Romanos et al. (2022): "There is wear from metallic, but not ceramic dental implants at the time of insertion"
Titanium wear is gaining growing attention as a critical concern in implant dentistry, since titanium implants can release abrasion particles because of mechanical insertion (Meyer et al. 2006), which together with microbial environmental influences can trigger mucositis and peri-implantitis (Scridhar et al. 2015). Besides that, titanium, as a metal, is susceptible to corrosion, and titanium particles have consequently been found in peri-implant tissues (Olmedo et al., 2008).
What about zirconia? Romanos et al. (2022) examined in their study “titanium and zirconium wear from dental implants at the time of insertion” using X-ray fluorescence spectrometry (XRF) and an in vitro protocol with artificial bovine bone plates. The implants (titanium implants and Zeramex XT implants made of alumina-toughened zirconia (ATZ)) were placed into two bone blocks secured by a vice. After insertion, the blocks were separated, and the sites were examined for titanium (Ti) and zirconium (Zr) residues.
The authors found out that:
- There is wear from metallic, but not ceramic dental implants at the time of insertion
- There were greater quantities of titanium in the coronal thirds of the implants, and less in the apical thirds
- There was a direct correlation between implant length and the amount of titanium detected on the bone block
Further research shows that zirconia exhibits a high chemical inertness (Piconi & Porporati 2016), no cytotoxicity, high cell viability rate, and excellent biocompatibility (Molaei et al. 2021).
The full text of the paper by Romanos et al. (2022) is available here.
About the authors
Prof. Dr. med. dent. Georgios E. Romanos is a Professor and Associate Dean at Stony Brook University, NY, and a Professor of Oral Surgery and Implantology at the University of Frankfurt. He is American Board Certified in Periodontology (AAP) and has held faculty positions at NYU and the University of Rochester, where he also directed the Laser Dentistry section. He serves as a reviewer for journals like JOMI, Clinical Implant Dentistry and Related Research, J Prosthodontics, Odontology, and J Periodontol.
Dr. Rafael Delgado-Ruiz is an Associate Professor in the Department of Prosthodontics and Digital Technology at Stony Brook University's School of Dental Medicine. He earned his DDS from the National University of Colombia in 1996, followed by multiple advanced degrees, including MScs in Buco-Dental Preventive Programs and Oral Medicine from Complutense University, and a PhD from Murcia University, achieved summa cum laude in 2009.
Dr. Gerard Fischer, DDS graduated from Stony Brook University School of Dental Medicine in 2023. His professional interests include dentoalveolar surgery, maxillofacial trauma, and implantology.
Dr. Zaid T. Rahman, DDS earned his Doctor of Dental Surgery (DDS) degree from Columbia University College of Dental Medicine.
References
Meyer U, Bühner M, Büchter A, Kruse-Lösler B, Stamm T, Wiesmann H P. Fast element mapping of titanium wear around implants of different surface structures. Clin. Oral Impl. Res. 2006; 17,206-211
Molaei M, Attarzadeh N, Fattah-Alhosseini A. Tailoring the biological response of zirconium implants using zirconia bioceramic coatings: A systematic review. J Trace Elem Med Biol. 2021 Jul;66:126756. doi: 10.1016/j.jtemb.2021.126756. Epub 2021 Apr 2. PMID: 33831798.
Olmedo DG, Tasat DR, Evelson P, et al. Biological response of tissues with macrophagic activity to titanium dioxide. J Biomed Mater Res A. 2008;84(4):1087-1093.
Piconi, C., Porporati, A.A. (2016). Bioinert Ceramics: Zirconia and Alumina. In: Antoniac, I. (eds) Handbook of Bioceramics and Biocomposites. Springer, Cham. https://doi.org/10.1007/978-3-319-12460-5_4
Romanos, G. E., Fischer, G. A., Rahman, Z. T., & Delgado-Ruiz, R. (2022). Spectrometric Analysis of the Wear from Metallic and Ceramic Dental Implants following Insertion: An In Vitro Study. Materials, 15(3), 1200. https://doi.org/10.3390/ma15031200
Scridhar S, Wilson Jr TG, Palmer KL, Valderrama P, Mathew MT, Prasad S, Jacobs M, Gindri IM, Rodrigues DC. In Vitro Investigation of the Effect of Oral Bacteria in the Surface Oxidation of Dental Implants. Clin Impl Dent 2015; 17:562-75
