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Risk factors in Titanium Implantology: Reasons to Consider Zirconia Implants
- October 13, 2017, 1:30–2:30 pm (Pacific Standard Time)
- Hilton San Diego Bayfront
1 Park Boulevard
San Diego, California 92101
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Daniel Gustavo Olmedo, DDS, PhD
Elisabeth Jacobi-Gresser, DDS
Dr. Elisabeth Jacobi-Gresser
- 38 years experience in titanium
- 10 years experience in Zirconia
- Assistant Professor and Graduate Student, Loma Linda Univeristy, School of Dentistry
Daniel Olmedo, DDS, PhD
- Specialist and head professor in Oral Pathology, University of Buenos Aires, Argentina
- Associate Researcher, Nation Councial of Scientific and Technological Research
- Past President, Argentine Society of Dental Research (Argentine Division of the IARDR)
Over the past 50 years, oral implants fundamentally influenced reconstructive concepts in dental medicine. Due to its excellent biocompatibility titanium is the preferred metal not only in dental implantology but also in orthopedic joint replacement. However, the risks of inserted titanium implants remain underestimated. Titanium debris from the implant surface as result of frictional wear and corrosion (tribocorrosion) has been known for decades. Side effects from the incorporation of micro- and nanoparticles in biological systems has been mostly ignored, as titanium is widely considered to be inert. The chemically active metal ions/particles released from an implant surface, may bind to the surrounding tissues but may also bind to proteins and be disseminated to distant organs in the vascular and lymphatic systems. In this regard, research in human samples has shown the presence of titanium particles in:
- peri-implant tissue around failed human dental implants
- oral mucosa in contact with implant cover screws
- cells exfoliated from peri-implant oral mucosa around titanium dental implants
- reactive lesions in the peri-implant mucosa.
In addition, our studies in experimental animal models demonstrated deposition of titanium microparticles (MPs) and nanoparticles (NPs) and the presence of a tissue response to these particle deposits.
The development of special immuno-assays in the past 10 years gave insight into previously unknown immunological effects resulting from titanium wear debris. Histo-immunological stainings of peri-implant hard and soft tissues impressively confirm the presence of immune cells like macrophages, T- and B-lymphocytes reacting to disseminated titanium particles. Local as well as systemic immunological responses by proliferation of phagocytosing cells and subsequent liberation of pro-inflammatory cytokines have been verified through specific laboratory immuno-assays. In this regard, results obtained in our clinical study confirmed a statistically significant higher amount of pro-inflammatory cytokine release in patients with failed implants than in those with long-term implant success. Moreover, multiple worldwide gene association studies have shown that individual genetic risk profiles, in respect to inflammatory high-responder reactions, influence long-term implant success. Adequate individual risk assessment should be considered before insertion of titanium devices or application of ceramic implants should be preferred.
This presentation will address the local and systemic effects of tribocorrosion of titanium, as shown by studies in experimental animals and human tissues. Also, well-documented case reports with immunological, genetic and histological findings will be presented.
At completion of this presentation, paticipants should be able to:
1. Describe local and systemic effects of tribocorrosion of titanium
2. Conduct individual patient risk assessments
3. Determine whether titanium devices or ceramic implants should be used
AGD Subject Code: 698
Topics: Elisabeth Jacobi-Gresser, Titanium implantology, Zirconia Implants, Risk factors, Daniel Olmedo