Dental Titanium Implants and Chronic Inflammation

The quote itself is somewhat contradictory. Just as an infected tooth or periodontal ligament can “induce inflammation in the surrounding tissue over time...”, so may an infected implant do the same. I am wondering if the purpose of that statement is to pose a situation wherein no one can say it cannot happen? However, when an implant is in a healthful state capable of growing NEW bone over the top, such as many Bicon installations, fearing the “induced inflammation of surrounding tissues...” seems nonsensical. I.e. , if ANY implant is present in a healthy, non-infected, growing environment, such fears should be minimal. There is almost always some inflammatory process found along tissue boundaries. ANYTHING infected in the bone - teeth, implants, ligaments, tissues - will induce inflammation in the surrounding tissues. This is no mystery. The question is whether or not the levels are abnormal.

So sorry, I confused “surrounding tissue” with local tissue.

I think you could say that the statement is designed to be inflammatory. Inflammation is part of the body’s healing response so of course there will be an inflammatory response after an extraction and also implant placement. The author also states that most times this leads to uneventful healing. Nothing new about that. However the author then says that titanium implants can lead to local inflammation. We all know that unless maintained, implants can suffer from implantitis. However the same happens with teeth which are not maintained – a local inflammation called gingivitis or periodontitis. Nothing new about that. The author then states that inflammation can lead to the “expression” of certain mediators which can cause other health issues. Again nothing new about that. Periodontal disease has been implicated in many general health problems – although it is fair to say that many of these theories are not conclusive. The issues to determine are whether it is local infection causing the local inflammation or the actual titanium metal. If the metal, is it any worse than the same response to a normal restoration placed in a tooth? Is the potential proposal that titanium implants should not be placed? Is there an implication that ceramic implants should be used in preference to titanium? Are we heading down the same road as the amalgam versus resin debate? Or is the ultimate proposal that teeth should all be extracted with no replacements because of the possible inflammatory response to infection or inflammation of unknown causes? This type of debate has happened numerous times over the last 150 years. The profession has worked through the issues sensibly over time and I am sure the same will happen again. At the end of the day, we need scientific evidence before we make hasty decisions. Having said all this, this forum has more recently debated the philosophy that (where possible) saving teeth should be the preference to extracting and placing implants. I think it is reasonable to say this debate has not had a final conclusion – yet. However this recent post may eventually add another twist.

We have heard of cases where patients have a bad reaction to titanium...but very rare.To my knowledge there are no tests that can be done other than placing a titanium implant, and watching the results....however, when antibiotics were first prescribed, the early practitioners were not aware of an allergy to penicillin...… we know that titanium is generally well tolerated in human tissues …. and we have not heard of a titanium allergy bringing on an anaphylactic reaction.... we just have to keep trying until we find a better material to replace teeth.

I have an opinion which will not be very popular on this forum but here it is. The vast majority of dentists placing implants have very little, if any, appreciation for the relationship between surrounding mucossa/gingiva and over oral health. Docs go to courses and learn a cookbook recipe for "drill hole in bone-place screw in bone-wait-place restoration on screw". These docs feel that implants are one stop shop for permanent tooth replacement solution and as a result place them in unfavorable environment thus causing more inflammation. This inflammation while initially localized is systemic. 2+mm of attached gingiva is recommended around teeth and by the way the same is true for implants.

If you want to go down this rabbit hole you should check the following website: www.cleanimplant.com I would be interested to know which implants were used in this study you are talking about and the parameters the study was based on

It is clear from research, that the titanium particles from the drill bits, the machined implant and from the breakdown of the implant surface that the white blood cells (Macrophages) take up titanium. The unanswered question is "how much inflammation is bad?" and "for whom?" Dr Rudick is right. It will take time, research and open mindedness for those of us that enjoy the benefits of implantology.

So, no more hip replacements? heart valves? Bone fracture stabilisation? Lets wait for more studies... Keep up the good work!

I think that something needs to be put into an informed consent form of the possibility of titanium causing chronic inflammation and a hyper response of the immune system

I believe the comments of the article (which i have not read) are related to the effects of metal wear on dynamic implants such as hips, knees shoulders and TMJ joint replacements. In my practice when performing TMJ Total joint replacements patients are always advised of these small but potential consequences of the procedures and prosthesis. I do not however advise patients of metal degradation on dental implants as they are static in my opinion and have no wear to cause debri. Periodontal involvement around implants like teeth is a separate issue.

At this time titanium implants are the best and most versatile option we have to offer our patients to replace missing and diseased teeth in almost every situation and while “titanium allergy” is currently being proposed and investigated and the option of zirconia implants appears promising, they are not as versatile prosthetically nor as widely accepted...but they may be an answer to your delima.

Do micro/nano particles of titanium leach out of/off of an implant surface in biologic tissue ? Yep. Is it enough to cause the body to respond with chronic inflammation. Apparently not according to current studies ( or lack thereof ). Like everything else, time will tell. The lawyers will let us all know.

Special thanks to Dr. Moe for posting this. My initial response was due to my naïveté on the advances and discoveries in allergic and inflammatory reactions, as well as the human tendency to try to break down unfamiliar input. Sorry for that... ‘Having now studied this paper, I have a better understanding of how a non-inflammatory, perhaps allergic, response in one area of the body can bring about catastrophic conditions in distant tissues. Thanks again!

Noting that women are more at risk than men, it should be noted that Titanium Dioxide is a common component of makeups, powders, lotions, sunscreens, etc.. Could this type of exposure sensitize a person to the Titanium in Implants? Could there be some confusion regarding the source of Titanium in different tissues?

Another consideration regarding the body’s response to hip and knee replacements is the use of polymethyl methacrylate in the initial stability. Even epoxy can suffer an amine blush where the unset tertiary amines surface.

My husband had two dental studs (?screws) place upper gum two years ago for clip on dentures. Nine years ago he had a knee replacement—no problems ever since — until this past July he developed an infection in that knee, requiring cleaning out the knee joint replacement etc and got a picc line and 40 days of Xozyn antibiotics Every 6 hrs. All was well, but now his knee has a slight effusion starting, pain, Sed rate & CRP labs elevated today. Could the bacteria come from the dental studs? This is just terrible. Help! Laurie