Scaling of titanium implants entrains inflammation-induced osteolysis

Abstract

With millions of new dental and orthopedic implants inserted annually, periprosthetic osteolysis becomes a major concern. In dentistry, peri-implantitis management includes cleaning using ultrasonic scaling. We examined whether ultrasonic scaling releases titanium particles and induces inflammation and osteolysis. Titanium discs with machined, sandblasted/acid-etched and sandblasted surfaces were subjected to ultrasonic scaling and we physically and chemically characterized the released particles. These particles induced a severe inflammatory response in macrophages and stimulated osteoclastogenesis. The number of released particles and their chemical composition and nanotopography had a significant effect on the inflammatory response. Sandblasted surfaces released the highest number of particles with the greatest nanoroughness properties. Particles from sandblasted/acid-etched discs induced a milder inflammatory response than those from sandblasted discs but a stronger inflammatory response than those from machined discs. Titanium particles were then embedded in fibrin membranes placed on mouse calvariae for 5 weeks. Using micro-CT, we observed that particles from sandblasted discs induced more osteolysis than those from sandblasted/acid-etched discs. In summary, ultrasonic scaling of titanium implants releases particles in a surface type-dependent manner and may aggravate peri-implantitis. Future studies should assess whether surface roughening affects the extent of released wear particles and aseptic loosening of orthopedic implants.

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.…”

Treatment of peri‐implant mucositis with a chitosan brush—A pilot randomized clinical trial

“…7,8 Leftover titanium fragments released from dental implants after the use of an ultrasonic instrument have been shown to introduce foreign bodies to the peri-implant space, which may aggravate the situation. 9 To easily access affected areas when treating dental implants, both overly contoured and rigid devices do not provide the simple access offered by a brush with a flexible shaft. The natural polysaccharide chitosan (poly-N-acetyl glycosaminoglycan) was chosen because it is a nontoxic and bioabsorbable substance that exhibits bacteriostatic and anti-inflammatory properties.…”

Effect of cobalt ions on the interaction between macrophages and titanium

“…These findings have been confirmed by Wachi et al who also found that Ti ions induced monocyte infiltration and osteoclast differentiation in the epithelium 37. Recruited macrophages will phagocytize nanoparticles of Ti‐protein aggregates into the phagolysosomes and try to degrade them 38, 39. High Ti content in the phagocytosed particles will protect them from proteolysis and result in intracellular disruption of the lysosome membrane.…”

“…37 Recruited macrophages will phagocytize nanoparticles of Tiprotein aggregates into the phagolysosomes and try to degrade them. 38,39 High Ti content in the phagocytosed particles will protect them from proteolysis and result in intracellular disruption of the lysosome membrane. This will induce the assembly of the inflammasome complex, which will activate and release pro-inflammatory cytokines.…”