Patient requests removal of a titanium implant and replacement with a ZERAMEX XT implant

“There is presently a lack of information if and how titanium (Ti) particles from dental implants affect the tissues in the oral cavity, particularly peri-implant tissues such as bone and connective tissue cells” (Happe et al 2019).

Concerns:

• Ti particle pollution may be perceived clinically as discoloration of the marginal tissues and histologically, we see lymphocytes in the peri-implant tissues with increased Ti concentration (Zipprich et al 2018)
• Ti particles can provoke a dual effect, reducing bone formation due to inhibition of osteoblast proliferation and increasing bone resorption by IL-6 osteoblast-mediated osteoclastogenesis (Goodman et al 2016)
• Titanium wear microparticles shown to activate osteoclastogenesis (Mishra et al 2011)
• A recent cell culture experiment demonstrated a cytotoxic effect of Ti debris on human osteoblasts and gingival fibroblasts (Happe et al 2019)
• If Ti particles create an inflammatory cell response or induce bone resorption they may play an important role in peri-implant disease.