Fit and forget: The future of dental implant therapy via nanotechnology

Unlike orthopedic implants, dental implants require the orchestration of both osseointegration at the bone-implant interface and soft-tissue integration at the transmucosal region in a complex oral micro-environment with ubiquitous pathogenic bacteria. This represents a very challenging environment for early acceptance and long-term survival of dental implants, especially in compromised patient conditions, including aged, smoking and diabetic patients. Enabling advanced local therapy from the surface of titanium-based dental implants via novel nano-engineering strategies is emerging. This includes anodized nano-engineered implants eluting growth factors, antibiotics, therapeutic nanoparticles and biopolymers to achieve maximum localized therapeutic action. An important criterion is balancing bioactivity enhancement and therapy (like bactericidal efficacy) without causing cytotoxicity. Critical research gaps still need to be addressed to enable the clinical translation of these therapeutic dental implants. This review informs the latest developments, challenges and future directions in this domain to enable the successful fabrication of clinically-translatable therapeutic dental implants that would allow for long-term success, even in compromised patient conditions.

Bio-Tribocorrosion of Titanium Dental Implants and Its Toxicological Implications: A Scoping Review

Bio-tribocorrosion is a phenomenon that combines the essentials of tribology (friction, wear, and lubrication) and corrosion with microbiological processes. Lately, it has gained attention in implant dentistry because dental implants are exposed to wear, friction, and biofilm formation in the corrosive oral environment. They may degrade upon exposure to various microbial, biochemical, and electrochemical factors in the oral cavity. The mechanical movement of the implant components produces friction and wear that facilitates the release of metal ions, promoting adverse oro-systemic reactions. This review describes the bio-tribocorrosion of the titanium (Ti) dental implants in the oral cavity and its toxicological implications. The original research related to the bio-tribo or tribocorrosion of the dental implants was searched in electronic databases like Medline (Pubmed), Embase, Scopus, and Web of Science. About 34 studies included in the review showed that factors like the type of Ti, oral biofilm, acidic pH, fluorides, and micromovements during mastication promote bio-tribocorrosion of the Ti dental implants. Among the various grades of Ti, grade V, i.e., Ti6Al4V alloy, is most susceptible to tribocorrosion. Oral pathogens like Streptococcus mutans and Porphyromonas gingivalis produce acids and lipopolysaccharides (LPS) that cause pitting corrosion and degrade the TiO₂. The low pH and high fluoride concentration in saliva hinder passive film formation and promote metal corrosion. The released metal ions promote inflammatory reactions and bone destruction in the surrounding tissues resulting in peri-implantitis, allergies, and hyper-sensitivity reactions. However, further validation of the role of bio-tribocorrosion on the durability of the Ti dental implants and Ti toxicity is warranted through clinical trials.

Diffusion of Vanadium Ions in Artificial Saliva and Its Elimination from the Oral Cavity by Pharmacological Compounds Present in Mouthwashes

In this study, diffusion coefficients of ammonium vanadate at tracer concentrations in artificial saliva with and without sodium fluoride, at different pH values, were measured using an experimental model based on the Taylor dispersion technique. Ternary mutual diffusion coefficients (D11, D22, D12, and D21) for four aqueous systems {NH4VO3 (component 1) + β-cyclodextrin (β-CD) (component 2),} {NH4VO3 (component 1) + β-cyclodextrin (HP-β-CD) (component 2)}, {NH4VO3 (component 1) + sodium dodecyl sulphate (SDS) (component 2)} and {NH4VO3 (component 1) + sodium hyaluronate (NaHy) (component 2)} at 25.00 °C were also measured by using the same technique. These data showed that diffusion of ammonium vanadate was strongly affected in all aqueous media studied. Furthermore, a significant coupled diffusion of this salt and β-CD was observed through the non-zero values of the cross-diffusion coefficients, D12, allowing us to conclude that there is a strong interaction between these two components. This finding is very promising considering the removal, from the oral cavity, of vanadium resulting from tribocorrosion of Ti-6Al-4V prosthetic devices.

Corrosion Behavior of Selective Laser Melting (SLM) Manufactured Ti6Al4V Alloy in Saline and BCS Solution

The frequency of surgeries involving the use of metal implants in orthopedic medicine to replace degenerative or fractured joints is increasing, and it is therefore important to optimize the lifespan and quality of these implants. Advances in additive manufacturing (AM), or 3D printing, are creating new opportunities to personalize implants in ways that reduce mechanical stress at the joint implant interface and improve bone ingrowth and implant stability; however, it is not well understood if and to what degree the AM process alters the corrosion behavior of the materials it produces. In this study, six Ti6Al4V prints manufactured via a selective laser melting (SLM) method were examined regarding their corrosion behavior in both saline and bovine calf serum (BCS) solutions. Ecorr and Icorr values were comparable between the CM-Ti6Al4V control and SLM-EDM surfaces; however, SLM surfaces were found to have more narrow passivation behavior evidenced by significant decreases in Epass values relative to CM-Ti6Al4V. We believe this is a consequence of microstructural differences between CM-Ti6Al4V and SLM-Ti6Al4V. Specifically, the SLM-Ti6Al4V demonstrated a dominant α' martensitic microstructure and decreased vanadium-rich β-phase. BCS solution had a detrimental effect on potential parameters, Ecorr and OCP, decreasing these values relative to their saline counterparts. Increased surface roughness of the SLM-printed surface seemed to amplify the effects of the BCS solution. Furthermore, modest decreases in Epass and Ipass were observed in BCS solution, suggesting that the presence of protein may also interfere with passivation behavior. These findings have implications for how SLM-Ti6Al4V implants will perform in vivo and could possibly influence implant longevity and performance.

The Impact of Early Saliva Interaction on Dental Implants and Biomaterials for Oral Regeneration: An Overview

The presence of saliva in the oral environment is relevant for several essential health processes. However, the noncontrolled early saliva interaction with biomaterials manufactured for oral rehabilitation may generate alterations in the superficial properties causing negative biological outcomes. Therefore, the present review aimed to provide a compilation of all possible physical-chemical-biological changes caused by the early saliva interaction in dental implants and materials for oral regeneration. Dental implants, bone substitutes and membranes in dentistry possess different properties focused on improving the healing process when in contact with oral tissues. The early saliva interaction was shown to impair some positive features present in biomaterials related to quick cellular adhesion and proliferation, such as surface hydrophilicity, cellular viability and antibacterial properties. Moreover, biomaterials that interacted with contaminated saliva containing specific bacteria demonstrated favorable conditions for increased bacterial metabolism. Additionally, the quantity of investigations associating biomaterials with early saliva interaction is still scarce in the current literature and requires clarification to prevent clinical failures. Therefore, clinically, controlling saliva exposure to sites involving the application of biomaterials must be prioritized in order to reduce impairment in important biomaterial properties developed for rapid healing.

Corrosion Behavior of a Nickel-Base Dental Casting Alloy in Artificial Saliva Studied by Weight Loss and Polarization Techniques

Objectives:

Nickel-chromium (Ni-Cr) base dental alloys with desirable properties have been employed in prosthodontics for years. Corrosion behavior of a Ni-Cr base alloy in artificial saliva with different pH values is determined in this work.

Materials and Methods:

Corrosion behavior of Ni-Cr alloy was studied in artificial saliva with different pHs (2.5, 5, 7, and 9), using weight loss described by corrosion rate (CR) in mils per year (mpy) and potentiodynamic polarization described by corrosion potential (CP) in mV and current density (CD) in mA/cm². Surface morphology was assessed using scanning electron microscopy (SEM). Statistical difference was determined using one-way ANOVA and post-hoc Tukey’s honestly significant difference test with a difference significance of 95%.

Results:

In the weight loss method, CR was 71.95±3.40, 17.26±1.03, 8.92±0.35, and 6.93±0.54 mpy at pH values of 2.5, 5, 7, and 9, respectively. Significant differences in CR were observed only at pH=2.5, while in CD, they were found at PH=2.5 and 5 (P<0.05). In the polarization method, CP values were significantly different. SEM exhibited the formation of preferential sites of corrosion attacks influenced by pH.

Conclusion:

Both techniques revealed consistent results. Corrosion resistance increases as pH increases towards less acidic conditions. In more acidic saliva, the corrosion rate is greater. The less acidic saliva leads to formation of a more stable passive film on Ni, and the dissolution of Ni decreases, leading to lower CRs.

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.

Wear and Corrosion Interactions at the Titanium/Zirconia Interface: Dental Implant Application

PURPOSE

Dental implants have been shown to have predictable success, but esthetic complications often arise. To reduce tissue shadowing from titanium, zirconia abutments may be used; however, the literature suggests that the use of zirconia leads to greater destruction of the implant interface that may result in biological complications such as titanium tattoos and heavy metal toxicity. Previous studies have examined the mechanical aspects of this implant/abutment relationship, but they have not accounted for the corrosive degradation that also takes place in the dynamic environment of the oral cavity. This study investigated the combined effect of both wear and corrosion on the materials at the implant and abutment interface.

MATERIALS AND METHODS

Using a simulated oral tribocorrosive environment, titanium (Ti) and zirconia (Zr) abutment materials were slid against titanium and Roxolid implant alloys. The four couplings (Ti/Ti, Ti/Rox, Zr/Ti, Zr/Rox) were selected for the tribocorrosion tests (N = 3). The testing was conducted for 25K cycles, and the coefficient of friction (CoF) and voltage evolution were recorded simultaneously. Following the tribocorrosion assays, the wear volume loss was calculated, and surface characterization was performed. Statistical analysis was completed using a one-way ANOVA followed by post-hoc Bonferroni comparisons.

RESULTS

Zr/Ti groups had the highest CoF (1.1647), and Ti/Ti had the lowest (0.5033). The Zr/Ti coupling generated significantly more mechanical damage than the Ti/Ti group (p = 0.021). From the corrosion aspect, the Ti/Ti groups had the highest voltage drop (0.802 V), indicating greater corrosion susceptibility. In comparison, the Zr/Roxolid group had the lowest voltage drop (0.628 V) and significantly less electrochemical degradation (p = 0.019). Overall, the Ti/Ti group had the largest wear volume loss (15.1 × 10⁷ μm³ ), while the Zr/Ti group had the least volume loss (2.26 × 10⁷ μm³ ). Both zirconia couplings had significantly less wear volume than the titanium couplings (p < 0.001).

CONCLUSIONS

This study highlights the synergistic interaction between wear and corrosion, which occurs when masticatory forces combine with the salivary environment of the oral cavity. Overall, the zirconia groups outperformed the titanium groups. In fact, the titanium groups generated 5 to 6 times more wear to the implant alloys as compared with the zirconia counterparts. The best performing group was Zr/Ti, and the worst performing group was Ti/Ti.

Initial investigation of the corrosion stability of craniofacial implants

STATEMENT OF PROBLEM

Although craniofacial implants have been used for retention of facial prostheses, failures are common. Titanium undergoes corrosion in the oral cavity, but the corrosion of craniofacial implants requires evaluation.

PURPOSE

The purpose of this in vitro study was to investigate the corrosion stability of commercially pure titanium (CP Ti) exposed to simulated human perspiration at 2 different pH levels (5.5 and 8).

MATERIAL AND METHODS

Fifteen titanium disks were divided into 3 groups (n=5 per group). The control group was subjected to simulated body fluid (SBF) (control). Disks from the 2 experimental groups were immersed in simulated alkaline perspiration (SA_KP) and simulated acidic perspiration (SA_CP). Electrochemical tests, including open circuit potential (3600 seconds), electrochemical impedance spectroscopy, and potentiodynamic tests were performed according to the standardized method of 3-cell electrodes. Data were analyzed by 1-way ANOVA and the Tukey honestly significant difference tests (α=.05).

RESULTS

Simulated human perspiration reduced the corrosion stability of CP Ti (P<.05). The SBF group presented the lowest capacitance values (P<.05). SA_KP and SA_CP groups showed increased values of capacitance and showed no statistically significant differences (P>.05) from each other. The increase in capacitance suggests that the acceleration of the ionic exchanges between the CP Ti and the electrolyte leads to a lower corrosion resistance. SA_KP reduced the oxide layer resistance of CP Ti (P<.05), and an increased corrosion rate was noted in both simulated human perspiration groups.

CONCLUSIONS

Craniofacial implants can corrode when in contact with simulated human perspiration, whereas alkaline perspiration shows a more deleterious effect. Perspiration induces a more corrosive effect than simulated body fluid.

The effect of fretting associated periodic cathodic potential shifts on the electrochemistry and in vitro biocompatibility of commercially pure titanium

This study explored how periodic cathodic polarization of commercially pure titanium (cpTi) alters its electrochemical properties and biocompatibility. MC3T3-E1 preosteoblast cells were cultured directly on cpTi samples and maintained at open circuit potential (OCP) for 24 h followed by an additional 24-h sequence of periodic cathodic polarization to -1000 or -750 mV (vs. Ag/AgCl) for 1 s followed by a 5-s recovery at OCP. Control experiments were performed where the samples were maintained at OCP throughout the entire test. Subsequent electrochemical impedance spectroscopy revealed both of the periodic cathodic polarization conditions significantly reduced the polarization resistance (R_p ), while only the -1000 mV condition significantly increased the capacitance (C) as compared to the controls. Scanning electron micrographs showed that the cells were fragmented and balled up on the samples periodically shifted to -1000 mV as compared to the cells that were well spread on the controls and samples periodically shifted to -750 mV. Additionally, live/dead fluorescence microscopy revealed that periodic polarizations to -1000 mV reduced cell viability to around 12% as compared to the greater than 95% cell viability observed on the controls and samples periodically polarized to -750 mV. This work showed that periodic cathodic potential shifts can notably alter the electrochemical behavior of cpTi and the viability and morphology of cells seeded directly onto its surface. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1591-1601, 2016.

Effects of Peracetic Acid on the Corrosion Resistance of Commercially Pure Titanium (grade 4)

The aim of this study was to evaluate the corrosion resistance of pure titanium grade 4 (cp-Ti-4), subjected to disinfection with 0.2% and 2% peracetic acid during different immersion periods using anodic potentiodynamic polarization test in acid and neutral artificial saliva. Cylindrical samples of cp-Ti-4 (5 mm x 5 mm) were used to fabricate 24 working electrodes, which were mechanically polished and divided into eight groups (n=3) for disinfection in 2% and 0.2% peracetic acid for 30 and 120 min. After disinfection, anodic polarization was performed in artificial saliva with pH 4.8 and 6.8 to assess the electrochemical behavior of the electrodes. A conventional electrochemical cell, constituting a reference electrode, a platinum counter electrode, and the working electrode (cp-Ti specimens) were used with a scanning rate of 1 mV/s. Three curves were obtained for each working electrode, and corrosion was characterized by using scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS). Data of corrosion potential (Ecorr) and passive current (Ipass) obtained by the polarization curves were analyzed statistically by Student's t-test (a=0.05). The statistical analysis showed no significant differences (p>0.05) between artificial saliva types at different concentrations and periods of disinfection, as well as between control and experimental groups. No surface changes were observed in all groups evaluated. In conclusion, disinfection with 0.2% and 2% peracetic acid concentrations did not cause corrosion in samples manufactured with cp-Ti-4.