Dental
Orthopedic
Medical
Environment
Basic
Titanium toxicity
82
102
150
252
643
Titanium alloy toxicity
42
30
35
5
37
Titanium implant toxicity
37
56
22
3
74
Titanium implant corrosion
145
63
22
7
220
Titanium allergy
22
26
20
2
15
Yellow nail syndrome
–
–
250
–
6
Total
328
277
499
269
995
1991–1995
1996–2000
2001–2005
2006–2010
2011–2015
2016–2018
Titanium toxicity
30
58
81
216
432
412
Titanium alloy toxicity
12
17
30
18
40
32
Titanium implant toxicity
8
20
30
26
53
55
Titanium implant corrosion
20
48
59
88
122
120
Titanium allergy
2
5
5
21
22
30
Yellow nail syndrome
22
30
31
39
61
73
...
Conclusion
Titanium is used in many fields in addition to being used in dental implants. As the use of titanium increases, concerns over safety are increasing as well. In recent years, studies with regard to titanium toxicity have been on the rise. Although they have mainly been focused on environmental and basic fields, studies are now expanding into the medical field. Thus, there is a need fo...
Alternative methods of implant materials are under investigation for the risk of titanium. Typically, these include zirconia and polyetheretherketone (PEEK) dental implants. These materials are considered to be alternatives to the hypersensitivity of titanium and are aimed at improving esthetics. Currently, zirconia is a clinically applied material for dental implants. There have been many s...
The next issue involves looking at the potential threats of titanium. Titanium is currently used in a wide range of fields. As such, there are many studies with regard to environment safety in the field and basic science. Such titanium is primarily used as titanium oxide nanoparticles. Animal experiments, especially in rodents, are being conducted to study the effects of titanium oxide nanop...
Titanium is known to yield fewer allergic reactions than other metals such as nickel and palladium. However, as mentioned in the "Results" section, titanium allergy symptoms have been reported in some cases. These symptoms can occur systemically with inflammation of the mouth, erythema, etc. Therefore, any history or suspicion of a titanium allergy would be considered prior to dental implan...
The absorbed titanium can accumulate in other organs in the body as shown in the animal and cultured cell experiments. In addition, Feng et al. reported that nanoparticles can pass through the blood-brain barrier (BBB) and may be toxic to the central nervous system (CNS). The testing methods still have limitation and further studies need to be performed, but the neurotoxic nanoparticles incl...
This is defined as a tribosystem which has three interrelated components: tribology (friction, wear, and lubrication), corrosion (material and environmental factors), and biochemistry (interactions between cells and protein). The wear and corrosion in the contacting surface of implant fixture and implant abutment can cause the failure of dental implant system, and the wear debris and metalli...
Discussion
Titanium is presently used in a variety of applications including dental implants, orthopedic prostheses, industrial cosmetics, drugs, confections, and paints. Due to its extensive usage, issues related to stability need to be discussed. Titanium dental implants possess many advantages and are now widely used with high rates of success. However, we need to look at the aforementio...
There are numerous reports showing the association between titanium and yellow nail syndrome in addition to the above reports. In 2015, Decker et al. reported a case of a 67-year-old female patient who had lost her claws 18 months prior and had changes in bronchitis, sinusitis, and nails within the last 5 years. Inhaled corticosteroids were used for initial continuous cough symptoms but were no...
At least 10 of 20 patients were reported to show an improvement in symptoms after 6 months of continuous vitamin E1 administration at 200 IU/day; however, there was a continuous debate regarding the medication details.
Efforts to elucidate the pathogenesis of yellow nail syndrome are currently underway. In 2001, D’Alessandro et al. reported that the protein content of pleural effusions was...
Titanium-related diseases
It has been reported that systemic disease can occur due to titanium. According to a study by Berglund and Carlmark in 2011, titanium can be attributed to the cause of “yellow nail syndrome.” In 30 patients with yellow nail syndrome, energy-dispersive X-ray fluorescence (EDXRF) was used to measure the titanium content in the nails of patients; the titanium content w...
All metal prostheses except the implant screw and abutment were removed, and the eczema reaction was reduced to 30%; the symptoms still remained. The removal of the titanium implant screw and abutment in 2014 led to a full recovery. In Korea, allergy condition has also been reported after the installation of titanium implants. In 2012, a 70-year-old woman exhibited a stomatitis that appeared to be...
They are the releasing due to the friction between implant and bone surface during installation, the wear during debridement at maintenance visits, and the corrosion. Fretwurst et al. reported the metal particle in peri-implant soft tissue along with M1 macrophages and the increasing in titanium concentration with lymphocytes detection. In association with the metal particle releasing, the damage ...
Recently, there are more studies working on the linking of titanium implants and implant complication or failure. Wachi et al. reported that Ti ions may be involved in the deteriorating effects of peri-implant mucositis, which can develop into peri-implantitis accompanied by alveolar bone resorption. Olmedo et al. reported two cases of reactive lesions of peri-implant mucosa associated with titani...
Maritini et al. compared implantation of titanium powder plasma-spray-coated titanium screws (TPS-Ti) and fluorohydroxyapatite-coated titanium screws (FHA-Ti). Authors reported the evidence of titanium dispersion inside the medullary spaces when TPS-Ti was implanted, which was the result of friction occurring at the implant surface-host bone interface, leading to loss of integration in the coating...
In the presence of both H2O2 and albumin, there was a very much higher rate of metal release from Ti6Al4V compared to the presence of albumin and H2O2 alone. Furthermore, in a recent study, Zhang et al. continuously worked on the synergistic effect of albumin and H2O2 on corrosion of Ti6Al4V in physiological saline with electrochemical method and showed the time-dependent dissolution of Ti6Al4V. ...
In 1993, Haynes et al. performed experiments using titanium-aluminum-vanadium (Ti-Al-V) and cobalt-chromium (Co-Cr) particles of similar size range and concentration similar to those found in failed hip prostheses. In the abdominal macrophage experiments of rats, Co-Cr yielded a high toxic response while Ti-Al-V increased the release of inflammation-inducing mediators such as prostaglandin E2, int...
The interaction between TiO2-NP and inflammatory cytokines, including CXCL8, a clinically relevant pro-inflammatory chemokine, was also investigated by Batt et al.. The authors found that the TiO2-NP could preferentially adsorb CXCL8 (and IFN-γ), which leads to the disruption of neutrophil chemotaxis and modifies local inflammatory mediator concentration and might result in hampered inflammatory ...
Recently, Kim et al. reported an in vitro experiment regarding the expression of mucin genes in human airway epithelial cells. The authors confirmed that TiO2-NP initiated the TLR4-dependent pathway, leading to the MUC5B overproduction, which relates to the inflammatory response in human airway. In Suarez-Lopez del Amo et al. experiment, the TiO2 particles derived following implantation were colle...
Valentini et al. investigated the toxicity of TiO2-NP to the cortical neuron cultures and in the brain of rats, reported the clear impact of TiO2-NP on the neuronal cells and rat brain, and indicated the new evidences of TiO2-NP toxicity in CNS.
While there have been reports of titanium toxicity in animal models, Fabian et al. and Warheit et al. reported that the risk of titanium toxicity was no...
The toxicity of TiO2 (titanium dioxide) nanoparticles (TiO2-NP) in rodents has been reported. Many authors studied the serum biochemical parameters, pathology changes, and the biodistribution of TiO2-NP in the liver, kidneys, lung, spleen, and brain tissue by facilitating a variety of methods including blood biomarker assays, histopathological examination, etc. The dependence of experiment results...
Results
Extensive data was searched as mentioned in the research methods. According to the data analysis, the number of papers from 2011 to 2015 was the highest at 730; the research shows a trend of rapid increase in recent years with the large number of papers from 2016 to 2018. In the author’s field of specialization, 995 fields of basic science were the most studied; fields within environm...
Methods
Focus question
“What is the general overview of the risks and stability associated with titanium materials?”
Literature search
This review was prepared using data collected from until November 2018 through a keyword online search using MEDLINE (PubMed), Embase, Cochrane Library, and Google Scholar. Additional data were gathered for the necessary detailed parts using keywords incl...
Background
Titanium is one of the most widely used materials for dental implants due to its mechanical strength, biocompatibility, and a long history of use. Current titanium dental implants possess a high success rate; however, failures are still being reported. Cause of these implant failures can be poor oral hygiene, uncontrolled deposition of plaque, and calculus around the implant which ca...
Abstract
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 comp...