Trouble with Titanium Dental Implants

corroded titanium dental implantWhen it comes to replacing teeth with dental implants, we opt for biocompatible ceramic instead of the usual titanium. Now new research offers even more support for this choice.

One of the biggest risks with implants is the potential for peri-implantitis. This condition is marked by inflammation and bone loss around a failing implant. It’s not something to be taken lightly. According to implant expert Dr. Stephen Jacobs, studies suggest that one-third of patients will be infected.

And according to a new study in the Journal of Periodontology, titanium may elevate the risk.

Researchers took plaque samples from 20 implants with peri-implantitis and 20 without, coming from 30 total patients. Then they looked for evidence of titanium. Why?

Increasing preclinical data suggest that peri-implantitis microbiota not only triggers an inflammatory immune response but also causes electrochemical alterations of the titanium surfaces, i.e., corrosion, that aggravate this inflammatory response.

That is, the bacteria causing the infection also corrode the titanium, and that makes the inflammation worse.

Thus, it was hypothesized that there is an association between dissolution of titanium from dental implants, which suggests corrosion, and peri-implantitis in humans.

And this is indeed what they found.

Greater levels of dissolved titanium were detected in submucosal plaque around implants with peri-implantitis compared with healthy implants, indicating an association between titanium dissolution and peri-implantitis.

Other studies have looked at other triggers for corrosion. According to research in the Dental Materials Journal, fluoride appears to have a significant impact on the dissolution of titanium.

Although titanium is well known for its superior corrosion resistance, it is not strongly resistant to corrosion caused by fluoride.

Hydrogen peroxide was also found to break down some titanium alloys. Peroxide is commonly used to bleach teeth and so appears in a good number of oral hygiene products and is often seen as an ingredient in natural DIY home care recipes.

Yet other research showed that ultrasonic scaling – deep cleaning – released titanium and thus increased inflammation. More, that inflammation triggered bone loss, which the study authors suggest ”is unlikely to be reversible.”

We’ll stick with ceramic.

For even more on corrosion, check out this excellent article by implant specialist Dr. Sammy Noumbissi.

Image via Dr. Noumbissi

A Look Back at…Biocompatibility & Dental Implants

Updated from the original post for August 4, 2016

Replace a Tooth by Mimicking Your Body’s Nature

Dr. Masoud Attar & Dr. Hamid Shafie

Dr. Attar with dental implant expert Dr. Hamid Shafie at a 2016 implant seminar in San Francisco

As we say on our home page, perfection is our passion – which is perhaps the biggest reason why Dr. Attar consistently pursues additional training and education. You can’t achieve perfection without being a perpetual student.

In fact, there’s a quote well-known in dental circles, by a fellow named G.V. Black, who’s considered the father of operative dentistry: “The professional man has no right other than to be a continuous student.”

Among the best learning opportunities Dr. Attar has had over the past year was a seminar in San Francisco that focused on replacing missing teeth with zirconia (ceramic) implants.

As a biological office, we constantly strive to use the most compatible materials for our patients. We know many of you have worked hard to eliminate metals from your mouth. We also believe when you’re looking for a way to replace your missing tooth, you shouldn’t have to compromise. While many offices place conventional metal alloy implants (usually titanium), we use only ceramic for the dental implants we place.

Here are 6 reasons why:

  1. Biocompatibility

    While any material placed in the body has the potential to react, zirconia appears to be very biocompatible for most patients. The firm bond that establishes itself between the bone and the ceramic implant is believed to be bio-inert. This means your body doesn’t react with an inflammatory response as it would with a foreign body.

    In contrast, research shows titanium-based implants both corrode and degrade, generating metallic debris. This debris may have harmful biological effects over time, including the development of renal hepatic injury and renal lesions.

    Additionally, an increasing number of individuals with titanium implants, dental or orthopedic, present with allergies, sensitivities and other skin and immune reactions that necessitate removing the implant from the body. These reactions happen over time with continued exposure to the metal. An allergy or reaction to a dental implant may cause pain, inflammation, infection, bone loss and implant removal. Material testing for implant materials should be considered, especially metals.

  2. Maintenance

    dental implant illustrationRegardless of the type of implant material you select, much attention should be giving to keeping the gum tissue around it clean. Like teeth, implants can fail if bacteria accumulate along the gum. To complicate the matter, tissue doesn’t attach to an implant in the same way it attaches to your natural teeth.

    But research indicates the lack of electric conductivity in ceramic implants makes it harder for bacteria to stick. This makes it easier to maintain healthy tissue with proper cleaning technique. And unlike a bridge, which can be hard to floss effectively, an implant, for all practical purposes, is like a tooth. You can, and should, floss like you do with your natural teeth.

  3. Meridian flow

    Because they’re biologically inert, zirconia implants may offer the best option for maintaining meridian flow from tooth to organ, and organ to tooth. This is especially important to those who employ the principles of acupuncture and pay particular attention to their body’s meridian flow and blockage.

    Not familiar with this concept? You can learn more about it here.

  4. Esthetics

    In contrast to titanium implants’ grey color, ceramic implants are white. This may not seem like a big deal because, let’s face it, they’re implanted in the gums. But in patients with gum tissue recession or thin gums, the grey cast of titanium can become visible. Ceramic implants, on the other hand, retain a natural look with no grey shadow or show through.

  5. Biomimicry in Design

    Ceramic implants have been optimally designed to mimic your natural tooth. Like your tooth, ceramic implants are a one-piece design. There’s no abutment connected with a fixation screw as you commonly see in titanium implant designs.

  6. Functionality

    When you’re looking at replacing a tooth, you want it to be successful. You don’t want to have to revisit this tooth again. To succeed, it must hold up with how you use your mouth, especially the forces of chewing. By creating the diameter and length to that of natural teeth, ceramic implants are foundationally tempered to withstand chewing force.

Any way you look at it – functionally, aesthetically, holistically – when opting for implants, ceramic is clearly the best option for mimicking your natural teeth.

Metal Dental Implants Can Cause Problems

titanium dental implantThough we use only biocompatible ceramic dental implants here in our office, most implants placed today continue to be titanium. But those metal implants can be a real breeding ground for harmful bacteria, as the video we shared with you last week showed. This may be one reason why dentists are seeing a rise in a condition known as peri-implantitis.

Like the gum disease that can lead to tooth loss, this persistent infection is an inflammatory condition which leads to a loss of supporting bone and often failure of the implant itself.

Ten years ago, professionals said the condition didn’t exist. But now it is on the rise, as increasing numbers of people have replacement porcelain crowns with titanium roots. Half-a-million adults have at least one dental implant, according to the latest Adult Dental Health Survey.

Studies have suggested that one third of patients will be infected. “We’re sitting on a time bomb,” says Dr Stephen Jacobs, a past president of the Association of Dental Implantology and well-respected implant surgeon. “We are going to be seeing more and more cases.”

And titanium may make the problem worse. As Dr. Alvin Danenberg noted recently in a column for Dr. Bicuspid,

A 2016 study from the Journal of Periodontology (November 18, 2016) reported that bacteria around dental implants could trigger inflammation. In addition, these bacteria also caused corrosion on the titanium implant surfaces. Corrosion dissolved the titanium surface and released titanium particles into the surrounding periodontal tissues. These particles aggravated the inflammatory response. These researchers also noted that fluoride ions from mouthwash, toothpaste, drinking water, and food could potentially cause corrosion on titanium implant surfaces.

titaniumYou can also wind up with metals in the general circulation. Earlier reports on other types of metal medical implants have suggested the kind of damage this can do. Dental research suggests that titanium “can induce toxicity” or allergic responses, particularly in patients who are already sensitive to other metals.

These reactions to titanium could be responsible for unexplained successive failure cases of dental implants in some patients….

Additionally, titanium implants are seldom if ever 100% titanium. One German study, for instance, found that nearly all samples tested contained some nickel, another toxic metal. Some implants may include a thin layer of aluminum over the titanium, ostensibly to help bone attach to the implant better. Aluminum is also toxic in the human body.

And it’s not just bacteria that can fuel metal implant corrosion. New research out of Israel shows that ultrasonic scaling – a common treatment for peri-implantitis – also releases titanium particles from the implants.This, in turn, “exponentially increase[s]” inflammation, and that, in turn, aggravates bone loss.

In short, a bad problem can be made worse by the attempt to address it.

And if you have metal implants now? Should you be worried? If you’re concerned, it would be a good idea to see a qualified biological dentist, who can clinically examine your implants and surrounding issue, as well as test for any physical or energetic burden they may be placing on your body. If there’s evidence of that, then replacement and supportive treatment may be an option that makes sense.

The first step, though, is always to evaluate. When dental conditions may be affecting your overall health and well-being, the last thing you want to do is rush to treatment and risk making things any worse.

Titanium image by RTC

Ceramic vs. Titanium Implants

What a difference a choice in dental materials can make…

For more on why we favor the metal-free option for replacing teeth, check out our previous post “Replace a Tooth by Mimicking Your Body’s Nature.”