Titan-based alloys: History
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Please note this is an old version of this entry, which may differ significantly from the current revision.
Subjects: Materials Science, Coatings & Films
Contributor:
Ioana Bunoiu
,
Mihai Andrei
,
Cristian Scheau
,
Claudiu Constantin Manole
,
Andrei Bogdan Stoian
,
Vladimir Sorin Ibric Cioranu
,
Andreea Cristiana Didilescu

Titan-based alloys are the most-utilized materials in dental implantology, due to their physical and chemical properties. The various components of the oral environment should be considered in order to obtain a good stability of dental reconstructions. Salivary ions, proteins, enzymes, and microorganisms of the oral biofilm, may interact with and influence the implant's corrosion process. Peri-implantitis is a multifactorial process which needs to be properly addressed in order to prevent secondary implant failure. 

  • titanium alloy
  • corrosion
  • peri-implantitis
  • oral environment
Since their introduction by Brånemark in the 1960s, oral implants have become an increasingly used option in dental practices for restoring dento-maxillary functions by replacing teeth that were lost through trauma or various pathological processes [1][2]. The clinical results [3] and prognosis [4] of implant therapy are influenced by the patient’s alveolar bone, regulated by local and systemic factors, but also by the physical and chemical properties of the implanted materials [5]. These properties include the implant microstructure and the composition and characteristics of its surfaces [6]. Thus, an ideal implant material should be biocompatible and resistant to corrosion, wear, and fractures [7][8]. With such requirements, Ti alloys are the most-used dental materials for implant works [9].
 
Titan-based alloys are the most utilized in dental implantology due to their stability in the human physiological environment, on account of the native amorphous oxide on their surface [14][15]. The oxide layer on the surface of the implant plays a crucial role in its stability, preventing the release of metal ions into the surrounding areas. As such, the layer of native oxides arising from the alloy’s elements prevents the dissemination of corrosion processes from the surface of the biomaterial [16][17]. Discontinuities in the oxide film may occur due to the actions of active oxygen species, proteins, cells, or organic ions [18].
 
To obtain a good stability of dental reconstructions [10], all the factors that contribute to the oral environment should be considered [11]. Salivary factors, microbial biofilms, and factors related to reconstructions are part of a unique, dynamic, and complex system that influences short- and long-term prosthetic implant therapy [12][13].
 
Implant failure may be influenced by mobility, wear, or the exposure of the implant to the oral cavity environment [19]. Peri-implantitis is a chronic pathological microbial process [20] that affects the soft tissue and surrounding bony areas of an osseointegrated dental arch implant and leads to bone resorption [21]. Peri-implantitis may favor implant rejection, increasing the accumulation of bacterial biofilm on the implant surfaces and initiating an increased number of inflammatory cells in the subepithelial conjunctive tissue [22][23]. Systemic conditions, such as HIV, may cause an increase in peri-implant infections and slightly worse results of the implant rehabilitation, which may be hindered by heavy smoking, but apparently not by oral hygiene [24][25][26].
Secondary implant failure related to peri-implantitis may be predicted using the plaque index (PI) and the presence of bleeding on probing (BOP) and of pocket probing depth (PPD), which have proven to be significant risk indicators [27]. The treatment of peri-implantitis may be conservatory, but surgery is an option, employing resection or regeneration [28]. Preventive measures when implanting, such as employing a partial thickness flap, may allow an adequate development of keratinized tissue around the implant, increasing implant survival [29].
 
Bacteria may colonize the implant’s rough surface and facilitate the adherence of other colonizers, which causes a time-dependant aggression on the implant, with detrimental effects such as pitting corrosion after one month, and flexural strength decline after three months [30][31]. The colonization of the peri-implant sulcus by Gram-negative anaerobes alongside other factors, such as poorly controlled diabetes, smoking, implant design, and mechanical stress, creates an inflammatory environment facilitating loss of bony support and ultimately leading to implant failure [35]. The bacterial profile seems to correlate with the degree of inflammation and the prognosis of the implant, however, the surface structure of the implant is also an important factor, due to the attachment affinity of some bacteria to specific implant surface types [36]. The inconsistently reported prevalence of peri-implantitis seems to confirm that it is a complex multifactorial process, and the correct identification of bacterial pathogens to peri-implantitis may help limit the disease severity [37].
 
Sulfur is an important component of proteins and is found in high quantities in the oral cavity in the composition of filaggrin [38]. Filaggrin (filament aggregating protein) is a filament protein connected to keratin fibers in the epithelial cells. In the epithelial tissue, these structures are found in keratohyalin granules in the granulous layers [39]. This protein is essential in the homeostasis of the epithelial tissue. In the corneous layer, filaggrin monomers are part of the skin barrier structures. Alternatively, these proteins may interact with keratin intermediary filaments. The impact of the keratinized gum on dental implants has long been debated and is a subject of controversy, however, most studies underline the importance of an adequate keratinization area around implants [40][41].
 
Some studies have shown an association between the lack of keratinized tissue and slight bone loss [42], with a higher accumulation of bacterial plaque and increased soft tissue retraction [43]. Alongside these clinical signs, an increased bleeding on probing index was recorded, noting a significant increase in gingival inflammation [44]. The discontinuity of the oxide film exposes a fragment of the alloy surface to the external environment, leading to a release of metallic ions and the initiation of alloy corrosion. The intensity of the galvanic effect is influenced by the potential difference between the metals that trigger this process [45]. In dental implantation, the exposure is to the oral environment and the presence of saliva. Salivary ions, such as chloride, sodium, calcium, and potassium, but also proteins, enzymes, and microorganisms of the oral biofilm, may interact with and influence the corrosion process [46][47].

This entry is adapted from the peer-reviewed paper 10.3390/coatings10030209

References

  1. Umberto Demoner Ramos; Flávia Suaid; Ulf M. E. Wikesjö; Cristiano Susin; Patrícia Conde Vital; Sérgio Luis Scombatti De Souza; Michel Reis Messora; Daniela Bazan Palioto; Arthur Belém Novaes; Microbiologic effect of two topical anti-infective treatments on ligature-induced peri-implantitis: A pilot study in dogs. Journal of Periodontology 2018, 89, 995-1002, 10.1002/jper.17-0630.
  2. Ioana Bunoiu; Mihaela Mindroiu; Claudiu Constantin Manole; Mihai Andrei; Adrian Ionut Nicoara; Ecaterina Vasilescu; Mónica Popa; Andreea Cristiana Didilescu; Electrochemical testing of a novel alloy in natural and artificial body fluids. Annals of Anatomy - Anatomischer Anzeiger 2018, 217, 54-59, 10.1016/j.aanat.2017.12.011.
  3. Olga Charyeva; Kubeysin Altynbekov; Rahmed Zhartybaev; Asylbek Sabdanaliev; Long-term dental implant success and survival--a clinical study after an observation period up to 6 years.. Swedish dental journal 2012, 36, , .
  4. Ralf Smeets; Anders Henningsen; Ole Jung; Max Heiland; Christian Hammächer; J. M. Stein; Definition, etiology, prevention and treatment of peri-implantitis – a review. Head & Face Medicine 2014, 10, 34-34, 10.1186/1746-160X-10-34.
  5. Factors associated with dental implant survival: a 4-year retrospective analysis. British Dental Journal 2012, 212, 129-129, 10.1038/sj.bdj.2012.93.
  6. Matys, J.; Swider, K.; Flieger, R.; Dominiak, M. Assessment of the primary stability of root analog zirconia implants designed using cone beam computed tomography software by means of the Periotest(R) device: An ex vivo study. A preliminary report. Adv. Clin. Exp. Med. 2017, 26, 803–809. [Google Scholar] [CrossRef]
  7. R. Adell; U Lekholm; B. Rockler; P.-I. Brånemark; A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. International Journal of Oral Surgery 1981, 10, 387-416, 10.1016/s0300-9785(81)80077-4.
  8. D C Smith; Dental implants: materials and design considerations.. The International Journal of Prosthodontics 1993, 6, , .
  9. M. V. Popa; I. Demetrescu; D. Iordachescu; Anisoara Cimpean; Ecaterina Vasilescu; Paula Drob; M. Istratescu; The relation between electrochemical tests and in vitro evaluation of titanium alloy biocompatibility. Materials and Corrosion 2007, 58, 687-695, 10.1002/maco.200704053.
  10. Ana Rodríguez-Hernández; Antonio Juárez; E. Engel; F. J. Gil; Streptococcus sanguinis adhesion on titanium rough surfaces: effect of shot-blasting particles. Journal of Materials Science: Materials in Electronics 2011, 22, 1913-1922, 10.1007/s10856-011-4366-8.
  11. Francisco Javier Gil; Ana Rodriguez; Eduardo Espinar; Jose Maria Llamas; Esteban Padullés; Antonio Juárez; Effect of oral bacteria on the mechanical behavior of titanium dental implants.. The International Journal of Oral & Maxillofacial Implants 2012, 27, , .
  12. Pedro Babo; Ricardo Leandro Pires; Rui L. Reis; Manuela Estima Gomes; Membranes for periodontal tissues regeneration. Ciência & Tecnologia dos Materiais 2014, 26, 108-117, 10.1016/j.ctmat.2015.03.007.
  13. Ashwin M Pangi; Manoj Shetty; D Krishna Prasad; Hema Kanathila; The Release of Elements from the Base Metal Alloys in a Protein Containing Biologic Environments and Artificial Saliva – An Invitro Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH 2016, 10, ZC23-ZC27, 10.7860/JCDR/2016/15763.7058.
  14. Lely Susita R.M. Sudjatmoko; EFFECTS OF NITROGEN ION IMPLANTATION ON HARDNESS AND WEAR RESISTANCE OF THE Ti-6Al-4V ALLOY. GANENDRA Majalah IPTEK Nuklir 2015, 18, 61-68, 10.17146/gnd.2015.18.2.2657.
  15. J Levignac; [Periimplantation osteolysis- periimplantosis - periimplantitis].. Revue francaise d'odonto-stomatologie 1965, 12, , .
  16. Ahmad Reza Ebadian; Mahdi Kadkhodazadeh; Parisa Zarnegarnia; Gunnar Dahlén; Bacterial analysis of peri-implantitis and chronic periodontitis in Iranian subjects.. ACTA MEDICA IRANICA 2012, 50, , .
  17. Hwey-Chin Yeh; Jang-Jih Lu; Shih-Cheng Chang; Mao-Cheng Ge; Identification of microbiota in peri-implantitis pockets by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Scientific Reports 2019, 9, 774, 10.1038/s41598-018-37450-5.
  18. Daniela Ionita; Anca Mazare; Diana Portan; Ioana Demetrescu; Aspects relating to stability of modified passive stratum on TiO2 nanostructure. Metals and Materials International 2011, 17, 321-327, 10.1007/s12540-011-0421-8.
  19. J. R. Scully; Polarization Resistance Method for Determination of Instantaneous Corrosion Rates. CORROSION 2000, 56, 199-218, 10.5006/1.3280536.
  20. Shuyue Liu; Bing Wang; Peirong Zhang; Effect of Glucose Concentration on Electrochemical Corrosion Behavior of Pure Titanium TA2 in Hanks’ Simulated Body Fluid. Materials 2016, 9, 874, 10.3390/ma9110874.
  21. H. Naujokat; Burkhard Kunzendorf; Jörg Wiltfang; Dental implants and diabetes mellitus-a systematic review.. International Journal of Implant Dentistry 2016, 2, 5, 10.1186/s40729-016-0038-2.
  22. Luciana Reis Azevedo; Antonio Adilson Soares De Lima; Maria Angela Naval Machado; Ana Maria Trindade Grégio; Patricia Del Vigna De Almeida; Saliva Composition and Functions: A Comprehensive Review. The Journal of Contemporary Dental Practice 2008, 9, 72-80, 10.5005/jcdp-9-3-72.
  23. Érica Miranda De Torres; Renata Cristina Silveira Rodrigues; Maria Da Gloria Chiarello De Mattos; Ricardo F. Ribeiro; The effect of commercially pure titanium and alternative dental alloys on the marginal fit of one-piece cast implant frameworks. Journal of Dentistry 2007, 35, 800-805, 10.1016/j.jdent.2007.07.013.
  24. Sally A. Smith; Beverly A. Dale; Immunologic Localization of Filaggrin in Human Oral Epithelia and Correlation with Keratinization. Journal of Investigative Dermatology 1986, 86, 168-172, 10.1111/1523-1747.ep12284213.
  25. Petra Ovaere; Saskia Lippens; Peter Vandenabeele; Wim Declercq; The emerging roles of serine protease cascades in the epidermis. Trends in Biochemical Sciences 2009, 34, 453-463, 10.1016/j.tibs.2009.08.001.
  26. Lukas Poskevicius; Antanas Šidlauskas; Gintaras Juodzbalys; Pablo Galindo-Moreno; Dimensional soft tissue changes following soft tissue grafting in conjunction with implant placement or around present dental implants: a systematic review. Clinical Oral Implants Research 2015, 28, 1-8, 10.1111/clr.12606.
  27. Ugo Covani; Simone Marconcini; Giovanni Galassini; Roberto Cornelini; Stefano Santini; Antonio Barone; Connective Tissue Graft Used as a Biologic Barrier to Cover an Immediate Implant. Journal of Periodontology 2007, 78, 1644-1649, 10.1902/jop.2007.060461.
  28. Jan L. Wennstrom; F Bengazi; U Lekholm; The influence of the masticatory mucosa on the peri-implant soft tissue condition.. Clinical Oral Implants Research 1994, 5, , .
  29. Gary Greenstein; John Cavallaro; The clinical significance of keratinized gingiva around dental implants.. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 2011, 32, , .
  30. Jun-Beom Park; Increasing the Width of Keratinized Mucosa Around Endosseous Implant Using Acellular Dermal Matrix Allograft. Implant Dentistry 2006, 15, 275-281, 10.1097/01.id.0000227078.70869.20.
  31. Maud Bergman; Olle Ginstrup; Bo Nilsson; Potentials of and currents between dental metallic restorations. European Journal of Oral Sciences 1982, 90, 404-408, 10.1111/j.1600-0722.1982.tb00754.x.
  32. A. K. Lee; D. K. Newman; Microbial iron respiration: impacts on corrosion processes. Applied Microbiology and Biotechnology 2003, 62, 134-139, 10.1007/s00253-003-1314-7.
  33. Hansen, D.C. Metal corrosion in the human body: The ultimate bio-corrosion scenario. Electrochem. Soc. Interface 2008, 17, 31.
  34. Marc Long; H.J Rack; Titanium alloys in total joint replacement—a materials science perspective. Biomaterials 1998, 19, 1621-1639, 10.1016/s0142-9612(97)00146-4.
  35. M. V. Popa; Ecaterina Vasilescu; Paula Drob; I. Demetrescu; B. Popescu; D. Ionescu; Ecaterina Vasilescu; In vitro assessment and monitoring of the implant titanium materials – physiological environment interactions. Materials and Corrosion 2003, 54, 215-221, 10.1002/maco.200390049.
  36. Ioana Demetrescu; Passive and Bioactive Films on Implant Materials and their Efficiency in Regenerative Medicine. Molecular Crystals and Liquid Crystals 2008, 486, 110-119, 10.1080/15421400801917858.
  37. Ruggero Bosco; Jeroen J. J. P. Van Den Beucken; Sander G. C. Leeuwenburgh; J A Jansen; Surface Engineering for Bone Implants: A Trend from Passive to Active Surfaces. Coatings 2012, 2, 95-119, 10.3390/coatings2030095.
  38. Nicola Zitzmann; Tord Berglundh; Definition and prevalence of peri-implant diseases. Journal of Clinical Periodontology 2008, 35, 286-291, 10.1111/j.1600-051x.2008.01274.x.
  39. Jan Lindhe; Joerg Meyle; on behalf of Group D of the European Workshop on Periodontology; Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology. Journal of Clinical Periodontology 2008, 35, 282-285, 10.1111/j.1600-051x.2008.01283.x.
  40. Stuart J Froum; Scott H Froum; Paul S Rosen; Successful management of peri-implantitis with a regenerative approach: a consecutive series of 51 treated implants with 3- to 7.5-year follow-up.. The International Journal of Periodontics & Restorative Dentistry 2012, 32, , .
  41. J M Salcetti; J D Moriarty; L F Cooper; F W Smith; J G Collins; S S Socransky; S. Offenbacher; The clinical, microbial, and host response characteristics of the failing implant.. The International Journal of Oral & Maxillofacial Implants 1997, 12, , .
  42. Enrico F. Gherlone; Paolo Capparè; Simona Tecco; Elisabetta Polizzi; Giuseppe Pantaleo; Giorgio Gastaldi; Maria Gabriella Grusovin; A Prospective Longitudinal Study on Implant Prosthetic Rehabilitation in Controlled HIV-Positive Patients with 1-Year Follow-Up: The Role of CD4+ Level, Smoking Habits, and Oral Hygiene. Clinical Implant Dentistry and Related Research 2015, 18, 955-964, 10.1111/cid.12370.
  43. Enrico F. Gherlone; Paolo Capparè; Simona Tecco; Elisabetta Polizzi; Giuseppe Pantaleo; Giorgio Gastaldi; Maria Gabriella Grusovin; Implant Prosthetic Rehabilitation in Controlled HIV-Positive Patients: A Prospective Longitudinal Study with 1-Year Follow-Up. Clinical Implant Dentistry and Related Research 2015, 18, 725-734, 10.1111/cid.12353.
  44. Paolo Capparé; Giulia Teté; Georgios E Romanos; Matteo Nagni; Gianpaolo Sannino; Enrico Felice Gherlone; The 'All-on-four' protocol in HIV-positive patients: A prospective, longitudinal 7-year clinical study.. 2019, 12, 501-510, .
  45. Simona Tecco; Mg Grusovin; Simona Sciara; F Bova; Giuseppe Pantaleo; Paolo Capparè; The association between three attitude-related indexes of oral hygiene and secondary implant failures: A retrospective longitudinal study. International Journal of Dental Hygiene 2017, 16, 372-379, 10.1111/idh.12300.
  46. R.L. Fiese; Osseointegration and its experimental background. Journal of Oral and Maxillofacial Surgery 1984, 42, 273, 10.1016/0278-2391(84)90464-6.
  47. Giovanni B Bruschi; Roberto Crespi; Paolo Capparè; Enrico Gherlone; Clinical Study of Flap Design to Increase the Keratinized Gingiva Around Implants: 4-Year Follow-Up. Journal of Oral Implantology 2014, 40, 459-464, 10.1563/aaid-joi-d-11-00236.
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