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.

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.”

Cosmetic Dentistry, Confidence-ially

Does confidence sell? The cosmetic dentistry industry seems to think so. A quick Google search shows that building confidence is usually one of the top ten reasons to whiten your teeth.

Be confident on your wedding day with whiter teeth!
Have an interview coming up? Whiten your teeth!
Boost your confidence and self-esteem!
More smiling, more confidence, more success!

You get the drift.

smiling womanCosmetic dentistry ranges from teeth whitening to dental implants after an accident, but the message remains similar: If you want better self-esteem, correct your teeth.

Of course, there are plenty of benefits of having a good smile — from health benefits to better employment/promotion prospects to attractiveness. But is a pretty smile enough to make you completely and totally, 100% happy?

According to a recent study in the British Dental Journal, not really.

The researchers looked at the influence of “personality and pre-treatment contentment” on post-treatment satisfaction. So they assessed patients’ personalities, as well as how patients felt about their faces and bodies both before and after having cosmetic work done. And what did they find?

Although all participants were more satisfied post-treatment with the body overall and their face in particular, those scoring highly on neuroticism were generally unhappier both before and after treatment.

In other words, all were happier about their appearance, but some were happier than others. It largely depended on how content they were before treatment.

In this respect, cosmetic dentistry is like other kinds of physical self-improvement, such as getting a new hairstyle or losing weight. It’s no panacea. Some get a confidence boost, some don’t. Struggles with anxiety, depression, obsession and other troubles can cast a pall.

The degree of “internal improvement” – feeling better about yourself – depends, as ever, on the individual.

Don’t get us wrong: A beautiful smile can help. And we love to provide them – and to do so in a healthy, holistic way that considers your wellness as a whole.

But as for self-confidence, fortunately, it is a less a state of mind than a skill that can be learned. This wonderful TED Talk includes some great tips and tricks you can put to work today:

Image by Caden Crawford

The Dental Implant Option

As anyone who’s missing a tooth can tell you, there isn’t much to love about a hole in your smile. Aside from affecting how you talk and eat, it’s not considered especially attractive. And it leaves your mouth more vulnerable to infection, disease and even more missing teeth down the road.

But how to replace that missing tooth?

dental implant illustrationThese days, growing numbers of people are turning to implants. Unlike bridges, which require removing structure from the neighboring teeth that will anchor it, implants can actually strengthen adjacent teeth, as well as protect and preserve jaw bone. Considered more stable, lifelike and functional than bridges or dentures, implants are comfortable for chewing, provide plenty of room for the tongue, and are far more aesthetically appealing.

Of course, one concern – especially when tooth loss is due to gum disease – is always the health of the tissue into which an implant is to be placed. Yet new research suggests that with proper disinfection and support, even implants placed in less than ideal tissue may succeed.

The study, published last month in the Journal of Dentistry, found that dental implants may be successfully placed in an infected socket immediately after an extraction of an infected tooth, provided proper pre-treatment and a combination of techniques are applied during the procedure.

During the course of the three-year study, 36 teeth (10 incisors, 10 canines, and 16 premolars) were extracted and 36 titanium implants (Mis Ibérica) were placed after extraction, half of which were at infected sites, the test group. Implants in the control group, or at healthy sites, were placed at the same time as those in the test group.

For the test group, the researchers combined conventional techniques: pre-op antibiotics; debridation and curettage, guided bone regeneration, 90% hydrogen peroxide and clinical laser during the procedure; and post-op disinfectant rinses. The authors claimed a 100% success rate.

Of course, it must be noted that a study published last fall in the Journal of Dental Research found a strong tendency toward inflated success rates for implants. Its authors warned against promoting anything higher than a 95% survival rate.

Also notable – and more to our concern here – is that the Journal of Dentistry study used titanium implants. Metal implants can corrode over time, degrading the health of the bone, and allowing bacteria to get into the root, causing infection, abscess and maybe even loss of the implant. As these metals deteriorate, they make their way into the bloodstream and contribute to the toxic load on the entire body, causing immunological problems such as allergies, weakness to infections, depression and hair loss.

And then there’s the matter of galvanism – an an electric charge caused when dissimilar metals in the mouth (mercury in amalgams, say, along with titanium in the implant) react with electrolytes in the saliva. Galvanism can cause a multitude of symptoms such as migraines, memory loss, and chronic fatigue.

Fortunately, there are metal-free, biocompatible options available, such as the zirconium implants that holistic practices like ours are turning to. Zirconium is an inert, ceramic material that’s highly durable and hypoallergenic. Used in aerospace technology for its durability under pressure and high heat, zirconium is highly biocompatible and has been shown to osseointegrate with the jawbone more effectively than titanium alloy. It’s also naturally white in color, blending well with the gumline, heightening the natural look.

 before & after dental implant 

Ideally, you keep your natural teeth for the whole of your life. It’s certainly not impossible, and your natural teeth are the best ones you’ll ever have. But if you should ever lose one, it’s good to know you’ve got healthy and attractive options available to help you keep your smile whole.

Illustration via AXIS biodental