Titanium release in peri‐implantitis

Abstract

Since the discovery of osseointegration in the 1960s by Per-Ingvar Brånemark, 1 dental titanium (Ti) implants have been widely used as a standard treatment for edentulism. An estimated 5 million implants are placed annually in the United States, and a total of 15-20 million implants are placed worldwide. 2,3 Long-term follow-up studies show that implant usage to replace missing or lost teeth is a safe and predictable treatment with an overall 5-year survival rate of 98.1% for the implants and 97.1% for the prosthetics. 4 However, researchers and dentists are concerned about the rising number of published reports on inflammatory problems and bone loss around dental implants, so-called peri-implantitis. 5-8 A wide range of estimates of peri-implantitis prevalence has been reported in different studies, that is 6.2%-28% at the implant level. 9-15 Peri-implantitis is a multifactorial disease, and ongoing research is trying to identify the cause Summary Objectives: The aim of this study was to investigate the titanium (Ti) content of biopsies from patients with severe peri-implantitis or controls without Ti exposure.Background: Peri-implantitis is considered to be an infectious disease, but recent studies have shown that Ti can aggravate inflammation in combination with bacterial products. The Ti content of peri-implantitis and periodontitis (controls) tissue is unknown.Methods: Thirteen patients referred for peri-implantitis and eleven for periodontitis treatment were included in the study. Disease severity was obtained from dental records. Biopsies were taken from both groups and chemically analysed with inductively coupled plasma mass spectrometry for Ti content. Additionally, two patients with peri-implantitis and two with periodontitis were recruited and their biopsies were analysed microscopically with light microscopy, transmission electron microscopy and scanning electron microscopy with element analysis to investigate the presence of particulate Ti.Results: All patients lost one or more implants despite undergoing peri-implant or treatment. Peri-implantitis tissue contained significantly higher concentrations of Ti than control samples with a mean ± SD of 98.7 ± 85.6 and 1.2 ± 0.9 μg/g, respectively. Particulate metal was identified in peri-implantitis and control biopsies, but element analyses could confirm only the presence of Ti in peri-implantitis tissue. Conclusion:We showed that high contents of particulate and submicron Ti were present in peri-implantitis tissue. These high Ti contents in peri-implant mucosa can potentially aggravate inflammation, which might reduce the prognosis of treatment interventions. K E Y W O R D Senergy dispersive X-ray spectroscopy, inductively coupled plasma mass spectrometry, light microscopy, peri-implantitis, scanning electron microscopy, titaniumCheng Choo Lee at Umeå Core Facility Electron Microscopy, Umeå University, Sweden, for their help with the transmission and SEM.

Bone loss around oral and orthopedic implants: An immunologically based condition

“…In a similar manner, bleeding on probing may only reflect low-grade chronic inflammation and/or release of titanium particles around oral implants instead of being indicative of particular forms of disease. Released titanium particles may act as additional foreign bodies initiating the release of inflammatory mediators associated with bone resorption [70][71][72][73][74][75][76][77][78] as already described in the case of orthopedic implants. 79 Evaluated sites presented a higher number of titanium particles compared to healthy implants.…”

Is Peri-Implant Probing Causing Over-Diagnosis and Over-Treatment of Dental Implants?

“…In vivo, titanium particles have been found in soft and hard tissue biopsies retrieved from sites with peri-implantitis [74,75]. Peri-implantitis tissues have been shown to contain high concentrations of Ti compared to controls from periodontitis tissues, leading to the conclusion that the high Ti content in peri-implant mucosa has the potential to aggravate inflammation [76]. Furthermore, greater levels of dissolved titanium have been detected in submucosal plaque around implants with peri-implantitis compared with healthy implants, indicating an association between titanium dissolution and peri-implantitis [77].…”

Salivary Levels of Titanium, Nickel, Vanadium, and Arsenic in Patients Treated with Dental Implants: A Case-Control Study

“…Based on their results, there was no clear evidence to support the use of salivary biomarkers (IL-6, IL-1β) in peri-implantitis detection. Pettersson et al [45] performed gingival biopsies during surgical treatment of patients with severe periodontitis or peri-implantitis in order to evaluate titanium levels via ICP-MS. They found higher titanium values in peri-implantitis patients (p < 0.001) compared to periodontitis subjects, however samples were obtained after surgical treatment of dental implants and titanium release may be, therefore, exacerbated by ultrasonic scaling, as previously demonstrated by Eger et al [46].…”