What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review

Abstract

Objectives To compile the current evidence regarding the association between the release of titanium particles and biologic complications of dental implants. Material and methods This is a critical review. We searched the literature using the terms “corrosion,” “allergy,” “hypersensitivity,” or “particles” together with “titanium,” “Ti,” “TiO2.” The bibliographies of identified publications and previously published review articles were scanned to find additional related articles. We included clinical studies, in vivo and in vitro experiments. Results Titanium particles and degradation products of titanium have been detected in oral and nonoral tissues. Particles are released from surfaces of dental implants because of material degradation in a process called tribocorrosion. It involves mechanical wear and environmental factors, notably contact to chemical agents and interaction with substances produced by adherent biofilm and inflammatory cells. In vitro, titanium particles can interfere with cell function and promote inflammation. A temporal association between exposure to titanium and occurrence of tissue reactions suggested hypersensitivity in a limited number of cases. However, there is poor specificity as the observed reactions could be initiated by other factors associated with the placement of implants. Titanium particles are commonly detected in healthy and diseased peri‐implant mucosa alike, at low levels even in gingiva of individuals without titanium implants. Rather than being the trigger of disease, higher concentrations of titanium in peri‐implantitis lesions could be the consequence of the presence of biofilms and inflammation. Conclusion There is an association between biocorrosion, presence of titanium particles, and biological implant complications, but there is insufficient evidence to prove a unidirectional causal relationship.

Experimental implantoplasty outcomes correlate with fibroblast growth in vitro

“…There is limited scientific evidence to support an effect on the course of peri-implant diseases. Furthermore, the procedure leads to the release of titanium debris in vast quantities to the peri-implant tissues, which may have adverse biological effects [38]. For this reason, only the supracrestal parts of the implant exposed following bone loss due to peri-implantitis, or as a result of mucosal recessions should be carefully considered for implantoplasty therapy.…”

Two‐piece zirconia versus titanium implants after 80 months: Clinical outcomes from a prospective randomized pilot trial

“…Titanium particles have been reported to cause degenerative changes in peri-implant tissue where they are phagocytosed by macrophages and neutrophils activated as part of the biological response (Fage et al, 2016;Noronha Oliveira et al, 2018;Thomas et al, 2013). Although recent studies have demonstrated a potential of titanium particles to cause inflammatory reactions in peri-implant tissue, hard evidence for a causal relationship is yet to be provided (Fretwurst, Nelson, Tarnow, Wang, & Giannobile, 2018;Mombelli, Hashim, & Cionca, 2018). Whether zirconia implants may cause immunological reactions similar to titanium (Cionca, Hashim, Cancela, Giannopoulou, & Mombelli, 2016) or no such effects (Siddiqi, Duncan, De Silva, & Zafar, 2016) continues to be debated.…”

Titanium particles and ions favor dysbiosis in oral biofilms

“…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 …”

“…11 Bacterial accumulation around dental implants triggers inflammation and can lead to corrosion and release of Ti products on the surrounding tissues. 6 Although the effect of Ti products on human cells is widely recognized, their microbiological effect has only been tested in models using planktonic growth of few bacterial species. [14][15][16] The disadvantage of this type of methodology is not mimicking the complex structure/composition of the oral biofilm.…”