and more specifically defines a spacing  964  between the leg portions  932 ,  936  that can be further opened by inwardly squeezing the proximal ends of the arm portions  940 ,  944  to enable the apparatus  900  to be releasably secured over the teeth and gums of a patient, the latter being schematically shown as  904  in  FIG.  5 ( a ) . 
     Referring to  FIGS.  5 ( a ) and  5 ( c ) , the legs  932 ,  936  include inwardly faced surfaces at each side of the defined spacing  964 . The inwardly facing surface of leg portion  932  is provided with a metal contact  968  with the inwardly facing surface of the remaining leg portion  936  being provided with a soft pad  972 , that is adhesively or otherwise attached. The metal contact  968  is directly wired through an imbedded wire (not shown) extending through the half section  924  to a proximal end of the arm portion  940 , and further extending as an electrical lead  976 , shown only in  FIGS.  5 ( a ) and  5 ( c ) , which is configured to make an electrical connection to an external voltage supply, such as potentiostat  404 ,  FIG.  2 ( b ) , of the treatment system  500 ,  FIG.  2 ( b ) . 
     According to this exemplary embodiment, the metal contact  968  is configured to make electrical contact with the exposed metal area  234  of the dental implant  200 ,  FIGS.  1 ( a ) - 1 ( c ) , while the soft pad  972  on the remaining leg portion  936  of the apparatus  900  is preferably made from silicon, to help grip the tooth. As shown in  FIGS.  5 ( b ) and  5 ( d ) , the metal contact could be formed as a cantilevered section of spring steel  968 A, as shown in  FIG.  5 ( b ) , or a spring loaded pin  968 B, as shown in  FIG.  5 ( d ) . Alternatively, the metal contact  968  could also be made from a conductive sponge material or steel wool such as those described in prior embodiments, each of which is preferably biased to make an electrical connection with a dental implant, such as  200 ,  FIGS.  1 ( a ) -  1 ( c ) , or otherwise the clip member  900  could be configured with a needle (not shown) positioned to engage the dental implant below the gum line. According to another alternative version shown in  FIG.  5 ( e ) , a half circular clip  968 C on the lower end of the leg portion  932  may also be appropriate to clip on and contact the base of an abutment of an implant (not shown) that is very exposed. As in the preceding versions described, the apparatus  900  is preferably configured to provide connection to the working electrode of a CVCES treatment system, such as those shown in  FIGS.  2 ( a ) -  2 ( c ) , with the dental implant serving as the working electrode. 
     As previously discussed and in order to complete a circuit, there must at least exist one other electrode in a CVCES or other electrochemically based treatment system other than the metal dental implant, the latter acting as a working electrode, as previously shown in  FIGS.  2 ( a ),  2 ( b ) and  2 ( c ) . In the case of a dental implant, a counter electrode of a CVCES treatment system ideally interfaces with the gums of the patient and more specifically, the gum in which the implant is implanted as opposed to a gum on the opposite side of the jaw or the other jaw entirely (upper or lower). Electrochemical current will flow between the implant and the counter electrode due to the conductiveness of the tissue. Though a two (2) electrode treatment system  400 , such as shown in  FIG.  2 ( a )  will function, a two-electrode treatment system only allows for minimal control of the electrochemical processes on the working electrode because the potentials of the metal(s) of the implant can drift into thermodynamic regions that can cause corrosion or metal immunity. Accordingly, a treatment system having additional electrodes as shown in  FIGS.  2 ( b ) and  2 ( c )  is preferable. 
     Though any number of electrodes can be used, a three-electrode system that includes an additional stable reference electrode is more favorable due to its balance of sufficient electrochemical control and number of electrodes that need to be in the mouth of the patient. In a preferred embodiment, the reference electrode is made from Ag/AgCl, thus providing a stable electrochemical biopotential for the working electrodes voltage to be referenced to. This function keeps the working electrode in safe electrochemical regions of thermodynamics. Although the counter electrode needs to interface with the gums to promote electrochemical current through the tissue to the dental implant, the electrode’s metal surface can exist either internal or external to the mouth as described herein. 
     According to one version, shown in  FIGS.  6 ( a ) and  6 ( b ) , an exemplary apparatus  1000  is defined by a highly flexible connective body  1006  retaining a flexible electrode  1008  fabricated from a plurality of stacked layers that create an electrical connection. The connective body  1006  according to this embodiment is shaped and configured to be placed within the mouth of a patient and more specifically placed or wrapped over the teeth, with opposing sides of the flexible electrode  1008  being in contact with the gums of the patient. 
     According to this embodiment and as shown in  FIG.  6 ( b ) , the flexible electrode  1008  is shown in an exploded form and includes a hydrogel layer  1012 , which is preferably carbon backed with at least one buffering agent, an anodic conductive film layer  1016 , a conductive mesh layer  1020 , and an exterior layer  1024 . The exterior layer  1024  is preferably being made from a flexible material, such as a fabric, that is sized and configured to surround the assembly  1000  and further includes an exterior adhesive that permits flexible attachment over the teeth and gums  1004  of the patient. An electrical lead  1030  extends from a stimulation device such as a potentiostat  404 ,  FIG.  2 ( b ) , and attaches through the back of the exterior layer  1024 . The conductive mesh layer  1020  behind the conductive anodic (preferably carbon) layer  1016  spreads the point of contact over a considerably larger area, wherein the mesh layer  1020  is preferably made from copper or platinum. The carbon film layer  1016  behind the buffered hydrogel layer  1012  acts as the conductive electrode surface for the reaction. Layer  1016  can alternatively be made from platinum, or other suitable metal that is chemically stable under anodic reactions. Additional details relating to this assembly are described in copending U.S. Pat. Application Serial No. 62/984,332, the entire contents of which are incorporated by reference. 
     In a preferred embodiment, the flexible connective body  1006  of the apparatus  1000  interfaces with the gums on both the inner and outer sides of the jaw around the implant, though in a less preferred embodiment there may exist only one electrode on only one side of the implant. Preferably, the electrode  1008  of the herein described apparatus  1000  is sufficiently flexible and may wrap over the teeth to adhere to both sides of the gum, or alternatively exist as two (2) separate electrodes that adhere to both sides of the gum, but are electrically connected to one another. Having the flexible electrode  1008  on both sides of the gums creates a more evenly distributed treatment on the dental implant itself. The electrode  1008  may incorporate flexible segments that contour more effectively to the jaw. The anodic reaction will build up an acidic pH within the hydrogel, and thus the starting pH of the hydrogel will be neutral or basic, preferably with a pH between 6 and 11. Preferably, the surface area of the electrode  1008  should be at least the same as the surface area of the dental implant to promote a more optimized treatment. This embodiment is directed to the counter electrode of a CVCES treatment system, such as treatment system  500 ,  FIG.  2 ( b ) , but may also contain the reference electrode, herein shown as  1011  that can be incorporated into the flexible connective body  1006 . The reference electrode  1011  may alternatively be provided as a separate electrode adhered to the gums, as opposed to being built into the herein described counter electrode while maintaining electrical isolation between the carbon and the Ag/Ag/Cl metal surfaces of the counter and reference electrodes, respectively. 
     The foregoing described an apparatus used in connection with a CVCES or other suitable treatment system, such as treatment systems  400 ,  500 ,  600 ,  FIGS.  2 ( a ) -  2 ( c ) , with the counter electrode being disposed within the mouth of the patient proximate the dental implant. As noted above, the counter electrode of the treatment system can alternatively be disposed external to the mouth of a patient. As shown in  FIGS.  7  and  8   , an external electrolytic system  1200  is represented, the system  1200  including a metal counter electrode surface  1220  supported within a container  1240  or cartridge that is external to the mouth of the patient. The container  1240  is shaped and configured to retain a suitable quantity of a conductive fluid  1242 , such as a salt solution, for enabling electrochemical current transport to the gum interface. In a preferred embodiment, the salt solution would be composed of sodium chloride and water; however, the salt solution may contain any suitable electrolytic salt compound that can be safely maintained within the oral cavity. According to one version, the container  1240  retains approximately 100 mL of conductive fluid. In other embodiments, for example, the container  1240  can be configured and sized to retain between 20 mL and 10 liters of conductive fluid, though it will be apparent that the amount of a retained conductive fluid  1242  can be easily varied. 
     According to this embodiment and in order to create an electrolytic bridge, the conductive fluid  1242  exits the container  1240  through a lid  1248  via a hollow tube  1250  having one proximal end extending through the lid  1248  and into the interior of the container  1240 . The electrode  1220  according to this embodiment is defined by a carbon sheet or a platinum mesh that is fully or substantially immersed within the conductive fluid  1242  retained in the container  1240 . The conductive fluid  1242  according to this embodiment can possess any pH and can be mildly acidic (pH of about 5.0), but preferably is neutral to basic and even more preferably is basic in pH in order to counteract the acid generation during treatment. 
     According to this embodiment, at least one cotton roll  1254  is disposed at a distal end  1249  of the hollow tube  1250 . The at least one cotton roll  1254  can preferably be made from traditionally used dental cotton that often lines the gums for dental procedures. Alternatively, the roll  1254  can be made from synthetic cotton or other similar material. In a preferred embodiment, the distal end  1249  of the tube  1250  inserts into an end of the cotton roll  1254 , as opposed to the cotton roll  1254  being inserted into the opening of the hollow tube  1250 . A single cotton roll  1254  is shown for illustrative purposes, but it will be understood that one or more cotton rolls can be used. According to a preferred embodiment, the tube  1250  can be bifurcated with tube portions being separately attached to two cotton rolls that are disposed within the oral cavity of a patient. 
     The conductive fluid  1242  can be caused to flow from the container  1240  to the cotton roll(s)  1254  via the hollow tube  1250  by various means. For example, the container  1240  can be made from a flexible material that can be squeezed. According to another version, the container  1240  can be pressurized during its manufacture and provided with a seal (not shown) that can be broken by the dentist or physician/caregiver prior to use. In another version, the container  1240  can be provided with a one-way valve  1262 ,  FIG.  8   , permitting the user to push air into the container  1240  in order to displace conductive fluid  1242  through the attached tube  1250  to the cotton roll(s)  1254 . According to yet another version, the container  1240  can be suspended or hung above the head of the patient wherein gravity can be used in order to feed the conductive fluid  1242  to the cotton roll(s)  1254 . The foregoing are merely examples, as it will be readily understood that other suitable means configured for moving conductive fluid  1242  from the container  1240  to the cotton roll(s)  1254  can be employed. 
       FIG.  7    schematically depicts the flow of current through the external electrolytic system  1200 . Lines  1264  represent current flow that transports electrically from the external voltage supply, such as potentiostat  404 ,  FIG.  5 ( b )  of a treatment system, to the metal electrode surface  1222  (counter electrode) disposed in the fluid container  1240  via a connector, shown diagrammatically as  1260 . The current then is converted to electrochemical current through faradaic and non-faradaic reactions and enters the conductive fluid  1242 , shown as arrows  1276 . The current can then shuttle via the electrolyte through the hollow tube  1250 , into the at least one saturated cotton roll(s)  1254 , and into the gum interface as shown by arrows  1278 . The cotton roll(s)  1254  are retained at the gum interface of a patient, as shown in  FIGS.  9 ( a ) -  9 ( c )  using an connective body disposed within the oral cavity of a patient in order to permit the conductive fluid  1242  to be directed to the gum interface. An example of a suitable connective body is described in U.S. Pat. No. 5,203,699, herein incorporated by reference in its entirety. The connective body according to the above patent is described for removing saliva from a patient in a dental procedure wherein the present apparatus is configured to support one and preferably two (or more) cotton rolls in a frame that is configured to positively engage and receive the conductive fluid (and current) to the gum interface for purposes of implant treatment. 
     As noted, it is preferable that a three-electrode treatment system or configuration such as shown in  FIG.  2 ( b )  be utilized. Regarding the herein described external electrolytic system embodiment, it is highly preferred that a stable reference electrode  1270  such as Ag/Ag-Cl stays internal to the mouth to be as close to the working electrode (e.g., the dental implant) as possible. High resistance between the working electrode and the reference electrode  1270  can cause marked drops in treatment current. Therefore, the reference electrode  1270  can be disposed as a typical adhesive hydrogel electrode to the gum line or alternatively be incorporated into the body of the cotton roll  1254  as shown schematically in  FIGS.  7  and  8   . In each of the foregoing arrangements, the reference electrode  1270  is separately coupled via lead  1268  to the external voltage supplying device (potentiostat  404 ,  FIG.  2 ( b ) ) of the treatment system  500 ,  FIG.  2 ( b )  through the connector  1260 . 
     The fluidic configuration of the external system  1200  is shown in  FIG.  8   . An electrode applicator is configured to retain cotton roll(s)  1254  on opposing sides of a frame (not shown) and receive conductive fluid  1242  from the container  1240 , saturating the cotton roll(s)  1254  and creating an electrolytic bridge with the gums of the patient and forming an electrochemical cell with the working electrode (metal dental implant). Once an amount of conductive fluid  1242  is moved from the container  1240  and saturates the at least one cotton roll  1254 , the cotton roll(s)  1254  is mechanically stabilized to the gum interface of the patient in a manner similar to that described with regard to the internally disposed electrode  1008 , previously shown in  FIGS.  6 ( a ) and  6 ( b ) , including both the inner and outer sides of the gum. The continuous electrolyte bridge created and extending from the dental implant, through the gums, the at least one cotton roll(s)  1254 , the conductive fluid  1242 , and the metal surface  1222  enables this external electrolytic system  1200 . As such, the herein disclosed embodiment is configured to supply the cotton roll(s)  1254  with a fluid in order to promote a conductive pathway to the metallic dental implant. 
     A main advantage of the foregoing external electrolytic system  1200 , as compared to the version of  FIGS.  6 ( a ) and  6 ( b ) , is that acid build-up from the anodic reaction on the counter electrode can be mitigated to a much higher degree with an external metal surface  1220 . The externally disposed metal surface  1220  can be provided with a much higher surface area than an internally disposed counter electrode because there is no size restriction, such as found in the mouth of the patient. The external metal surface  1220  may exist as a planar sheet, a conductive mesh, or alternatively as folded sheets in order to increase the surface area. With an increase in surface area, fewer faradaic chemical reactions are needed to take place to support the reaction at the working electrode and thus acid build-up is reduced. Also, the container  1240  of conductive fluid  1242  provides a much larger volume of electrolyte for the acid to diffuse into, and thus concentrations of acid per volume can be reduced. As noted, the conductive fluid  1242  also preferably exists as a neutral to basic pH to assist in neutralizing any acid build-up. However, one disadvantage of the described external system  1200  is that there now exists more electrochemical resistance between the electrodes due to distance and volume of fluid between the electrodes. This increase in resistance may cause losses in current and thus therapy strength to the biofilm layer of the implant(s) being treated. This challenge can be overcome by increasing the conductivity of the conductive fluid  1242 , optimizing the overall distance of the hollow tube  1250  (thus reducing volume of fluid), maximizing the surface area size of the counter electrode sheet or mesh  1220 , and ensuring that the electronics of the external power supply of the stimulation device of the treatment system, such as system  500 ,  FIG.  2 ( b ) , contains suitable voltage limitations, such that the voltages required by the treatment reaction can be accommodated by the external power supply (potentiostat  404 ,  FIG.  2 ( b ) ). 
     
       
         
           
               
               
             
               
                 PARTS LIST FOR  FIG.  1  -  9 ( c ) 
 
               
             
            
               
                 
                   200 
                 
                 dental implant 
               
               
                 
                   208 
                 
                 abutment 
               
               
                 
                   210 
                 
                 post 
               
               
                 
                   220 
                 
                 crown 
               
               
                 
                   224 
                 
                 hollow cavity, crown 
               
               
                 
                   230 
                 
                 metallic core 
               
               
                 
                   234 
                 
                 exposed surface area 
               
               
                 
                   240 
                 
                 jawbone/gums 
               
               
                 
                   400 
                 
                 treatment system 
               
               
                 
                   404 
                 
                 potentiostat 
               
               
                 
                   408 
                 
                 electrical lead 
               
               
                 
                   412 
                 
                 electrical lead 
               
               
                 
                   420 
                 
                 counter electrode 
               
               
                 
                   500 
                 
                 treatment system 
               
               
                 
                   508 
                 
                 electrical lead 
               
               
                 
                   512 
                 
                 electrical lead 
               
               
                 
                   516 
                 
                 electrical lead 
               
               
                 
                   520 
                 
                 working electrode 
               
               
                 
                   524 
                 
                 reference electrode 
               
               
                 
                   600 
                 
                 treatment system 
               
               
                 
                   608 
                 
                 electrical lead 
               
               
                 
                   612 
                 
                 electrical lead 
               
               
                 
                   616 
                 
                 electrical lead 
               
               
                 
                   620 
                 
                 working electrode 
               
               
                 
                   624 
                 
                 reference electrode 
               
               
                 
                   632 
                 
                 sense electrode 
               
               
                 
                   700 
                 
                 apparatus 
               
               
                 
                   720 
                 
                 custom mouth guard 
               
               
                 
                   721 
                 
                 outer side or surface 
               
               
                 
                   723 
                 
                 inner side or surface 
               
               
                 
                   728 
                 
                 front or outer circumferential section 
               
               
                 
                   732 
                 
                 rear or inner circumferential section 
               
               
                 
                   736 
                 
                 circumferential recess 
               
               
                 
                   740 
                 
                 electrical lead 
               
               
                 
                   744 
                 
                 grounding plate 
               
               
                 
                   748 
                 
                 imbedded wire 
               
               
                 
                   752 
                 
                 contact 
               
               
                 
                   756 
                 
                 conductive sponge 
               
               
                 
                   760 
                 
                 steel wool 
               
               
                 
                   800 
                 
                 apparatus 
               
               
                 
                   820 
                 
                 working mouth guard 
               
               
                 
                   821 
                 
                 outer facing side or surface 
               
               
                 
                   823 
                 
                 inner surface 
               
               
                 
                   826 
                 
                 front or outer circumferential section 
               
               
                 
                   830 
                 
                 rear or inner circumferential section 
               
               
                 
                   834 
                 
                 recess 
               
               
                 
                   840 
                 
                 electrical lead 
               
               
                 
                   844 
                 
                 grounding plate 
               
               
                 
                   848 
                 
                 imbedded wire 
               
               
                 
                   850 
                 
                 releasably attachable contact 
               
               
                 
                   854 
                 
                 base portion, contact 
               
               
                 
                   858 
                 
                 spacing, contact 
               
               
                 
                   860 
                 
                 leg portion, contact 
               
               
                 
                   864 
                 
                 leg portion, contact 
               
               
                 
                   900 
                 
                 apparatus 
               
               
                 
                   904 
                 
                 jaw line/ gums (patient) 
               
               
                 
                   920 
                 
                 torsional clip 
               
               
                 
                   924 
                 
                 half section, clip 
               
               
                 
                   928 
                 
                 half section, clip 
               
               
                 
                   932 
                 
                 leg portion 
               
               
                 
                   936 
                 
                 leg portion 
               
               
                 
                   940 
                 
                 arm portion 
               
               
                 
                   944 
                 
                 arm portion 
               
               
                 
                   950 
                 
                 torsional spring 
               
               
                 
                   964 
                 
                 spacing 
               
               
                 
                   968 
                 
                 contact, metal 
               
               
                   968 A 
                 cantilevered piece of metal 
               
               
                   968 B 
                 spring-loaded pin 
               
               
                   968 C 
                 half-circular clip 
               
               
                 
                   972 
                 
                 pad 
               
               
                 
                   976 
                 
                 electrical lead 
               
               
                 
                   1000 
                 
                 apparatus 
               
               
                 
                   1006 
                 
                 connective body 
               
               
                 
                   1008 
                 
                 electrode 
               
               
                 
                   1012 
                 
                 buffered hydrogel layer 
               
               
                 
                   1016 
                 
                 conductive layer 
               
               
                 
                   1020 
                 
                 conductive mesh layer 
               
               
                 
                   1024 
                 
                 exterior layer 
               
               
                 
                   1030 
                 
                 electrical lead 
               
               
                 
                   1200 
                 
                 external electrolytic system 
               
               
                 
                   1220 
                 
                 metal electrode surface 
               
               
                 
                   1240 
                 
                 container 
               
               
                 
                   1242 
                 
                 conductive fluid 
               
               
                 
                   1248 
                 
                 lid, container 
               
               
                 
                   1249 
                 
                 distal end, tube 
               
               
                 
                   1250 
                 
                 tube 
               
               
                 
                   1254 
                 
                 cotton roll(s) 
               
               
                 
                   1260 
                 
                 connector 
               
               
                 
                   1262 
                 
                 one way valve 
               
               
                 
                   1264 
                 
                 line 
               
               
                 
                   1268 
                 
                 line 
               
               
                 
                   1270 
                 
                 reference electrode 
               
               
                 
                   1276 
                 
                 arrows 
               
               
                 
                   1278 
                 
                 arrows 
               
               
                 
                   1280 
                 
                 arrows 
               
            
           
         
       
     
     The preceding embodiments are examples and it will be understood to the reader that a number modifications and variations can be made in accordance with the present invention including the following claims. For example and though the embodiments have been described for use with specific electrodes, the various apparatus could be used in conjunction with other electrodes. For example, the internal mouth disposed counter electrode could also be optimal to use in conjunction with the torsional clip working electrode contacting mechanism.