Originally the first dental implants (1980’s) had two parts: the fixture (which goes screwed into the bone) and the abutment (where the prosthetic crown is cemented).
The improvements in new ceramic materials made it possible on 2000 to have the abutment part made of ceramic. This material was commonly known to be more tissue friendly than titanium.
In 2005, the CeraRoot full ceramic implant (fixture and abutment in one body/part) was introduced into the European market and in 2011 accepted by the FDA to be used in U.S. dental clinics. The main advantage of a one-piece zirconia implant is that it has no prosthetic connections, where bacteria can grow, and therefore have better gum health. Another big advantage is that the implant is 100% white. This means that no metal will ever be visible when smiling or communicating with other people.
Titanium is a metal, and suffers corrosion.
Corrosion, the gradual degradation of materials by electrochemical attack is a concern particularly when a metallic implant is placed in the hostile electrolytic environment provided by the human body.
The term corrosion is defined as the process of interaction between a solid material and its chemical environment, which leads to a loss of substance from material, a change in its structural characteristics, or loss of structural integrity.
The clinical importance of degradation of metal implants is evidenced by particulate corrosion and wear products in tissue surrounding the implant, which may ultimately result in a cascade of events leading to periprosthetic bone loss. Furthermore, many authors have reported increased concentrations of local and systemic trace metal in association with metal implants.
Zirconia is a ceramic and does not suffer any corrosion.
Throughout the decades, the materials that have been used for the dental treatments have been made with metal. The main reason was to give mechanical strength and therefore augment the longevity of the treatment. Overtime, the scientific research contributed enormously to the improvement of the ceramic’s mechanical strength. In the beginning, ceramics were introduced into the patients mouth because of it’s fabulous esthetic properties. However, the latests research shows that the esthetic is not the most important characteristic of this material. Ceramics due to its inert, non-corrosive and nonallergic properties, it is actually many times more beneficial to the patient than any other dental material ever made. We encourage patients to demand treatments without metal. Metal-free treatments. All-ceramic treatments.
WHAT TO KNOW ABOUT TITANIUM (metal implants)
Titanium allergy is barely recognized in mainstream medicine – yet laboratories using the MELISA® technology have reported that about 4% of all patients tested to titanium will be allergic to it (Valentine-Thon E., et al. “LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity”. Neuro Endocrinol Lett 2006; 27(Suppl 1):17–24). For those affected with titanium allergy, the symptoms can be multiple and bewildering. These can range from simple skin rashes to muscle pain and fatigue.
From foodstuff to medicine, titanium is now an everyday metal. Several brands of candy, such as Skittles and M&M, have titanium dioxide in the coating – often described by its E-number: E171. Some brands of toothpaste contain titanium particles. Hospitals use titanium implants to rebuild bones after accidents.
More than just a rash: the effects of titanium allergy
Like all metals, titanium releases particles through corrosion. These metals become ions in the body and bind to body proteins. For those who react, the body will try to attack this structure. This starts a chain reaction which can lead to many symptoms including Chronic Fatigue Syndrome. The MELISA® test is the only scientifically-proven test which can objectively diagnose titanium allergy and measure its severity.
Those who test positive are advised to avoid exposure if possible. This may include switching to titanium-free toothpaste and cosmetics, or in some cases, consider removing a titanium implant from the body.
Titanium: where to find it
Titanium dioxide (TiO2) is widely used in consumer products, as it is non-toxic – even though it triggers allergies in certain people. It is known as a “pearling agent” as it makes paper and paint glossy and white. Always check the content of food stuff, pills and cosmetics for titanium dioxide. It is found in the following:
Body implants, such as Brånemark (for teeth) or to rebuild bones.
Dentistry: as a color pigment in composites
Sunscreen agents: Finely ground titanium dioxide will block the harmful ultraviolet rays from the sun.
Confectionery: Used to make candy look brighter and adding a crunchy coat to for example chewing gum.
Cosmetics: Used to brighten and intensify the color of make-up. It is regularly found in shadow, blush, nail polish, lotions, lipstick and powder.
Toothpaste: Used as a pigment agent to make the toothpaste whiter.
Paint: TiO2 will improve the durability of coatings and gives white color.
Plastic carrier bags: Improves durability and gives white color.
Medical pills and vitamin supplements may also get their white coating from titanium dioxide.
Piercing & Jewelry: For example watches and all types of body piercing. Fewer people are allergic to titanium than for example to nickel.
Titanium polluted with nickel
Several studies show that titanium alloys contain traces of nickel as a result of the production process. This can pose trigger health problems in patients with nickel allergy, and also mean that a reaction may be falsely attributed to titanium itself.
Do you suspect you have titanium allergy?
If a health problem starts after you have received a titanium implant it is possible that you are allergic to titanium. You can take a MELISA® test for titanium allergy through one of the clinics we cooperate with or send a sample to a laboratory. If you are planning to have a test before receiving a titanium implant it is advised to find out the exact composition of the implant. Vanadium, aluminium and other metals are sometimes added to improve the properties of titanium implants, and allergy to these metals can also be tested.
How about clinical studies?
The articles Hypersensitivity to titanium: Clinical and laboratory evidence and LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity published in 2006 can be downloaded from our Article page.
In the former article fifty-six (56) patients who had developed clinical symptoms after receiving titanium-based implants were tested in MELISA® against 10 metals including titanium. Out of 56 patients, 54 were patch-tested with titanium as well as with other metals. The implants were removed in 54 patients (2 declined explantation), and 15 patients were retested in MELISA®.
Of the 56 patients, 21 (37.5%) were positive, 16 (28.6%) ambiguous, and 19 (33.9%) negative to titanium. In the latter group, 11 (57.9%) showed lymphocyte reactivity to other metals, including nickel. All 54 patch-tested patients were negative to titanium. Following removal of the implants, all 54 patients showed remarkable clinical improvement. In the 15 retested patients, this clinical improvement correlated with normalization in MELISA® reactivity.
The conclusion of the article is that these data clearly demonstrate that titanium can induce clinically relevant hypersensitivity in a subgroup of patients chronically exposed via dental or endoprosthetic implants. Below, you will also find several articles which discuss the issue of corrosion of titanium implants and possible reactions due to hypersensitivity.
Medical articles relating to titanium allergies:
Titanium allergy or not? “Impurity” of titanium implant materials. Harloff T, et al.. Health 2010(2)4:306-310
Download full article HERE.
Titanium: A New Allergen. Laurence Evrard
Download the full article HERE.
The Epidemiology of Contact Allergy to Metals in the General Population:
Download the full article HERE.
Corrosion aspect of dental implants—An overview and literature review
Download the full article HERE.
Hypersensitivity to titanium: Clinical and laboratory evidence
Download the article HERE.
Allergy related to dental implant and its clinical significance
Download the article HERE.
Oral Factors Affecting Titanium Elution and Corrosion: An In Vitro Study Using Simulated Body Fluid
Download the article HERE
More articles for your reference:
- Study on patch test reagent for titanium. Nakajima K. Kokubyo Gakkai Zasshi. 2007 Jun;74(2):92-8.
- Allergies to dental metals. Titanium: a new allergen. Evrard L, Waroquier D, Parent D. Rev Med Brux. 2010 Jan-Feb;31(1):44-9.
- Implant failure due to Titanium hypersensitivity/allergy? – Report of a case SADJ February 2007
- Ultrafine titanium dioxide particles in the absence of photoactivation can induce oxidative damage to human bronchial epithelial cells Toxicology 2005
- Titanium particles stimulate bone resorption by inducing differentiation of murine osteoclast J Bone Joint Surg Am. 2001
- Immunohistochemical study of the soft tissue around long-term skin-penetrating titanium implants Biomaterials 1995
- Titanium dermatitis after failure of metal-backed patellas, Am J Knee Surg 1993
- In vitro corrosion of titanium Biomaterials. 1998
- Sensitivity to titanium. A cause of implant failure? J Bone Joint Surg Br. 1991
- A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing breast-conserving therapy Breast Cancer. 2001
- Biocompatibility of dental casting alloys Crit Rev Oral Biol Med. 2002
- Validity of MELISA® for metal sensitivity testing Neuro Endocrinol Lett. 2003
- Das Allergiepotenzial von Implantatwerkstoffen auf Titanbasis A. Schuh, et al. Der Orthopäde Volume 34, Number 4, 327-33
- Tissue reaction to bone plates made of pure titanium: a prospective, quantitative clinical study. A. Ungersboeck, et al. Journal of Materials Science: Materials in Medicine Volume 6, Number 4, 223-229
- Maternal exposure to nanoparticulate titanium dioxide during the prenatal period alters gene expression related to brain development in the mouse. M Shimizu et al. Particle and Fibre Toxicology 2009, 6:20
- Allergic contact dermatitis caused by titanium screws and dental implants. Hosoki M et al. J Prosthodont Res. 2016 Jan 8. pii: S1883-1958
- Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. Fage SW. Contact Dermatitis. 2016 Jun;74(6):323-45
- Metal implant sensitivity: clinical and histological presentation. Hautarzt. 2016 May;67(5):373-9.
- Effects of decontamination solutions on the surface of titanium: investigation of surface morphology, composition, and roughness Wheelis Clin Oral Implants Res. 2015 Jan 12
Corrosion of titanium implants (publication January 2015)
On this research performed by Dr. Wheelis, shows that after using liquids such as Citric Acid, Fluoride toothpaste, peroxyacetic acid there is corrosion on titanium surfaces.
Journal Name: Clin Oral Implants Res. 2015 Jan 12
Title of scientific publication: Effects of decontamination solutions on the surface of titanium: investigation of surface morphology, composition, and roughness.
Authors: Wheelis et al
To investigate the impact of treatments used to detoxify dental implants on the oxide layer morphology and to infer how changes in morphology created by these treatments may impact re-osseointegration of an implant.
MATERIALS AND METHODS:
Pure titanium (cpTi) and the alloy Ti6Al4V were subjected to a series of chemical treatments and mechanical abrasion simulating surface decontamination of dental implants. The morphology and roughness of the surface layer before and after treatment with these solutions were investigated with optical and atomic force microscopy (OM, AFM). The solutions employed are typically used for detoxification of dental implants. These included citric acid, 15% hydrogen peroxide, chlorhexidine gluconate, tetracycline, doxycycline, sodium fluoride, peroxyacetic acid, and treatment with carbon dioxide laser. The treatments consisted of both immersions of samples in solution and rubbing with cotton swabs soaked in solution for 1, 2, and 5 min. Cotton swabs used were analyzed with energy dispersive spectroscopy (EDS).
The microscopy investigation showed that corrosion and pitting of the samples were present in both metal grades with immersion and rubbing methods when employing more acidic solutions, which had pH <3. Mildly acidic solutions caused surface discoloration when coupled with rubbing but did not cause corrosion with immersion. Neutral or basic treatments resulted in no signs of corrosion with both methods. EDS results revealed the presence of titanium particles on all rubbing samples.
It was demonstrated in this study that acidic environments coupled with rubbing are able to introduce noticeable morphological changes and corrosion on the surface of both titanium grades.
AFM ; corrosion; detoxification; oxide layer; titanium