Dental implants‐associated release of titanium particles: A systematic review

Abstract

Objectives The presence of titanium (Ti) particles around dental implants has been reported in the literature for decades. The prospective presence of Ti debris on soft tissues surrounding dental implants has not been systematically investigated and remains to be explored. Hence, this review aimed to evaluate the origin, presence, characteristics, and location of Ti particles in relation to dental implants. Material and methods Literature searches were conducted by two reviewers independently based on the PRISMA guidelines. The systematic review identified studies on Ti particles derived from dental implants. We evaluated several parameters, including anatomical location, and the suspected methods of Ti particles release. Results The search resulted in 141 articles, of which 26 were eligible and included in the systematic review of the literature. The investigations reported Ti and metal‐like particles in the soft (i.e., epithelial cells, connective tissue, and inflammatory cells) and hard (bone crest and bone marrow) tissues around the dental implants. Shape and size of the particles varied. The current literature reported a size range from 100 nm to 54 µm identified by multiple particles identification methods. Conclusion Ti particles surrounding peri‐implant tissues are a common finding. Peri‐implantitis sites presented a higher number of particles compared to healthy implants. The particles were mostly around the implants and inside epithelial cells, connective tissue, macrophages, and bone. Various mechanisms were described as causes of Ti release, including friction during implant insertion, corrosion of the implant surface, friction at the implant–abutment interface, implantoplasty, and several methods used for implant surface detoxification.

Titanium particles and ions favor dysbiosis in oral biofilms

“…These findings corroborate the results of studies with planktonic cultures and showed a specie‐specific effect on bacteria growth in a dose‐dependent manner . Moreover, biofilm can lead to implant corrosion and even decontamination methods can affect products releasing; therefore, a synergistic effect is expected between Ti products concentration and biofilm virulence, since Ti products can increase bacteria levels and biofilm formation can enhance implant degradation.…”

“…Titanium (Ti) is the main dental implant material due to its excellent physical‐chemical properties and high biocompatibility with oral tissues . Nonetheless, once exposed to the oral environment, dental implants can be affected by mechanical and chemical degradation processes, such as surface corrosion and wear, which leads to the release and accumulation of Ti particles in the peri‐implant surrounding tissues . In contact with biological fluids, these particles can dissolve and generate Ti ions .…”

“…In contact with biological fluids, these particles can dissolve and generate Ti ions . Although Ti particles and ions may be found in healthy and diseased peri‐implant surrounding tissues, higher concentrations of these products have been found in peri‐implantitis sites . In addition, recent studies have suggested that both Ti particles and ions can influence the pathogenesis of peri‐implantitis …”

Progression of Bio-Tribocorrosion in Implant Dentistry

“…In this way, the tribolayer of Ti-based implants are commonly subjected to damages by tribocorrosion phenomena since the implantation and along the lifetime service (Trino et al, 2018). Firstly, material loss can occur during the implantation when friction forces are applied to implants exposed to body fluids (Suárez-López Del Amo et al, 2018). The insertion torque, loading, and implant replacement cause friction at the bone/implant interface which may be responsible for the release of metallic wear debris causing modifications to the surface and implants geometry (Franchi et al, 2004;Fretwurst et al, 2016).…”

“…These implant degradation products can trigger unfavorable biological responses such as increase in peri-implant infection and progressive bone loss . Consequently, such harmful effects influence the implant lifetime and increase the failure probability (Delgado-Ruiz and Romanos, 2018;Suárez-López Del Amo et al, 2018). For this reason, the study of the bio-tribocorrosion phenomenon has been considered a relevant topic of dental research.…”