Titanium Wear of Dental Implants from Placement, under Loading and Maintenance Protocols

Abstract

The objective of this review was to analyze the process of wear of implants leading to the shedding of titanium particles into the peri-implant hard and soft tissues. Titanium is considered highly biocompatible with low corrosion and toxicity, but recent studies indicate that this understanding may be misleading as the properties of the material change drastically when titanium nanoparticles (NPs) are shed from implant surfaces. These NPs are immunogenic and are associated with a macrophage-mediated inflammatory response by the host. The literature discussed in this review indicates that titanium NPs may be shed from implant surfaces at the time of implant placement, under loading conditions, and during implant maintenance procedures. We also discuss the significance of the micro-gap at the implant-abutment interface and the effect of size of the titanium particles on their toxicology. These findings are significant as the titanium particles can have adverse effects on local soft and hard tissues surrounding implants, implant health and prognosis, and even the health of systemic tissues and organs.

Spectrometric Analysis of the Wear from Metallic and Ceramic Dental Implants following Insertion: An In Vitro Study

“…Titanium is considered highly biocompatible with low toxicity, but there is growing concern about titanium particles liberated from dental implant surfaces, which become shed in the bone and peri-implant tissues [ 7 , 8 ]. Similarly, other materials, such as zirconium and zirconia alloys, have presented with similar surface modifications when utilized in implant dentistry [ 9 ]. A more critical review of current research reveals that there are many stages during an implant’s life, during which titanium particles may be shed from the surface into the surrounding local structures.…”

Effect of Implant Surface Roughness and Macro- and Micro-Structural Composition on Wear and Metal Particles Released

“…Titanium and its alloy are the most commonly used materials due to their biocompatibility, mechanical characteristics and chemical stability [2]. However, many studies do not focus on the properties of dental implant materials when they are broken down to smaller particle [3][4][5]. As a consequence of implant placement, microfractures and compression can occur at the bone side and the implant surface can be simultaneously subjected to a combination of torsional and frictional forces, which may alter the original implant surface.…”

“…As a consequence of implant placement, microfractures and compression can occur at the bone side and the implant surface can be simultaneously subjected to a combination of torsional and frictional forces, which may alter the original implant surface. [5,6]. Stress concentration on the implant surface can destroy the titanium oxide layer on the implant and wares the cover favoring the release of titanium particles in the surrounding tissues [7].…”

“…These particles, in fact, have been proved to inhibit the differentiation of osteoblast precursor cells and promote the bone resorption function of the osteoclast by inducing the differentiation of osteoclast [7]. They may also be transported away from the bone-implant interface causing inflammation in distant tissues, with potential systemic involvement [5]. Pathological alterations of the peri-implant tissue could also be caused by factor other than the implant material itself.…”

Treatment of peri-implantits

“…Hence these triggers might be another important factor that might partially explain the limited clinical effect found in the studies presented in chapter 3, 4 & 5. Recent reviews on titanium particle release, underline that titanium particles in peri-implant tissues are a common finding and that peri-implantitis sites revealed a higher number of particles compared to healthy conditions (Delgado-Ruiz R. & Romanos G. 2018, Noronha Oliveira et al 2018, Suárez-López Del Amo et al 2019, Romanos et al 2021). In addition, titanium dissolution products have been shown to act as a modifier in the peri-implant microbiome structure and diversity (Daubert et al, 2018).…”