Potential Causes of Titanium Particle and Ion Release in Implant Dentistry: A Systematic Review

Abstract

Implant surface characteristics, as well as physical and mechanical properties, are responsible for the positive interaction between the dental implant, the bone and the surrounding soft tissues. Unfortunately, the dental implant surface does not remain unaltered and changes over time during the life of the implant. If changes occur at the implant surface, mucositis and peri-implantitis processes could be initiated; implant osseointegration might be disrupted and bone resorption phenomena (osteolysis) may lead to implant loss. This systematic review compiled the information related to the potential sources of titanium particle and ions in implant dentistry. Research questions were structured in the Population, Intervention, Comparison, Outcome (PICO) framework. PICO questionnaires were developed and an exhaustive search was performed for all the relevant studies published between 1980 and 2018 involving titanium particles and ions related to implant dentistry procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the selection and inclusion of the manuscripts in this review. Titanium particle and ions are released during the implant bed preparation, during the implant insertion and during the implant decontamination. In addition, the implant surfaces and restorations are exposed to the saliva, bacteria and chemicals that can potentially dissolve the titanium oxide layer and, therefore, corrosion cycles can be initiated. Mechanical factors, the micro-gap and fluorides can also influence the proportion of metal particles and ions released from implants and restorations.

Biological Reactions to Metal Particles and Ions in the Synovial Layer of Mice

“…Subsequently, recruited macrophages phagocytize some small CoCrMo particles, while foreign body multinucleated giant cells surround very large particles [44]. Inside the cells, the particles are exposed to oxidative attacks, and consequently, high levels of ions might be released during the chemical corrosion processes [45]. Therefore, CoCrMo particles not only have a destructive effect because of their physical properties-the corrosion process and the presence of metal ions can also cause some biological reactions in the surrounding tissues [46].…”

Progression of Bio-Tribocorrosion in Implant Dentistry

“…Recent systematic reviews have confirmed the negative effect of implants degradation products on biological systems (Delgado-Ruiz and Romanos, 2018;Suárez-López Del Amo et al, 2018). In fact, weakened surfaces due to the bio-tribocorrosion process may release metallic wear debris produced by the implant material degradation (Souza et al, 2015).…”

“…FIGURE 2 | Gray bars indicate the number of literature reviews published articles with significant discussion of tribocorrosion for restorative dentistry application. The literature reviews reference of each subtopic division are listed as follows: (1) Toh et al, 2018); (2) (Mathew et al, 2014a;Dundon et al, 2017;Espallargas et al, 2017;Villanueva et al, 2017;Cao and Mischler, 2018;López-Ortega et al, 2018;Mombelli et al, 2018; (3) Stack, 2005;Wood, 2007;Wang et al, 2015;Manoj et al, 2019;and, (4) Mathew et al, 2009;Souza et al, 2015;Apaza-Bedoya et al, 2017;Balla and Das, 2017;Revathi et al, 2017;Delgado-Ruiz and Romanos, 2018;Noronha Oliveira et al, 2018). Blue bars indicate the number of tribocorrosion published articles of dental implants and frameworks materials in experimental conditions.…”

“…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.…”

Diverse Responses of Neurons and Monocytes to Titanium Dioxide Nanoparticle Exposure

“…They may contribute to the disruption of epithelial barriers, induce oxidative stress and may have cytotoxic and genotoxic potential for tissues. [65][66][67][68] In fact, NAC, as a precursor of GSH, is used as an adjunct to standard therapy for the treatment of chronic obstructive pulmonary disease via improving the neurogenic inflammatory response, a deleterious condition that may support the vicious circle between oxidative stress and inflammation. [69,70] In this study, NAC has been shown to provide a significant protection against titanium toxicity.…”