Cobalt-chromium alloys fabricated with four different techniques: Ion release, toxicity of released elements and surface roughness

Marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser melted cobalt chromium bar: a randomized clinical trial

BACKGROUND

To assess marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser-melted cobalt chromium (Co-Cr) bars.

METHOD

This research was set to be a parallel, triple-blinded, randomised controlled trial. Twenty completely edentulous patients received new conventional complete dentures according to conventional techniques. Two implants were placed at mandibular canine areas bilaterally, and patients were randomly allocated into two equal groups: the milled Co-Cr bar group and the selective laser melted (SLM) Co-Cr bar group. Marginal bone loss (MBL), modified plaque index (mPI), modified gingival index (mGI), and probing depth (PD) were evaluated at 0-month (baseline), 6-month, and 12-month follow-up visits. Repeated measures ANOVA test and Bonferroni's post-hoc test were used for parametric data as PD, while for non-parametric data as MBL, mGI, and mPI, Mann-Whitney U test and Friedman's test were used. A P-value ≤ 0.05 was set as the statistical level of significance. The study protocol was approved by the Faculty Research Ethics Committee at Minia University (636 4/10/2022). Registration for the clinical trial was made retrospectively on clinicaltrials.gov with ID NCT06401200 at 04/30/2024.

RESULTS

The follow-up period (one year) was completed without a dropout. Regarding MBL, no statistically significant difference was found between the two groups throughout the study. However, the milled group showed significantly increased MBL from 0- to 6-month follow up period. In both groups, mPI increased significantly from 0- to 6-months post-loading. On the other hand, no statistically significant difference between the two groups was found regarding mPI and mGI throughout the study follow-up periods. The PD was significantly lower in the milled compared to the SLM group at the 6- and 12-month follow up period.

CONCLUSION

Two-implant mandibular overdenture retained with milled or SLM Co-Cr bar can provide an acceptable treatment option for completely edentulous patients regarding marginal bone loss and soft tissue outcomes.

Accurate analysis of titanium and PolyEtherEtherKetone materials as an alternative to cobalt-chrome framework in removable partial denture: A systematic review

STATEMENT OF PROBLEM

New materials have emerged in the dental field to replace the cobalt-chrome (CoCr) alloy used for the metal frameworks in removable partial denture (RPD) such as Titanium (Ti) and PolyEtherEtherKetone (PEEK). However, few studies have demonstrated their mechanical and biological performance.

PURPOSE

The purpose of this systematic review was to compare the performance of Ti and PEEK in RPD using CoCr metal framework as a reference.

MATERIAL AND METHODS

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three data bases were analyzed, including PubMed/MEDLINE, Embase and Web of Science before March 2024. Only studies assessing the mechanical and/or biological properties of RPD in Ti, PEEK and CoCr were included. The quality of the studies was assessed by using the software Rayyan. The risks of bias were assessed with the methodological index for nonrandomized studies (MINORS). The mechanical (retention force, fatigue life, deformation strength, machinability, rigidity, porosity and surface roughness) and biological (plaque indices, ion release and biocompatibility) aspects were assessed.

RESULTS

Among 138 articles identified, only 18 studies were included in this review. Majority had a low to moderate risk of bias. Retention forces and fatigue were significantly lower for Ti and PEEK than for CoCr, and the same was true for Ti rigidity. PEEK showed less deformation. Both materials were suitable for machining. In terms of biological properties, both materials showed adequate biocompatibility for clinical use.

CONCLUSION

Ti and PEEK seems to be promising as alternative materials to CoCr frameworks for RPD, in terms of both their mechanical and biological performance. However, additional studies are needed to better understand their clinical and long-term limitations to enable the best-informed clinical choice for the patients and the professionals.

SPA, Naveen J, Khan T, Khahro SH. Advancement in biomedical implant materials-a mini review

Metal alloys like stainless steel, titanium, and cobalt-chromium alloys are preferable for bio-implants due to their exceptional strength, tribological properties, and biocompatibility. However, long-term implantation of metal alloys can lead to inflammation, swelling, and itching because of ion leaching. To address this issue, polymers are increasingly being utilized in orthopedic applications, replacing metallic components such as bone fixation plates, screws, and scaffolds, as well as minimizing metal-on-metal contact in total hip and knee joint replacements. Ceramics, known for their hardness, thermal barrier, wear, and corrosion resistance, find extensive application in electrochemical, fuel, and biomedical industries. This review delves into a variety of biocompatible materials engineered to seamlessly integrate with the body, reducing adverse reactions like inflammation, toxicity, or immune responses. Additionally, this review examines the potential of various biomaterials including metals, polymers, and ceramics for implant applications. While metallic biomaterials remain indispensable, polymers and ceramics show promise as alternative options. However, surface-modified metallic materials offer a hybrid effect, combining the strengths of different constituents. The future of biomedical implant materials lies in advanced fabrication techniques and personalized designs, facilitating tailored solutions for complex medical needs.

A review on manufacturing processes of cobalt-chromium alloy implants and its impact on corrosion resistance and biocompatibility

Cobalt-Chromium (CoCr) alloys are currently used for various cardiovascular, orthopedic, fracture fixation, and dental implants. A variety of processes such as casting, forging, wrought processing, hot isostatic pressing, metal injection molding, milling, selective laser melting, and electron beam melting are used in the manufacture of CoCr alloy implants. The microstructure and precipitates (carbides, nitrides, carbonitrides, and intermetallic compounds) formed within the alloy are primarily determined by the type of manufacturing process employed. Although the effects of microstructure and precipitates on the physical and mechanical properties of CoCr alloys are well reviewed and documented in the literature, the effects on corrosion resistance and biocompatibility are not comprehensively reviewed. This article reviews the various processes used to manufacture CoCr alloy implants and discusses the effects of manufacturing processes on corrosion resistance and biocompatibility. This review concludes that the microstructure and precipitates formed in the alloy are unique to the manufacturing process employed and have a significant impact on the corrosion resistance and biocompatibility of CoCr alloys. Additionally, a historical and scientific overview of corrosion and biocompatibility for metallic implants is included in this review. Specifically, the failure of CoCr alloys when used in metal-on-metal bearing surfaces of total hip replacements is highlighted. It is recommended that the type of implant/application (orthopedic, dental, cardiovascular, etc.) should be the first and foremost factor to be considered when selecting biomaterials for medical device development.

Toxicological assessment of divalent ion-modified ZnO nanomaterials through artificial intelligence and in vivo study

The nanotechnology-driven industrial revolution widely relies on metal oxide-based nanomaterial (NM). Zinc oxide (ZnO) production has rapidly increased globally due to its outstanding physical and chemical properties and versatile applications in industries including cement, rubber, paints, cosmetics, and more. Nevertheless, releasing Zn2+ ions into the environment can profoundly impact living systems and affect water-based ecosystems, including biological ones. In aquatic environments, Zn2+ ions can change water properties, directly influencing underwater ecosystems, especially fish populations. These ions can accumulate in fish tissues when fish are exposed to contaminated water and pose health risks to humans who consume them, leading to symptoms such as nausea, vomiting, and even organ damage. To address this issue, safety of ZnO NMs should be enhanced without altering their nanoscale properties, thus preventing toxic-related problems. In this study, an eco-friendly precipitation method was employed to prepare ZnO NMs. These NMs were found to reduce ZnO toxicity levels by incorporating elements such as Mg, Ca, Sr, and Ba. Structural, morphological, and optical properties of synthesized NMs were thoroughly investigated. In vitro tests demonstrated potential antioxidative properties of NMs with significant effects on free radical scavenging activities. In vivo, toxicity tests were conducted using Oreochromis mossambicus fish and male Swiss Albino mice to compare toxicities of different ZnO NMs. Fish and mice exposed to these NMs exhibited biochemical changes and histological abnormalities. Notably, ZnCaO NMs demonstrated lower toxicity to fish and mice than other ZnO NMs. This was attributed to its Ca2+ ions, which could enhance body growth metabolism compared to other metals, thus improving material safety. Furthermore, whether nanomaterials' surface roughness might contribute to their increased toxicity in biological systems was investigated utilizing computer vision (CV)-based AI tools to obtain SEM images of NMs, providing valuable image-based surface morphology data that could be correlated with relevant toxicology studies.

Tribocorrosion and Surface Protection Technology of Titanium Alloys: A Review

Titanium alloy has the advantages of high specific strength, good corrosion resistance, and biocompatibility and is widely used in marine equipment, biomedicine, aerospace, and other fields. However, the application of titanium alloy in special working conditions shows some shortcomings, such as low hardness and poor wear resistance, which seriously affect the long life and safe and reliable service of the structural parts. Tribocorrosion has been one of the research hotspots in the field of tribology in recent years, and it is one of the essential factors affecting the application of passivated metal in corrosive environments. In this work, the characteristics of the marine and human environments and their critical tribological problems are analyzed, and the research connotation of tribocorrosion of titanium alloy is expounded. The research status of surface protection technology for titanium alloy in marine and biological environments is reviewed, and the development direction and trends in surface engineering of titanium alloy are prospected.

Effect of Fluoride Content of Mouthwashes on the Metallic Ion Release in Different Orthodontics Archwires

Metal ion release studies were carried out on three of the most commonly used orthodontic wires in the clinic: austenitic stainless steel, Ti-Mo, and superelastic NiTi, using three mouthwashes with different fluoride concentrations: 130, 200, and 380 ppm. Immersions were carried out in these mouthwashes at 37 °C for 1, 4, 7, and 14 days, and the ions released were determined by inductively coupled plasma-mass spectrometry (ICP-MS). All wires were observed by scanning electron microscopy (SEM). The results showed a moderate ion release in the stainless steel wires, with nickel and chromium values of 500 and 1000 ppb in the worst conditions for the wires: concentrations of 380 ppm fluoride and 14 days of immersion. However, in the Ti-Mo and NiTi alloys, an abrupt change in release was observed when the samples were immersed in 380 ppm fluoride concentrations. Titanium releases in Ti-Mo wires reached 200,000 ppb, creating numerous pits on the surface. Under the same conditions, the release of Ni and Ti ions from the superelastic wires also exceeded 220,000 ppb and 180,000 ppb, respectively. This release of ions causes variations in the chemical composition of the wires, causing the appearance of martensite plates in the austenitic matrix after 4 days of immersion. This fact causes it to lose its superelastic properties at a temperature of 37 °C. In the case of immersion in 380 ppm mouthwashes for more than 7 days, rich-nickel precipitates can be seen. These embrittle the wire and lose all tooth-correcting properties. It should be noted that the release of Ni ions can cause hypersensitivity in patients, particularly women. The results indicate that the use of mouthwashes with a high content of fluoride should not be recommended with orthodontic archwires.

Analytical Study Regarding the Behavior of Cr-Co and Ni-Cr in Saliva

Background and Objectives: The interaction between dental alloys and saliva affects both its own properties and those of metallic materials. Materials and Methods: Samples made of Cr-Co and Ni-Cr were studied. It was opted for corrosion under tension, scanning electron microscopy was used to characterize the surface morphology, and the chemical composition of the surface was assessed with the help of an Energy Dispersive Spectrometer. In vitro testing of the cytotoxic impact of the study eluates was carried out by flow cytometric analysis. Results: Pitting areas appear in the mass of the Ni-Cr alloy. Nickel, Manganese, and Cobalt dissolve and go into the solution. Corrosion is superficial in the case of the Cr-Co alloy, the corrosion points are shallow, and the amount of dissolved metal is relatively small. Mostly Nickel passes into the solution, unlike Chromium and Cobalt, which remain at this level. We noticed an increase in the viability of cell cultures in the case of Cr-Co alloy and a decrease in the number of living cells (87%) for Ni-Cr alloy. Conclusions: Common alloys (Ni-Cr and Cr-Co) are prone to corrosion, because they lack structural features that would shield the alloy from corrosion agents.

Minimization of Adverse Effects Associated with Dental Alloys

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

Influence of various class cleaning agents for prosthesis on Co–Cr alloy surface

Introduction

Denture cleaners should not be harmful to dental prostheses elements, but immersions in cleaner solutions during a long time of using prosthesis may cause changes on Co–Cr alloy surfaces. There are five classes of denture cleaners: alkaline hypochlorites, alkaline peroxides, disinfectants, diluted acids, and enzymes. The aim of this work was to evaluate the influence of denture cleaners solutions on the surface properties of Co–Cr alloy.

Materials and method

Specimens cast from cobalt–chromium alloy were divided into eight groups: 1 – dry; 2 – ultrapure water; 3 – 20% wt/wt sodium; 4 – 20% chlorhexidine digluconate; 5 – Correga Tabs BioFormula; 6 – 20% wt/wt citric acid; 7 – 0.5% NaOCl; and 8 – 5.0% NaOCl. After immersion in 200 mL of cleaning agent solution at 45°C in 3 years, simulation of use, surface roughness, contact angle, surface free energy (SFE), and microscopic observation was performed.

Results

For citric acid and NaOCl, roughness (R a) raised clearly. These cleaning agents also caused R q, R v, R p, and R Sm to increase the most. The observed water contact angle after using denture cleaners, especially citric acid, and NaOCl decreases, and the values of SFE increase. Under a digital microscope, the harmful effect of citric acid and solutions of NaOCl was visible.

Conclusions

Diluted acids and alkaline hypochlorites in presented concentrations influence Co–Cr surface parameters like roughness and wettability. Other classes of denture cleaning agents do not affect surface roughness parameters which make them safer for the metallic components of removable partial dentures.

New generation CAD-CAM materials for implant-supported definitive frameworks fabricated by using subtractive technologies

Innovations in digital manufacturing enabled the fabrication of implant-supported fixed dental prostheses (ISFDPs) in a wide variety of recently introduced materials. Computer-aided design and computer-aided manufacturing (CAD-CAM) milling allows the fabrication of ISFDPs with high accuracy by reducing the fabrication steps of large-span frameworks. The longevity of ISFDPs depends on the overall mechanical properties of the framework material including its fit, and the physical properties of the veneering material and its bond with the framework. This comprehensive review summarizes the recent information on millable CAD-CAM framework materials such as pre-sintered soft alloys, fiber-reinforced composite resins, PEEK, and PEKK in high-performance polymer family, and 4Y-TZP. Even though promising results have been obtained with the use of new generation millable CAD-CAM materials for ISFDPs, clinical studies are lacking and future research should focus on the overall performance of these millable materials in both static and dynamic conditions.

Latest Trends in Surface Modification for Dental Implantology: Innovative Developments and Analytical Applications

An increase in the world population and its life expectancy, as well as the ongoing concern about our physical appearance, have elevated the relevance of dental implantology in recent decades. Engineering strategies to improve the survival rate of dental implants have been widely investigated, focusing on implant material composition, geometry (usually guided to reduce stiffness), and interface surrounding tissues. Although efforts to develop different implant surface modifications are being applied in commercial dental prostheses today, the inclusion of surface coatings has gained special interest, as they can be tailored to efficiently enhance osseointegration, as well as to reduce bacterial-related infection, minimizing peri-implantitis appearance and its associated risks. The use of biomaterials to replace teeth has highlighted the need for the development of reliable analytical methods to assess the therapeutic benefits of implants. This literature review considers the state-of-the-art strategies for surface modification or coating and analytical methodologies for increasing the survival rate for teeth restoration.

Effect of Cobalt and Chromium Ions on the Chlorhexidine Digluconate as Seen by Intermolecular Diffusion

Metal ions such as cobalt (II) and chromium (III) might be present in the oral cavity, as a consequence of the corrosion of Co-Cr dental alloys. The diffusion of such metal ions into the organism, carried by saliva, can cause health problems as a consequence of their toxicity, enhanced by a cumulative effect in the body. The effect of the chlorhexidine digluconate, which is commonly used in mouthwash formulations, on the transport of these salts is evaluated in this paper by using the Taylor dispersion technique, which will allow an assessment of how the presence of chlorhexidine digluconate (either in aqueous solution or in a commercial formulation) may affect the diffusion of metal ions. The ternary mutual diffusion coefficients of metal ions (Co and Cr) in the presence of chlorhexidine digluconate, in an artificial saliva media, were measured. Significant coupled diffusion of CoCl₂ (and CrCl₃) and chlorhexidine digluconate is observed by analysis of the non-zero values of the cross-diffusion coefficients, D₁₂ and D₂₁. The observed interactions between metal ions and chlorhexidine digluconate suggest that the latter might be considered as an advantageous therapeutic agent, once they contribute to the reduction of the concentration of those ions inside the mouth.

Experimental Study Regarding the Behavior at Different pH of Two Types of Co-Cr Alloys Used for Prosthetic Restorations

Cobalt-chromium (Co-Cr) alloys are widely utilized in dentistry. The salivary pH is a significant factor, which affects the characteristics and the behavior of dental alloys through corrosion. This study aimed to evaluate the corrosion behavior in artificial saliva with different pH values (3, 5.7, and 7.6) of two commercial Co-Cr dental alloys manufactured by casting and by milling. Corrosion resistance was determined by the polarization resistance technique, and the tests were carried out at 37 ± 1 °C, in Carter Brugirard artificial saliva. After the electrochemical parameters, it can be stated that the cast Co-Cr alloy has the lowest corrosion current density, the highest polarization resistance, and the lowest speed of corrosion in artificial saliva with pH = 7.6. In the case of milled Co-Cr alloy, the same behavior was observed, but in artificial saliva with pH = 5.7, it recorded the most electropositive values of open circuit potential and corrosion potential. Although both cast and milled Co-Cr alloys presented a poorer corrosion resistance in artificial saliva with a more acidic pH value, the milled Co-Cr alloy had better corrosion behavior, making this alloy a better option for the prosthetic treatment of patients suffering from GERD.

Ion Release from Dental Implants, Prosthetic Abutments and Crowns under Physiological and Acidic Conditions

Ion release from dental implants and prosthetic restoration can affect osteointegration and implant viability over a long period of time. Therefore, the aim of this study was to study the ion release from implants and crowns, with and without intermediate anodized abutments, in two different media, simulating clinical conditions. The implants, intermediate prosthetic abutments and Cr–Co crowns were divided into two groups depending on the media: Hanks’ solution and 1% lactic acid, simulating body fluids and microbiologically conditioned fluids, respectively. The study followed the ISO 10271:2011 and 10993-15:2000 standards modified to simulate the replacement of fluids in the oral environment. The ions’ release was measured by inductively coupled plasma mass spectroscopy (ICP-EOS), and only aluminum, chromium, cobalt, titanium and vanadium were identified. Ion concentration was higher in lactic acid than in Hanks’ solution at all time points (p < 0.05). Only vanadium showed a very low ion release in lactic acid, with no statistically significant differences from the ion release in Hanks’ solution (p = 0.524). Both anodized abutments and the immersion medium influenced the release of ions and affected the corrosion of these structures. The presence of an intermediate anodized abutment also affected ion release, as the level of ions was lower in groups with this component.

Cobalt–Chromium Dental Alloys: Metal Exposures, Toxicological Risks, CMR Classification, and EU Regulatory Framework

During the 20th century, metal alloys have assumed an important role as restorative materials. Among existing examples, cobalt–chromium (Co–Cr) alloys increasingly began to be used in medicine and especially in dentistry. Their success is mainly due to their mechanical properties such as stiffness, strength and corrosion resistance, thus allowing a high biocompatibility. There are quite meaningful data on the corrosion and toxicity of Co–Cr alloys for their use in restorative materials such as dental prostheses. Toxicological studies following Co and Cr exposures in the oral cavity are more difficult to conduct because there are many different situations leading to the release of metal ions and wear particles. Furthermore, the links between exposure and the appearance of local or systemic toxicity are not automatic. Since 2017, the European Union (EU) regulatory framework for Co–Cr alloys has been undergoing profound changes. A new EU Medical Devices Regulation (MDR) (2017/745) will be applied in May 2021 with the need to consider that Co metal is a new carcinogenic, mutagenic and toxic to reproduction (CMR) substance. On 18 February 2020, the 14th Adaptation to Technical Progress (ATP14) to the Classification, Labelling and Packaging (CLP) regulation was published, including the harmonised classification for Co metal as a CMR 1B substance. In this context, the use of Co might be forbidden if the medical devices are invasive and as soon as they include more than 0.1% (m/m) Co. This review provides a specific overview on Co–Cr dental alloys in terms of metal ions and wear particles release, toxicological risks, and the actual and new EU regulatory framework.