Wear and Corrosion Interactions on Titanium in Oral Environment: Literature Review

Is galvanic corrosion between implant abutments and roots a possible scenario? An experimental study under simulated healthy and inflammatory peri-implant conditions and F anions

PURPOSE

To assess the effect of healthy and inflammatory conditions and the presence of F anions on the galvanic coupling between the root surface and titanium abutments of commercially available titanium implants MATERIALS AND METHODS: Eight pairs of three dental root-abutment couples (BEGO, MIS, NOBEL) were exposed to a neutral (pH=7.4) (HE) and an acidic (pH=4.0) (IN) phosphate buffer solution (PBS) simulating healthy and inflammatory conditions respectively. In order to simulate the presence of F anions, which is commonly used in toothpastes, 3.12 gr of NaF was added in both solutions simulating healthy conditions (HEF) and inflammatoy conditions (INF) with the presence of F anions respectively. The galvanic potential difference was recorded for 48 h and averaged. Physical appearance of abutment and roots were tested under a stereomicroscope. Scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDX) was used to characterize the materials under reseach and compare the surfaces before and after galvanic testing.

RESULTS

All abutments are composed of Ti-6Al-4V alloy along with root of MIS system, while BEG and NOB are made of Ti according to the SEM/EDX analysis. No differences were identified in surface morphology before and after galvanic testing, while EDX analysis revealed only the presence of Na and F on the surface of MIS abutments after testing in INF conditions. All groups tested showed negligible potential difference and below the nominal threshold for triggering galvanic corrosion under HE, IN and HEF conditions. The same applies for BEG and MIS under INF conditions, while NOB presented an average potential difference value of -273 mV, which is above nominal thresshold for galvanic action. Only MIS abutment showed a color change from yellow to blue under INF conditions.

CONCLUSIONS AND CLINICAL IMPLICATIONS

BEG and MIS implant systems are not prone to galvanic corrosion in all conditions tested. NOB was found vulnerable to galvanic corrosion under inflammatory peri-implant conditions in the presence of F anions. Galvanic reactions is a possible scenario even between Ti base implant components.

Fretting-corrosion at the Implant-Abutment Interface Simulating Clinically Relevant Conditions

OBJECTIVE

Implant treatment is provided to individuals with normal, idealized masticatory forces and also to patients with parafunctional habits such as grinding, clenching, and bruxing. Dental erosion is a common increasing condition and is reported to affect 32 % of adults, increasing with age. This oral environment is conducive to tribocorrosion and the potential loss of materials from the implant surfaces and interfaces with prosthetic components. Although several fretting-corrosion studies have been reported, until now, no study has simulated clinically relevant micromotion. Therefore, our aim is to investigate fretting-corrosion using our new micro-fretting corrosion system, simulating clinical conditions with 5 µm motion at the implant-abutment interface under various occlusal loads and acidic exposures.

METHODS

We simulated four conditions in an oral environment by varying the contact load (83 N and 233 N) and pH levels (3 and 6.5). The commonly used dental implant material, Grade IV titanium, and abutment material Zirconia (ZrO2)/ Grade IV titanium were selected as testing couple materials. Artificial saliva was employed to represent an oral environment. In addition, a standard tribocorrosion protocol was followed, and the pin was controlled to oscillate on the disk with an amplitude of 5 μm during the mastication stage. After the testing, 3D profilometry and scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) were utilized to analyze the worn surfaces. Inductively coupled plasma mass spectrometry (ICP-MS) was also used to measure the metal ion release.

RESULTS

Energy ratios were below 0.2, indicating a fretting regime of partial slip for all groups. Open-circuit potential (OCP) and electrochemical impedance spectroscopy (EIS) were analyzed to compare the electrochemical behavior among groups. As a result, corrosive damage was observed to be more in the Ti4- Ti4 groups than in Zr-Ti4 ones, whereas more mechanical damage was found in the Zr-Ti4 groups than in the Ti4-Ti4 groups. Possible mechanisms were proposed in the discussion to explain these findings.

SIGNIFICANCE

The results observed from this study might be helpful to clinicians with implant selection. For example, for patients with bruxism, a titanium implant paired with a titanium abutment may be preferable, while patients with GERD may benefit more from a titanium implant paired with a zirconia abutment.

Chronic exposure to TiO2 micro- and nano particles: A biochemical and histopathological experimental study

The aim of this work was to analyze the effects of long-term exposure to titanium dioxide (TiO2) micro- (MPs) and nanoparticles (NPs) (six and 12 months) on the biochemical and histopathological response of target organs using a murine model. Male Wistar rats were intraperitoneally injected with a suspension of TiO2 NPs (5 nm; TiO2-NP5 group) or MPs (45 μm; TiO2-NP5 group); the control group was injected with saline solution. Six and 12 months post-injection, titanium (Ti) concentration in plasma and target organs was determined spectrometrically (ICP-MS). Blood smears and organ tissue samples were evaluated by light microscopy. Liver and kidney function was evaluated using serum biochemical parameters. Oxidative metabolism was assessed 6 months post-injection (determination of superoxide anion by nitroblue tetrazolium (NBT) test, superoxide dismutase (SOD) and catalase (CAT), lipid peroxidation, and paraoxonase 1). Titanium (Ti) concentration in target organs and plasma was significantly higher in the TiO2-exposed groups than in the control group. Histological evaluation showed the presence of titanium-based particles in the target organs, which displayed no structural alterations, and in blood monocytes. Oxidative metabolism analysis showed that TiO2 NPs were more reactive over time than MPs (p < .05) and mobilization of antioxidant enzymes and membrane damage varied among the studied organs. Clearance of TiO2 micro and nanoparticles differed among the target organs, and lung clearance was more rapid than clearance from the lungs and kidneys (p < .05). Conversely, Ti concentration in plasma increased with time (p < .05). In conclusion, neither serum biochemical parameters nor oxidative metabolism markers appear to be useful as biomarkers of tissue damage in response to TiO2 micro- and nanoparticle deposits at chronic time points.

Titanium corrosion products from dental implants and their effect on cells and cytokine release: A review

INTRODUCTION

Titanium is considered to be an inert material owing to the ability of the material to form a passive titanium oxide layer. However, once the titanium oxide layer is lost, it can lead to exposure of the underlying titanium substructure and can undergo corrosion.

SUMMARY

The article explores the role of titanium ions and particles from dental implants on cells, cytokine release, and on the systemic redistribution of these particles as well as theories proposed to elucidate the effects of these particles on peri-implant inflammation based on evidence from in-vitro, human, and animal studies. Titanium particles and ions have a pro-inflammatory and cytotoxic effect on cells and promote the release of pro-inflammatory mediators like cytokines. Three theories to explain etiopathogenesis have been proposed, one based on microbial dysbiosis, the second based on titanium particles and ions and the third based on a synergistic effect between microbiome and titanium particles on the host.

CONCLUSION

There is clear evidence from in-vitro and limited human and animal studies that titanium particles released from dental implants have a detrimental effect on cells directly and through the release of pro-inflammatory cytokines. Future clinical and translational studies are required to clarify the role of titanium particles and ions in peri-implant inflammation and the etiopathogenesis of peri-implantitis.

Dental Implant Abutment Screw Loss: Presentation of 10 Cases

Re-tightening the loosened dental implant abutment screw is an accepted procedure, however the evidence that such screw will hold sufficiently is weak. The purpose of this study was material analysis of lost dental implant abutment screws made of the TiAlV alloy from various manufacturers, which became lost due to unscrewing or damaged when checking if unscrewed; undamaged screws could be safely re-tightened. Among 13 failed screws retrieved from 10 cases, 10 screws were removed due to untightening and 3 were broken but without mechanical damage at the threads. Advanced corrosion was found on nine screws after 2 years of working time on all surfaces, also not mechanically loaded. Sediments observed especially in the thread area did not affect the corrosion process because of no pit densification around sediments. Pitting corrosion visible in all long-used screws raises the question of whether the screws should be replaced after a certain period during service, even if they are well-tightened. This requires further research on the influence of the degree of corrosion on the loss of the load-bearing ability of the screw.

Phenotypic Analysis, Molecular Characterization, and Antibiogram of Caries-Causing Bacteria Isolated from Dental Patients

Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Despite scientific advances in cariology, dental caries remains a severe global concern. The aim of this study was to determine the optimization of microbial and molecular techniques for the detection of cariogenic pathogens in dental caries patients, the prevalence of cariogenic bacteria on the basis of socioeconomic, climatological, and hygienic factors, and in vitro evaluation of the antimicrobial activity of selected synthetic antibiotics and herbal extracts. In this study, oral samples were collected from 900 patients for bacterial strain screening on a biochemical and molecular basis. Plant extracts, such as ginger, garlic, neem, tulsi, amla, and aloe vera, were used to check the antimicrobial activity against the isolated strains. Synthetic antimicrobial agents, such as penicillin, amoxicillin, erythromycin, clindamycin, metronidazole, doxycycline, ceftazidime, levofloxacin, and ciprofloxacin, were also used to access the antimicrobial activity. Among 900 patients, 63% were males and 37% were females, patients aged between 36 and 58 (45.7%) years were prone to disease, and the most common symptom was toothache (61%). For oral diseases, 21% used herbs, 36% used antibiotics, and 48% were self-medicated, owing to sweets consumption (60.66%) and fizzy drinks and fast food (51.56%). Staphylococcus mutans (29.11%) and Streptococcus sobrinus (28.11%) were found as the most abundant strains. Seven bacterial strains were successfully screened and predicted to be closely related to genera S. sobrinus, S. mutans, Actinomyces naeslundii, Lactobacillus acidophilus, Eubacterium nodatum, Propionibacterium acidifaciens, and Treponema Pallidum. Among plant extracts, the maximum zone of inhibition was recorded by ginger (22.36 mm) and amla (20.01 mm), while among synthetic antibiotics, ciprofloxacin and levofloxacin were most effective against all microbes. This study concluded that phyto extracts of ginger and amla were considered suitable alternatives to synthetic antibiotics to treat dental diseases.

Ti-15Zr and Ti-15Zr-5Mo Biomaterials Alloys: An Analysis of Corrosion and Tribocorrosion Behavior in Phosphate-Buffered Saline Solution

It is crucial for clinical needs to develop novel titanium alloys feasible for long-term use as orthopedic and dental prostheses to prevent adverse implications and further expensive procedures. The primary purpose of this research was to investigate the corrosion and tribocorrosion behavior in the phosphate buffered saline (PBS) of two recently developed titanium alloys, Ti-15Zr and Ti-15Zr-5Mo (wt.%) and compare them with the commercially pure titanium grade 4 (CP-Ti G4). Density, XRF, XRD, OM, SEM, and Vickers microhardness analyses were conducted to give details about the phase composition and the mechanical properties. Additionally, electrochemical impedance spectroscopy was used to supplement the corrosion studies, while confocal microscopy and SEM imaging of the wear track were used to evaluate the tribocorrosion mechanisms. As a result, the Ti-15Zr (α + α' phase) and Ti-15Zr-5Mo (α″ + β phase) samples exhibited advantageous properties compared to CP-Ti G4 in the electrochemical and tribocorrosion tests. Moreover, a better recovery capacity of the passive oxide layer was observed in the studied alloys. These results open new horizons for biomedical applications of Ti-Zr-Mo alloys, such as dental and orthopedical prostheses.

Development of a novel hybrid Ti6Al4V-ZrO2 surface with high wear resistance by laser and hot pressing techniques for dental implants

The development of implant metal-free surfaces has gained attention since non-benefic results have been reported related to the metallic ions released from metal implants to the human body. Ceramic coatings have been proposed as a possible solution however, the detachment of these coatings, during implantation or even in function, can compromise its function. In order to overcome this problem, this work proposes a novel hybrid Ti6Al4V-ZrO2 surface, starting with laser texturing of the Ti6Al4V substrate by Laser Nd:YV04, followed by the allocation of the zirconia (ZrO2) powder and its subsequent sintering by hot pressing process. Results revealed that zirconia strongly adheres to titanium textured surfaces since no detachment was found under tribological and adhesion scratch tests. Moreover, the tribological results showed that the incorporation of zirconia into textured titanium surface reduces significantly the wear rate of titanium (≈93%), which is a good indicator of low metallic particles/ions released to the body. These results suggest that this novel surface with good aesthetic properties and improved wear resistance (given by zirconia) and mechanical resistance (from titanium) can be a promising solution for dental implants, especially for implant/abutment or abutment/ceramic contact zones, and thus have a huge impact on the long-term performance of implants.

Titanium and titanium alloys in dentistry: current trends, recent developments, and future prospects

Many implant materials have been used in various dental applications depending on their efficacy and availability. A dental implant must possess the required characteristics, such as biocompatibility, corrosion & wear resistance, adequate mechanical properties, osseointegration, etc., to ensure its safe and optimum use. This review analyzes various aspects of titanium (Ti) and Ti alloys, including properties, manufacturing processes, surface modifications, applications as dental implants, and limitations. In addition, it also presents a perception of recent advances in Ti-based implant materials and the futuristic development of innovative dental implants.

Preventing Peri-implantitis: The Quest for a Next Generation of Titanium Dental Implants

Titanium and its alloys are frequently the biomaterial of choice for dental implant applications. Although titanium dental implants have been utilized for decades, there are yet unresolved issues pertaining to implant failure. Dental implant failure can arise either through wear and fatigue of the implant itself or peri-implant disease and subsequent host inflammation. In the present report, we provide a comprehensive review of titanium and its alloys in the context of dental implant material, and how surface properties influence the rate of bacterial colonization and peri-implant disease. Details are provided on the various periodontal pathogens implicated in peri-implantitis, their adhesive behavior, and how this relationship is governed by the implant surface properties. Issues of osteointegration and immunomodulation are also discussed in relation to titanium dental implants. Some impediments in the commercial translation for a novel titanium-based dental implant from "bench to bedside" are discussed. Numerous in vitro studies on novel materials, processing techniques, and methodologies performed on dental implants have been highlighted. The present report review that comprehensively compares the in vitro, in vivo, and clinical studies of titanium and its alloys for dental implants.

The role of foreign body response in peri-implantitis: What is the evidence?

Historically, there has been broad consensus that osseointegration represents a homeostasis between a titanium dental implant and the surrounding bone, and that the crestal bone loss characteristic of peri-implantitis is a plaque-induced inflammatory process. However, this notion has been challenged over the past decade by proponents of a theory that considers osseointegration an inflammatory process characterized by a foreign body reaction and peri-implant bone loss as an exacerbation of this inflammatory response. A key difference in these two schools of thought is the perception of the relative importance of dental plaque in the pathogenesis of crestal bone loss around implants, with obvious implications for treatment. This review investigates the evidence for a persistent foreign body reaction at osseointegrated dental implants and its possible role in crestal bone loss characteristic of peri-implantitis. Further, the role of implant-related material release within the surrounding tissue, particularly titanium particles and corrosion by-products, in the establishment and progression in peri-implantitis is explored. While it is acknowledged that these issues require further investigation, the available evidence suggests that osseointegration is a state of homeostasis between the titanium implant and surrounding tissues, with little evidence that a persistent foreign body reaction is responsible for peri-implant bone loss after osseointegration is established. Further, there is a lack of evidence for a unidirectional causative role of corrosion by-products and titanium particles as possible non-plaque related factors in the etiology of peri-implantitis.

Analysis of the Microbiome on the Surface of Corroded Titanium Dental Implants in Patients with Periimplantitis and Diode Laser Irradiation as an Aid in the Implant Prosthetic Treatment: An Ex Vivo Study

The paper presents the optimization of diode laser irradiation of corroded dental implants in order to reduce the number of microorganisms associated peri-implantitis. The research included the identification of microorganisms on the surface of removed dental implants in patients with peri-implantitis and the assessment of the biocidal effectiveness of the diode laser against these microorganisms. Laser desorption/mass spectrometry (MALDI-TOF MS) was used to identify microorganisms and metagens were examined by next generation sequencing (NGS). Irradiation was performed with a diode laser with a wavelength of λ = 810, operating mode: 25 W/15.000 Hz/10 μs, average = 3.84 W with the number of repetitions t = 2 × 15 s and t = 3 × 15 s. The structure and surface roughness of the implants were analysed before and after laser irradiation by optical profilometry and optical microscopy with confocal fixation. In total, 16 species of Gram-positive bacteria and 23 species of Gram-negative bacteria were identified on the surface of the implants. A total of 25 species of anaerobic bacteria and 12 species with corrosive potential were detected. After diode laser irradiation, the reduction in bacteria on the implants ranged from 88.85% to 100%, and the reduction in fungi from 87.75% to 96.77%. The reduction in microorganisms in the abutment was greater than in the endosseous fixture. The applied laser doses did not damage, but only cleaned the surface of the titanium implants. After 8 years of embedding, the removed titanium implant showed greater roughness than the 25-year-old implant, which was not exposed to direct influence of the oral cavity environment. The use of a diode laser in an optimised irradiation dose safely reduces the number of microorganisms identified on corroded dental implants in patients with peri-implantitis.

Electrical Potentiometry with Intraoral Applications

Dental implants currently in use are mainly made of titanium or titanium alloys. As these metallic elements are immersed in an electrolytic medium, galvanic currents are produced between them or with other metals present in the mouth. These bimetallic currents have three potentially harmful effects on the patient: micro-discharges, corrosion, and finally, the dispersion of metal ions or their oxides, all of which have been extensively demonstrated in vitro. In this original work, a system for measuring the potentials generated in vivo is developed. Specifically, it is an electrogalvanic measurements system coupled with a periodontal probe that allows measurement of the potentials in the peri-implant sulcus. This device was tested and verified in vitro to guarantee its applicability in vivo. As a conclusion, this system is able to detect galvanic currents in vitro and it can be considered capable of being employed in vivo, so to assess the effects they may cause on dental implants.

Mechanical, corrosion, nanotribological, and biocompatibility properties of equal channel angular pressed Ti-28Nb-35.4Zr alloys for biomedical applications

This study systematically investigated the effect of equal channel angular pressing (ECAP) on the microstructure, mechanical, corrosion, nano-tribological properties and biocompatibility of a newly developed β Ti-28Nb-35.4Zr (hereafter denoted TNZ) alloy. Results indicated that ECAP of the β TNZ alloy refined its microstructure by forming ultrafine grains without causing stress-induced phase transformation, leading to formation of a single β phase. The ECAP-processed TNZ alloy exhibited a compressive yield strength of 960 MPa, and high plastic deformation capacity without fracturing under compression loads. Potentiodynamic polarization tests revealed the higher tendency of ECAP-processed TNZ alloys to form passive oxide films on its surface, which exhibited a lower corrosion rate (0.44±0.07 µm/y) in Hanks' balanced salt solution compared to its as-cast counterpart (0.71±0.10 µm/y). Nanotribological testing also revealed higher resistance of the ECAP-processed TNZ alloy to abrasion, wear and scratching, when compared to its as-cast counterpart. Cytocompatibility and cell adhesion assessments of the ECAP-processed TNZ alloys showed a high viability (111%) of human osteoblast-like SaOS2 cells after 7 d of culturing. Moreover, the ECAP-processed TNZ alloy promoted adhesion and spreading of SaOS2 cells, which exhibited growth and proliferation on alloy surfaces. In summary, significantly enhanced mechanical, corrosion, and biological properties of ECAP-processed TNZ alloy advocate its suitability for load-bearing implant applications. STATEMENT OF SIGNIFICANCE: Equal channel angular pressing (ECAP) provides a unique combination of enhanced mechanical and functional properties of materials by optimizing their microstructures and phase transformations. This study investigated the mechanical, nano-tribological, corrosion, and biocompatibility properties of a newly developed β Ti-28Nb-35.4Zr (TNZ) alloy processed via ECAP. Our findings indicated that ECAP of the β TNZ alloy refined its microstructure by forming ultrafine grains without causing stress-induced phase transformation. Compared to its as-cast counterpart, ECAP-processed TNZ exhibited significantly enhanced compressive yield strength, plastic deformation capacity, hardness, wear, and corrosion properties. Moreover, in vitro cytocompatibility and cell adhesion studies revealed high cellular viabilities, growth and proliferation of osteoblast-like SaOS2 cells on the ECAP-processed TNZ alloy.

Comprehensive Review on the Degradation Chemistry and Toxicity Studies of Functional Materials

In recent decades there has been growing interest of material chemists in the successful development of functional materials for drug delivery, tissue engineering, imaging, diagnosis, theranostic, and other biomedical applications with advanced nanotechnology tools. The efficacy and safety of functional materials are determined by their pharmacological, toxicological, and immunogenic effects. It is essential to consider all degradation pathways of functional materials and to assess plausible intermediates and final products for quality control. This review provides a brief insight into chemical degradation mechanisms of functional materials like oxidation, photodegradation, and physical and enzymatic degradation. The intermediates and products of degradation were confirmed with analytical methods such as proton nuclear magnetic resonance (¹H NMR), gel permeation chromatography (GPC), UV-vis spectroscopy (UV-vis), infrared spectroscopy (IR), differential scanning calorimetry (DSC), mass spectroscopy, and other sophisticated analytical methods. These analytical methods are also used for regulatory, quality control, and stability purposes in industry. The assessment of degradation is important to predetermine the behavior of functional materials in specific storage conditions and can be relevant to their behavior during in vivo applications. Another important aspect is the evaluation of the toxicity of functional materials. Toxicity can be accessed with various methods using in vitro, in vivo, ex vivo, and in silico models. In vitro cell culture methods are used to determine mitochondrial damage, reactive oxygen species, stress responses, and cellular toxicity. In vitro cellular toxicity can be measured by MTT assay, LDH leakage assay, and hemolysis. In vivo studies are performed using various animal models involving zebrafish, rodents (mice and rats), and nonhuman primates. Ex vivo studies are also used for efficacy and toxicity determinations of functional materials like ex vivo potency assay and precision-cut liver slice (PCLS) models. The in silico tools with computational simulations like quantitative structure-activity relationships (QSAR), pharmacokinetics (PK) and pharmacodynamics (PD), dose and time response, and quantitative cationic-activity relationships ((Q)CARs) are used for prediction of the toxicity of functional materials. In this review, we studied the principle methods used for degradation studies, different degradation pathways, and mechanisms of functional material degradation with prototype examples. We discuss toxicity assessments with different toxicity approaches used for estimation of the safety and efficacy of functional materials.

Effects of titanium dioxide microparticles and nanoparticles on cytoskeletal organization, cell adhesion, migration, and proliferation in human gingival fibroblasts in the presence of lipopolysaccharide

BACKGROUND AND OBJECTIVE

Titanium wear particles may participate in the etiology of peri-implantitis. However, the influence of titanium wear particles on biological behavior of human gingival fibroblasts (HGFs) in the presence of LPS is still not clear. The present study demonstrated the effects of titanium dioxide micro- and nanoparticles (TiO₂  MPs and NPs) on HGF cell viability, cytoskeletal organization, adhesion, migration, and proliferation in vitro, and LPS was used to mimic the in vivo condition.

METHODS

Primary HGFs were treated with TiO₂ MPs (primary particle size <5 μm, 0.1 mg/ml) and NPs (primary particle size <100 nm, 0.1 mg/ml) with or without 1 μg/ml LPS. The effects of TiO₂ MPs and NPs on HGFs cell viability was measured by CCK-8 assay. The proliferation of HGF was detected by Ki67 nuclear staining. The confocal laser scanning microscope (CLSM) was used to detect the internalization of TiO₂ MPs and NPs in HGFs as well as the arrangement of F-actin, vinculin, and vimentin organization. Wound healing assay and transwell assay were performed to measure the migration of HGFs induced by TiO₂ MPs and NPs. Cell adhesion was measured using fibronectin-coated plates. The relative mRNA and protein expression of adhesion relative protein such as focal adhesion kinase (FAK), fibronectin (FN), and type I collagen (COL1) were measured using quantitative RT-PCR and western blot analysis. One-way analysis of variance (ANOVA) and Student's t-test were used to analyze the statistical significance, and p < .05 was considered statistically significant.

RESULTS

TiO₂ NPs significantly inhibited HGF cell viability, proliferation, and migration compared with TiO₂ MPs group and control group. Compared with control group (2.64 ± 0.09), the mean absorbance of the cells in 1 mg/ml TiO₂ MPs group and 0.25 mg/ml TiO₂ NPs group were significantly decreased to 1.93 ± 0.33 (p < .05) and 2.22 ± 0.18 (p < .01), respectively. The cytoskeleton disruption was found in TiO₂ NPs group. The mRNA and protein expression were significantly downregulated by TiO₂ NPs. Furthermore, both TiO₂ NPs and MPs induced more adverse effects on HGFs in the presence of LPS.

CONCLUSION

Our results indicate that TiO₂ NPs but not TiO₂ MPs significantly disrupt the cytoskeletal organization and inhibited cell adhesion, migration, and proliferation of HGFs. However, in the presence of LPS, TiO₂ MPs, and TiO₂ NPs enhance these negative effects in HGFs. Titanium wear particles are probably involved in the initiation and progression of peri-implant diseases.

Comparison of Corrosion Products From Implant and Various Gold-Based Abutment Couplings: The Effect of Gold Plating

This study compared titanium (Ti), palladium (Pd), platinum (Pt), and gold (Au) ion release following induced accelerated tribocorrosion from three Au alloy abutment groups coupled with Ti implants over time; investigated contacting surface structural changes; and explored the effect of Au plating. Three abutment groups, G (n = 8, GoldAdapt, Nobel Biocare), N (n = 8, cast UCLA, Biomet3i), and P (n = 8, cast UCLA, Biomet3i, Au plated), coupled with implants (Nobel Biocare), immersed in 1% lactic acid, were cyclically loaded. Ions released (ppb) at T1, T2, and T3, simulating 3, 5, and 12 months of function, respectively, were quantified by inductively coupled plasma mass spectrometry (ICP-MS) and compared. Surface degradation and fretted particle composition after T3 were evaluated with scanning electron microscopy and energy-dispersive X-ray spectroscopy (SEM/EDX). ICP-MS data were nonparametric, expressed as medians and interquartile ranges. SEM/EDX showed pitting, crevice corrosion, and fretted particles on the components. Released ion concentrations in all groups across time significantly decreased for Pd (P < .001, median range: 1.70-0.09), Pt (P = .021, 0.55-0.00), and Au (P < .001, 1.01-0.00) and increased for Ti (P = .018, 2.49-5.84). Total Ti release was greater than other ions combined for G (P = .012, 9.86-2.30) and N (P < .001, 13.59-5.70) but not for P (P = .141, 8.21-3.53). Total Ti release did not differ between groups (P = .36) but was less variable across group P. On average, total ion release was 13.77 ppb (interquartile range 8.91-26.03 ppb) across the 12-month simulation. Tribocorrosion of Ti implants coupled with Au abutments in a simulated environment was evidenced by fretted particles, pitting, and crevice corrosion of the coupling surfaces and release of ions. More Ti was released compared with Pd, Pt, and Au and continued to increase with time. Abutment composition influenced ion release. Au-plated abutments appeared to subdue variation in and minimize high-concentration spikes of titanium.

Differences in the effect of surface texturing on the wear loss of β-type Ti-Nb-Ta-Zr and (α+β)-type Ti-6Al-4V ELI alloys in contact with zirconia in physiological saline solution

The effectiveness of dimple surface texturing via picosecond pulsed laser processing for reducing wear loss was investigated using two types of titanium alloys, β-type Ti-29Nb-13Ta-4.6Zr (TNTZ) and α+β-type Ti-6Al-4V ELI (Ti64). The two alloys showed different modes of wear against zirconia. As the sliding distance increased, the wear loss was observed to increase for Ti64, but not necessarily for TNTZ. The wear debris of Ti64 acted as abrasive particles, but that of TNTZ easily adhered to the surface, and the adhered wear debris turned into a hard wear-protective layer. Therefore, the dependence of wear loss on the sliding distance for these two titanium alloys could be attributed to the difference in the roles of wear debris between each titanium alloy and zirconia. Further, depending on this difference in wear mode, the effect of dimple surface texturing on the wear was found to be different in Ti64 and TNTZ. As the dimples can trap the wear debris, they are effective for reducing wear in Ti64 but are detrimental in TNTZ.

Influence of Process Parameters on the Tribological Behavior of PEO Coatings on CP-Titanium 4+ Alloys for Biomedical Applications

Wear resistant ceramic coatings were generated on novel commercially pure titanium grade 4+ alloys by the plasma electrolytic oxidation technique (PEO) in an aluminate and zirconia containing electrolyte. The coatings were obtained adopting a full regular two-level factorial design of experiments (DoE) varying the PEO process parameters current density, repetition rate and duty cycle. The generated coatings were characterized with respect to its wear resistance and mechanical properties by reciprocal ball-on-flat tests and nanoindentation measurements. Thickness, morphology and phase formation of the PEO coatings was analyzed by scanning electron microscopy (SEM/EDS) and X-ray diffraction. XRD results indicate the formation of crystalline aluminium titanate (TiAl2O5) as well as t-ZrO2 and alumina leading to an increase in hardness and wear resistance of the PEO coatings. Evaluation of the DoE’s parameter interaction shows that the main effects for generating wear resistant coatings are current density and repetition rate. In particular, the formation of mechanically stable and adhesive corundum and zirconia containing coatings with increasing current density and frequency turned out to be responsible for the improvement of the tribological properties. Overall, the PEO processing significantly improves the wear resistance of the CP titanium base alloy.

Bacteria co-culture adhesion on different texturized zirconia surfaces

Zirconia is becoming reckoned as a promising solution for different applications, in particular those within the dental implant investigation field. It has been proved to successfully overcome important limitations of the commonly used titanium implants. The adhesion of microorganisms to the implants, in particular of bacteria, may govern the success or the failure of a dental implant, as the accumulation of bacteria on the peri-implant bone may rapidly evolve into periodontitis. However, bacterial adhesion on different zirconia architectures is still considerably unknown. Therefore, the adhesion of Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa to zirconia surfaces with different finishings was evaluated and compared to a titanium surface. The adhesion interaction between S. aureus and P. aeruginosa was also evaluated using a co-culture since these bacteria are infamous due to their common presence in chronic wound infections. Results showed that different bacterium species possess different properties which influence their propensity to adhere to different roughness levels and architectures. E. coli revealed a higher propensity to adhere to zirconia channelled surfaces (7.15 × 10⁶ CFU/mL), whereas S. aureus and P. aeruginosa adhered more to the titanium control group (1.07 × 10⁵ CFU/mL and 8.43 × 10⁶ CFU/mL, respectively). Moreover, the co-culture denoted significant differences on the adhesion behaviour of bacteria. Despite not having shown an especially better behaviour regarding bacterial adhesion, zirconia surfaces with micro-channels are expected to improve the vascularization around the implants and ultimately enhance osseointegration, thus being a promising solution for dental implants.

Recent Progress on Wear-Resistant Materials: Designs, Properties, and Applications

There has been tremendous interest in the development of different innovative wear-resistant materials, which can help to reduce energy losses resulted from friction and wear by ≈40% over the next 10-15 years. This paper provides a comprehensive review of the recent progress on designs, properties, and applications of wear-resistant materials, starting with an introduction of various advanced technologies for the fabrication of wear-resistant materials and anti-wear structures with their wear mechanisms. Typical strategies of surface engineering and matrix strengthening for the development of wear-resistant materials are then analyzed, focusing on the development of coatings, surface texturing, surface hardening, architecture, and the exploration of matrix compositions, microstructures, and reinforcements. Afterward, the relationship between the wear resistance of a material and its intrinsic properties including hardness, stiffness, strength, and cyclic plasticity is discussed with underlying mechanisms, such as the lattice distortion effect, bonding strength effect, grain size effect, precipitation effect, grain boundary effect, dislocation or twinning effect. A wide range of fundamental applications, specifically in aerospace components, automobile parts, wind turbines, micro-/nano-electromechanical systems, atomic force microscopes, and biomedical devices are highlighted. This review is concluded with prospects on challenges and future directions in this critical field.

Prediction of tribocorrosion processes in titanium-based dental implants using acoustic emission technique: Initial outcome

The use of dental implants is growing rapidly for the last few decades and Ti-based dental implants are a commonly used prosthetic structure in dentistry. Recently, the combined effect of corrosion and wear, called tribocorrosion, is considered as a major driving process in the early failure of dental implants. However, no previous study has reported the prediction of tribocorrosion processes in advance. Therefore, this study is a novel investigation on how the acoustic emission (AE) technique can predict tribocorrosion processes in commercially-pure titanium (cpTi) and titanium-zirconium (TiZr) alloys. In this study, tribocorrosion tests were performed under potentiostatic conditions and AE detection system associated with it captures AE data. Current evolution and friction coefficient data obtained from the potentiostatic evaluations were compared with AE absolute energy showcased the same data interpretation of tribocorrosion characteristics. Other AE data such as duration, count, and amplitude, matched more closely with other potentiostatic corrosion evaluations and delivered more promising results in the detection of tribocorrosion. Hence, AE can be consider as a tool for predicting tribocorrosion in dental implants. Experimental results also reveal Ti5Zr as one of the most appropriate dental implant materials while exposing Ti10Zr's lower effectiveness to withstand in the simulated oral environment.

Antibiofilm effects of titanium surfaces modified by laser texturing and hot-pressing sintering with silver

Peri-implant diseases are one of the main causes of dental implant failure. New strategies for dental implants manufacturing have been developed to prevent the accumulation of bacteria and related inflammatory reactions. The main aim of this work was to develop laser-treated titanium surfaces covered with silver that generate a electrical dipole to inhibit the oral bacteria accumulation. Two approaches were developed for that purpose. In one approach a pattern of different titanium dioxide thickness was produced on the titanium surface, using a Q-Switched Nd:YAG laser system operating at 1064 nm. The second approach was to incorporate silver particles on a laser textured titanium surface. The incorporation of the silver was performed by laser sintering and hot-pressing approaches. The anti-biofilm effect of the discs were tested against biofilms involving 14 different bacterial strains growth for 24 and 72 hr. The morphological aspects of the surfaces were evaluated by optical and field emission guns scanning electronical microscopy (FEGSEM) and therefore the wettability and roughness were also assessed. Physicochemical analyses revealed that the test surfaces were hydrophilic and moderately rough. The oxidized titanium surfaces showed no signs of antibacterial effects when compared to polished discs. However, the discs with silver revealed a decrease of accumulation of Porphyromonas gingivalis and Prevotella intermedia strains. Thus, the combination of Nd:YAG laser irradiation and hot-pressing was effective to produce silver-based patterns on titanium surfaces to inhibit the growth of pathogenic bacterial species. The laser parameters can be optimized to achieve different patterns, roughness, and thickness of the modified titanium layer regarding the type and region of the implant.

Cytotoxic effects of submicron- and nano-scale titanium debris released from dental implants: an integrative review

OBJECTIVE

This integrative review aimed to report the toxic effect of submicron and nano-scale commercially pure titanium (cp Ti) debris on cells of peri-implant tissues.

MATERIALS AND METHODS

A systematic search was carried out on the PubMed electronic platform using the following key terms: Ti "OR" titanium "AND" dental implants "AND" nanoparticles "OR" nano-scale debris "OR" nanometric debris "AND" osteoblasts "OR "cytotoxicity" OR "macrophage" OR "mutagenic" OR "peri-implantitis". The inclusion criteria involved articles published in the English language, until December 26, 2020, reporting the effect of nano-scale titanium particles as released from dental implants on the toxicity and damage of osteoblasts.

RESULTS

Of 258 articles identified, 14 articles were selected for this integrative review. Submicron and nano-scale cp Ti particles altered the behavior of cells in culture medium. An inflammatory response was triggered by macrophages, fibroblasts, osteoblasts, mesenchymal cells, and odontoblasts as indicated by the detection of several inflammatory mediators such as IL-6, IL-1β, TNF-α, and PGE2. The formation of a bioactive complex composed of calcium and phosphorus on titanium nanoparticles allowed their binding to proteins leading to the cell internalization phenomenon. The nanoparticles induced mutagenic and carcinogenic effects into the cells.

CONCLUSIONS

The cytotoxic effect of debris released from dental implants depends on the size, concentration, and chemical composition of the particles. A high concentration of particles on nanometric scale intensifies the inflammatory responses with mutagenic potential of the surrounding cells.

CLINICAL RELEVANCE

Titanium ions and debris have been detected in peri-implant tissues with different size, concentration, and forms. The presence of metallic debris at peri-implant tissues also stimulates the migration of immune cells and inflammatory reactions. Cp Ti and TiO₂ micro- and nano-scale particles can reach the bloodstream, accumulating in lungs, liver, spleen, and bone marrow.

Remnant oral biofilm and microorganisms after autoclaving sterilization of retrieved healing abutments

OBJECTIVE

The purpose of this study was to evaluate the sterilization effectiveness against biofilms on retrieved healing abutments used in implant dentistry.

BACKGROUND

A large number of clinicians reuse healing abutments to decrease treatment costs although it can promote infection due to the presence of remnant biofilm biomass.

METHODS

One hundred and eighty-five titanium healing abutments previously used for 3 months in oral cavity were assessed in this study. Abutments were submitted to cleaning, chemical disinfection, and autoclave sterilization according to clinical guidelines. The abutments were aseptically placed into glass tubes containing specific bacterial growth medium and then incubated for 10 days. From glass tubes with bacterial growth, 100 µl medium was transferred to Schaedler's agar for morphological identification and counting of strict anaerobes and to Columbia blood agar for presumptive identification of facultative anaerobes after incubation. Isolated strains were then identified at species level by enzymatic and biochemical tests within API microorganism detection platform. Also, polymerase chain reaction (PCR) was performed for identification of undefined strains.

RESULTS

After the standard cleaning and sterilization procedures, fifty-six (approximately 30%) retrieved abutments showed the presence of remnant biofilm biomass. The bacteria identified into the remnant biofilms covering the abutments were representative of the commensal oral microbiota including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Enterococcus faecalis.

CONCLUSION

Although some healing abutments did not reveal the existence of bacteria, organic components from biofilm biomass are still strongly adhered on the retentive micro-regions and surfaces of abutments and therefore that would support the accumulation of biofilm including pathogenic species leading to patients' cross-infections. Further studies should be performed on the assessment of different materials, design, and connections of the healing abutments associated with clinical disinfection procedures in implant dentistry.

Distribution and Chemical Speciation of Exogenous Micro- and Nanoparticles in Inflamed Soft Tissue Adjacent to Titanium and Ceramic Dental Implants

Degradation of the implant surface and particle release/formation as an inflammation catalyst mechanism is an emerging concept in dental medicine that may help explain the pathogenesis of peri-implantitis. The aim of the present study was a synchrotron-based characterization of micro- and nanosized implant-related particles in inflamed human tissues around titanium and ceramic dental implants that exhibited signs of peri-implantitis. Size, distribution, and chemical speciation of the exogenous micro- and nanosized particle content were evaluated using synchrotron μ-X-ray fluorescence spectroscopy (XRF), nano-XRF, and μ-X-ray absorption near-edge structure (XANES). Titanium particles, with variable speciation, were detected in all tissue sections associated with titanium implants. Ceramic particles were found in five out of eight tissue samples associated with ceramic implants. Particles ranged in size from micro- to nanoscale. The local density of both titanium and ceramic particles was calculated to be as high as ∼40 million particles/mm³. μ-XANES identified titanium in predominantly two different chemistries, including metallic and titanium dioxide (TiO₂). The findings highlight the propensity for particle accumulation in the inflamed tissues around dental implants and will help in guiding toxicological studies to determine the biological significance of such exposures.

A Comprehensive Review on the Corrosion Pathways of Titanium Dental Implants and Their Biological Adverse Effects

The main aim of this work was to perform a comprehensive review of findings reported by previous studies on the corrosion of titanium dental implants and consequent clinical detrimental effects to the patients. Most studies were performed by in vitro electrochemical tests and complemented with microscopic techniques to evaluate the corrosion behavior of the protective passive oxide film layer, namely TiO2. Results revealed that bacterial accumulation, dietary, inflammation, infection, and therapeutic solutions decrease the pH of the oral environment leading to the corrosion of titanium. Some therapeutic products used as mouthwash negatively affect the corrosion behavior of the titanium oxide film and promote changes on the implant surface. In addition, toothpaste and bleaching agents, can amplify the chemical reactivity of titanium since fluor ions interacting with the titanium oxide film. Furthermore, the number of in vivo studies is limited although corrosion signs have been found in retrieved implants. Histological evaluation revealed titanium macro- and micro-scale particles on the peri-implant tissues. As a consequence, progressive damage of the dental implants and the evolution of inflammatory reactions depend on the size, chemical composition, and concentration of submicron- and nanoparticles in the surrounding tissues and internalized by the cells. In fact, the damage of the implant surfaces results in the loss of material that compromises the implant surfaces, implant-abutment connections, and the interaction with soft tissues. The corrosion can be an initial trigger point for the development of biological or mechanical failures in dental implants.

Electrochemical Behavior of Ti6Al4V Alloy Used in Dental Implants Immersed in Streptococcus gordonii and Fusobacterium nucleatum Solutions

The titanium alloy, Ti6Al4V, is used in dentistry for dental implants because of its excellent resistance to corrosion and its high biocompatibility. However, periimplantitis is considered the main reason for treatment failure. The Ti6Al4V alloy was used to study the corrosion behavior for dental implant applications, using an experimental arrangement of three electrodes with the bacteria Streptococcus gordonii and Fusobacterium nucleatum, in addition to Ringer's lactate as electrolytes, at 37 °C and a pH of 5.6. Their electrochemical behavior was studied by open circuit potential (OCP) and cyclic potentiodynamic polarization (CPP) according to ASTM G3-14 and ASTM G61-11, respectively. Scanning electron microscopy (SEM) was employed to determine the morphology of the alloy studied. An experimental model, in situ, was established with the bacteria present in an oral environment to understand the electrochemical behavior of the alloy used in dental implants. The greatest corrosion in Ti6Al4V alloy was produced by the medium that contained the bacterium Streptococcus gordonii, which is considered a primary colonizer. In addition, the Ti6Al4V alloy presented uniform corrosion in the three solutions at the different exposure times showing a negative hysteresis in CPP.

Mammalian cell response and bacterial adhesion on titanium healing abutments: effect of multiple implantation and sterilization cycles

OBJECTIVE

Multiple implantations of the implant healing abutment (IHA) could adversely impact its surface properties in vivo. Furthermore, the effect of sterilization and reuse of the IHA on soft tissue viability and bacterial contamination has not been extensively studied. The goal of this study was to perform an in vitro analysis of mammalian cell viability and bacterial adhesion on the surfaces of retrieved IHA after single and multiple implantations and repetitive cycles of sterilization.

MATERIALS AND METHODS

IHA surface morphology was studied using optical microscopy. Cell viability of gingival fibroblasts (HGF-1) and oral keratinocytes (HOKg) in indirect contact with IHAs was assessed for 3 and 7 days. Immersion in bacterial culture was performed with a polyculture of Streptococcus species for 3 days and Streptococcus species with Fusobacterium nucleatum for 7 days.

RESULTS

IHAs exhibited signs of surface damage even after a single exposure to the oral cavity. Fibroblasts did not show a significant preference towards control IHAs over used IHAs, whereas keratinocytes exhibited a significant decrease in viability when exposed to IHAs after multiple implantation cycles as compared with controls. Adherent bacterial count increased with increasing number of IHA implantations for both polycultures.

CONCLUSIONS

Reusing of IHAs in vivo promoted surface degradation in addition to adversely impacting host cell viability and oral bacterial attachment in vitro. These findings show IHA reuse might potentially affect its clinical performance.

CLINICAL RELEVANCE

Careful consideration should be taken when reusing IHAs in patients because this practice can result in permanent surface changes that might affect soft tissue integration during the healing period and promote bacterial colonization.

Effects of multiple implantations of titanium healing abutments: Surface characteristics and microbial colonization

OBJECTIVE

Very few studies have investigated dental implant components involved in the early stage of healing, especially the implant healing abutment (IHA), despite its vital role in soft tissue contouring and shaping after implant placement. Although these components are labelled by the manufacturer for "single-use only," it is a common clinical practice to clean, sterilize, and reuse them.

METHODS

In the present study, IHAs after single and multiple implantations were retrieved as per standard procedures, and biological material isolated from the surface was subjected to 16S rRNA sequence analysis. The microbiome analysis was followed by cleaning and sterilization in order to replicate clinical sterilization techniques. Following sterilization, retrievals were subjected to surface characterization with optical and scanning electron microscopy to investigate surface features, and electrochemical testing was performed to evaluate corrosion behavior.

RESULTS

The microbiota was comprised of early colonizers including Streptococcus species and secondary anaerobic colonizers such as Fusobacterium, Capnocytophaga, and Prevotella species. The surface analysis revealed that irrespective of the cleaning and sterilization techniques, the pristine, homogeneous surface of the new, unused IHAs could not be restored. Both single and multiple-use IHAs had severe surface changes including discoloration, major abrasions, biological contamination, and the IHA retrievals exhibited higher corrosion rate as compared to control specimens.

SIGNIFICANCE

Reusing IHAs multiple times may not be a prudent practice as the microbial colonization and surface changes caused by using this component multiple times may affect the performance of IHAs in soft tissue healing.

Antimicrobial and Physicochemical Properties of Artificial Saliva Formulations Supplemented with Core-Shell Magnetic Nanoparticles

Saliva plays a crucial role in oral cavity. In addition to its buffering and moisturizing properties, saliva fulfills many biofunctional requirements, including antibacterial activity that is essential to assure proper oral microbiota growth. Due to numerous extra- and intra-systemic factors, there are many disorders of its secretion, leading to oral dryness. Saliva substitutes used in such situations must meet many demands. This study was design to evaluate the effect of core-shell magnetic nanoparticles (MNPs) adding (gold-coated and aminosilane-coated nanoparticles NPs) on antimicrobial (microorganism adhesion, biofilm formation), rheological (viscosity, viscoelasticity) and physicochemical (pH, surface tension, conductivity) properties of three commercially available saliva formulations. Upon the addition of NPs (20 µg/mL), antibacterial activity of artificial saliva was found to increase against tested microorganisms by 20% to 50%. NPs, especially gold-coated ones, decrease the adhesion of Gram-positive and fungal cells by 65% and Gram-negative bacteria cells by 45%. Moreover, the addition of NPs strengthened the antimicrobial properties of tested artificial saliva, without influencing their rheological and physicochemical properties, which stay within the range characterizing the natural saliva collected from healthy subjects.

Antibacterial Activity and Impact of Different Antiseptics on Biofilm-Contaminated Implant Surfaces

Several antiseptic agents have been proposed for the treatment of peri-implantitis as a complementary therapeutic strategy in addition to mechanical devices. The aim of this study was to compare six different antiseptics, as well as alternative formulations of the same chemical agent, with respect to their decontamination efficacy and impact on chemical properties of the implant surface. Titanium disks with a micro-rough surface, previously contaminated with Porphyromonas gingivalis and Streptococcus mutans biofilms, were treated for 2 min with different antiseptics (liquid sodium hypochlorite 5.25%, gel sodium hypochlorite 5.25%, liquid chlorhexidine 0.2%, gel chlorhexidine 1%, gel citric acid 40%, and gel orthophosphoric acid 37%) or sterile saline solution (control) and their antibacterial activity as well as their ability to remove biofilm were assessed by viable bacterial count and scanning electron microscopy, respectively. Spectroscopic analysis was also performed on non-contaminated disks after exposure to the antiseptics, in order to detect any change in the elemental composition of the titanium surface. All the antimicrobial formulations examined were effective against P. gingivalis and S. mutans biofilms. SEM analysis revealed however that liquid sodium hypochlorite 5.25% was more effective in dissolving biofilm residues. Spectroscopic analysis detected traces of the antiseptics, probably due to insufficient rinsing of the titanium surfaces. In conclusion, since gel formulations of these antiseptic agents possessed a similar antibacterial activity to the liquid formulations, these may be proposed as alternative treatments given their properties to avoid overflows and increase contact time without significant side effects on the bone.

Nano-scale modification of titanium implant surfaces to enhance osseointegration

The main aim of this review study was to report the state of art on the nano-scale technological advancements of titanium implant surfaces to enhance the osseointegration process. Several methods of surface modification are chronologically described bridging ordinary methods (e.g. grit blasting and etching) and advanced physicochemical approaches such as 3D-laser texturing and biomimetic modification. Functionalization procedures by using proteins, peptides, and bioactive ceramics have provided an enhancement in wettability and bioactivity of implant surfaces. Furthermore, recent findings have revealed a combined beneficial effect of micro- and nano-scale modification and biomimetic functionalization of titanium surfaces. However, some technological developments of implant surfaces are not commercially available yet due to costs and a lack of clinical validation for such recent surfaces. Further in vitro and in vivo studies are required to endorse the use of enhanced biomimetic implant surfaces. STATEMENT OF SIGNIFICANCE: Grit-blasting followed by acid-etching is currently used for titanium implant modifications, although recent technological biomimetic physicochemical methods have revealed enhanced osteoconductive and anti-microbial outcomes. An improvement in wettability and bioactivity of titanium implant surfaces has been accomplished by combining micro and nano-scale modification and functionalization with protein, peptides, and bioactive compounds. Such morphological and chemical modification of the titanium surfaces induce the migration and differentiation of osteogenic cells followed by an enhancement of the mineral matrix formation that accelerate the osseointegration process. Additionally, the incorporation of bioactive molecules into the nanostructured surfaces is a promising strategy to avoid early and late implant failures induced by the biofilm accumulation.

Tribology and Dentistry: A Commentary

Since 1966 the term “tribology” has integrated different topics like friction, lubrication and wear. After a few years, interest in this type of phenomena rapidly spread out around the world of biology and medicine, determining a new research area defined as biotribology. This commentary is conceived within this framework with the aim of underlining the close link between tribology and dentistry regarding both physiological and restorative issues. The contact between teeth requires investigation into their tribological behavior focusing on the enamel wear process against natural teeth and/or artificial teeth, allowing us to obtain useful information on the tribological behavior of restorative materials. Thus, tested materials may be natural teeth, restorative materials (metal alloys, ceramics, composites) or both. This work aims to make a contribution to underlining the need for greater standardization of tribological experimental procedures as well as to obtaining more homogeneous and indicative results on the tested tribo systems.

Tribological Capabilities of Graphene and Titanium Dioxide Nano Additives in Solid and Liquid Base Lubricants

In this study, the tribological behavior of both liquid (oil) and semi-liquid (grease) lubricants enhanced by multilayer graphene nano platelets and titanium dioxide nano powder was evaluated using ball-on-disk and shaft-on-plate tribo-meters. Oil samples for both 2D graphene nano platelets (GNP) and titanium nanopowders (TiNP) were prepared at three concentrations of 0.01 %w/w, 0.05 %w/w and 0.1 %w/w. In addition, 0.05% w/w mixtures of GNP and TiNP were prepared with three different ratios to analyze collective effects of both nano additives on friction and wear properties. For semi-liquid lubricants, 0.5% w/w concentrations were prepared for both nano additives for shaft-on-plate tests. Viscosity and oxidation stability tests were conducted on the liquid-base lubricants. Nano powders of both additive and substrate were analyzed using transmission electron microscopy (TEM) and scanning electron microscopy (SEM). In addition, Raman spectroscopy was conducted to characterize the graphene and titanium dioxide. The study shows that adding graphene and titanium dioxide individually sacrifices either the wear or friction of lubricants. However, use of both additives together can enhance friction resistance and wear preventive properties of a liquid lubricant significantly. For a semi-liquid lubricant, the use of both additives together and individually reduces friction compared to base grease.

General review of titanium toxicity

Background

Titanium is a commonly used inert bio-implant material within the medical and dental fields. Although the use of titanium is thought to be safe with a high success rate, in some cases, there are rare reports of problems caused by titanium. In most of these problematic reports, only individual reports are dominant and comprehensive reporting has not been performed. This comprehensive article has been prepared to review the toxicity of titanium materials within the medical and dental fields.

Methods

We used online searching tools including MEDLINE (PubMed), Embase, Cochrane Library, and Google Scholar by combining keywords such as “titanium implant toxicity,” “titanium implant corrosion,” “titanium implant allergy,” and “yellow nail syndrome.” Recently updated data has been collected and compiled into one of four categories: “the toxicity of titanium,” “the toxicity of titanium alloys,” “the toxicity of titanium implants,” and “diseases related to titanium.”

Results

Recent studies with regard to titanium toxicity have been increasing and have now expanded to the medical field in addition to the fields of environmental research and basic science. Problems that may arise in titanium-based dental implants include the generation of titanium and titanium alloy particles and ions deposited into surrounding tissues due to the corrosion and wear of implants, resulting in bone loss due to inflammatory reactions, which may lead to osseointegration failure of the dental implant. These titanium ions and particles are systemically deposited and can lead to toxic reactions in other tissues such as yellow nail syndrome. Additionally, implant failure and allergic reactions can occur due to hypersensitivity reactions. Zirconia implants can be considered as an alternative; however, limitations still exist due to a lack of long-term clinical data.

Conclusions

Clinicians should pay attention to the use of titanium dental implants and need to be aware of the problems that may arise from the use of titanium implants and should be able to diagnose them, in spite of very rare occurrence. Within the limitation of this study, it was suggested that we should be aware the rare problems of titanium toxicity.

Influence of contact configuration and lubricating conditions on the microtriboactivity of the zirconia-Ti6Al4V pair used in dental applications

Loosening and fracture of implanted dental crowns is a consequence of relative micromovements between the zirconia abutment and the titanium alloy of the implant, in a biochemical aggressive environment. Thus, it is important to establish the in vitro tribological testing conditions that better mimics such environment. The present work aims to evaluate the effect of ball-on-plate tests configuration on the tribological behavior of ZrO2/Ti6Al4V pair in dry and lubricated conditions, using different lubricants: water, artificial saliva solution and human saliva. Ceramic balls sliding on metallic plates (TiPlate) and metallic balls sliding on ceramic plates (TiBall) were tested and the coefficient of friction (CoF) and wear response was monitored trough nanotribological tests. Open circuit potential was also measured during the tests carried out in saline solution (artificial saliva) to access the tribochemical response. The wear mechanisms were evaluated by scanning electron microscopy and atomic force microscopy analysis. Relevant differences were found between the two configurations, with and without the presence of human saliva: TiPlate presented always a higher CoF than TiBall, which may have resulted from differences in the degradation and regeneration processes of the titanium passive film during sliding. TiBall demonstrated to be the best choice to reproduce the in vivo conditions, since the metallic surface contacts permanently with zirconia, impairing the titanium repassivation. Regarding the effect of the lubricants, it was observed that human saliva had a protective action of the surfaces, leading to the lowest CoF among the lubricants used (0.19 ± 0.05 for TiBall and 0.35 ± 0.08 for TiPlate) and neglectable wear.

Titanium Ions Promote Exogenous Calcium-Dependent Calcium Influx in Activated Jurkat T Cells: A Possible Mechanism to Explain Its Immunostimulatory Properties

Titanium and its alloys have been widely used in dental and orthopedic implants. Owing to the biotribocorrosion behavior of implants in simulated oral environment, Ti(IV) ions could be released into surrounding tissues. Current studies have found that Ti(IV) ions could affect the biological activities of immune cells in adjacent tissues and subsequently jeopardize the long-term performance of implant prostheses. However, the potential mechanism underlying its immunomodulatory properties remains unclear. Calcium signaling has been confirmed to be involved in regulation of lymphocyte immune function. Therefore, we hypothesize that Ti(IV) ions modulated T cell function through the change of intracellular calcium concentrations. This study is aimed at exploring the role of intracellular calcium responses in the modulatory effect of Ti(IV) ions on unactivated and phytohemagglutinin-activated Jurkat T cells. Here, we confirmed that Ti(IV) ions within a certain concentration range induced CD69 expression on both unactivated and activated T cells in our study. Additionally, the combined stimulation with Ti(IV) ions and PHA increased expression of IL-1β, TNF-α, and RANKL. Furthermore, we found that treatment with Ti(IV) induced a transitory increase in the levels of [Ca²⁺]_i in activated Jurkat cells, dependent on the presence of exogenous calcium. Treatment with different doses of Ti(IV) for 24 h significantly increased the levels of [Ca²⁺]_i in the activated Jurkat cells in a dose-dependent manner, but had little effect in the unactivated cells. Treatment with Ti(IV) did not significantly affect the PLCγ1 activation and inositol-1,4,5-trisphosphate (IP₃) secretion in Jurkat cells. Taken together, these data indicated that Ti(IV) enhanced calcium influx during the T cell activation, independent of IP₃-mediated intracellular calcium release. Our work provides insights into the mechanism involved in the regulation of lymphocyte behaviors under the effect of Ti(IV) ions, which may help to develop therapeutic strategies for dental implant failures.

Análise do processo de corrosão na falha clínica de mini-implantes ortodônticos

Resumo Introdução Mini-implantes ortodônticos são dispositivos de ancoragem confeccionados à base de titânio, possuindo uma camada de óxido de titânio, que desempenha função importante na resistência à corrosão. Objetivo O objetivo deste estudo foi avaliar a resistência à corrosão e a microestrutura superficial de mini-implantes novos, utilizados que foram perdidos precocemente e os que obtiveram sucesso de estabilidade, analisando se o processo de corrosão influencia a falha ou a perda de estabilidade, a fim de se comparar com as principais causas de sucesso e insucesso clínico. Material e método A amostra foi composta por 3 grupos de 7 mini-implantes divididos da seguinte maneira: Grupo C: mini-implantes na sua forma original, como são recebidos do fabricante (controle); Grupo PE: mini-implantes utilizados em pacientes e que apresentaram perda de estabilidade precoce em até 2 meses (média de 33,5 dias); Grupo E: mini-implantes utilizados em pacientes com sucesso de estabilidade (média de 230 dias). A análise visual da superfície da rosca dos mini-implantes foi feita através de microscópio eletrônico de varredura e todos foram submetidos a ensaio de polarização cíclica potenciodinâmica em potenciostato. Resultado A microestrutura superficial não foi significativamente alterada pela permanência e perda precoce de estabilidade em seus sítios ósseos. Conclusão Os dados sugeriram que a corrosão não foi fator associado à falha do dispositivo ou perda de sua estabilidade, sendo outros fatores, como o tipo do mini-implante, o seu comprimento e o local de implantação, considerados mais preponderantes com influência no seu insucesso.

Potential Causes of Titanium Particle and Ion Release in Implant Dentistry: A Systematic Review

Implant surface characteristics, as well as physical and mechanical properties, are responsible for the positive interaction between the dental implant, the bone and the surrounding soft tissues. Unfortunately, the dental implant surface does not remain unaltered and changes over time during the life of the implant. If changes occur at the implant surface, mucositis and peri-implantitis processes could be initiated; implant osseointegration might be disrupted and bone resorption phenomena (osteolysis) may lead to implant loss. This systematic review compiled the information related to the potential sources of titanium particle and ions in implant dentistry. Research questions were structured in the Population, Intervention, Comparison, Outcome (PICO) framework. PICO questionnaires were developed and an exhaustive search was performed for all the relevant studies published between 1980 and 2018 involving titanium particles and ions related to implant dentistry procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the selection and inclusion of the manuscripts in this review. Titanium particle and ions are released during the implant bed preparation, during the implant insertion and during the implant decontamination. In addition, the implant surfaces and restorations are exposed to the saliva, bacteria and chemicals that can potentially dissolve the titanium oxide layer and, therefore, corrosion cycles can be initiated. Mechanical factors, the micro-gap and fluorides can also influence the proportion of metal particles and ions released from implants and restorations.

Surface damage of dental implant systems and ions release after exposure to fluoride and hydrogen peroxide

OBJECTIVE

The aim of this study was to evaluate surface changes on dental implant systems and ions release after immersion in fluoride and hydrogen peroxide.

METHODS

Ten implant-abutment assemblies were embedded in acrylic resin and cross-sectioned along the implant vertical axis. Samples were wet ground and polished. Delimited areas of groups of samples were immersed in 1.23% sodium fluoride gel (F) or in 35% hydrogen peroxide (HP) for 16 min. Gels (n = 3) were collected from the implant surfaces and analyzed by inductively coupled plasma mass spectrometry (ICP-MS), to detect the concentration of metallic ions released from the implant systems. Selected areas of the abutment and implant (n = 15) were analyzed by atomic force microscopy (AFM) and scanning electron microscopy (SEM).

RESULTS

SEM images revealed surface topographic changes on implant-abutment joints after immersion in fluoride. Implants showed excessive oxidation within loss of material, while abutment surfaces revealed intergranular corrosion after immersion in fluoride. ICP-MS results revealed a high concentration of Ti, Al, V ions in fluoride after contact with the implant systems. Localized corrosion of implant systems could not be detected by SEM after immersion in hydrogen peroxide although the profilometry showed increase in roughness. ICP-MS showed the release of metallic ions in hydrogen peroxide medium after contact with dental implants.

CONCLUSION

Therapeutical substances such as fluorides and hydrogen peroxide can promote the degradation of titanium-based dental implant and abutments leading to the release of toxic ions.