Research Progress on the Effects of Different Implant Materials on Osseointegration

Benzhe Gong; Jianqing Hao; Shu Zhu; Xinhao Fan

doi:10.54097/mwh26x33

Authors

Benzhe Gong
Jianqing Hao
Shu Zhu
Xinhao Fan

DOI:

https://doi.org/10.54097/mwh26x33

Keywords:

Osseointegration, Titanium, Titanium Alloy, Zirconia, PEEK, Implant Materials

Abstract

Successful dental implantation fundamentally relies on effective osseointegration, wherein the choice of implant material plays a critical role. Currently, a wide range of implant materials are used in clinical practice, including metals, ceramics, polymers, and composites. The intrinsic properties of these materials—such as elastic modulus, surface characteristics, and biocompatibility—profoundly influence the stress distribution at the implant-bone interface, cellular responses, and the progression of osseointegration. This study aims to systematically analyze and summarize the performance and osseointegration capacity of various implant materials, thereby identifying their respective advantages and limitations in promoting bone integration. A review of domestic and international literature indicates that titanium alloys demonstrate superior osseointegration efficiency compared to commercially pure titanium. Ceramic implants, such as those made from zirconia, exhibit comparable osseointegration performance to titanium alloys, while offering additional benefits in terms of mechanical strength and aesthetic properties. Although polyetheretherketone (PEEK) shows relatively limited innate osseointegration capacity, surface modification techniques and the development of bioactive composites have been shown to enhance its bioactivity to varying degrees. Further investigation is warranted to optimize PEEK-based materials for clinical applications.

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References

[1] Branemark, P.I., Vital microscopy of bone marrow in rabbit. Scand J Clin Lab Invest, 1959. 11 Supp 38: p. 1-82.

[2] Brånemark, P.I., Osseointegration and its experimental background. J Prosthet Dent, 1983. 50(3): p. 399-410.

[3] Brånemark, R., et al., Osseointegration in skeletal reconstruction and rehabilitation: a review. J Rehabil Res Dev, 2001. 38(2): p. 175-81.

[4] Brånemark, P.I., et al., Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl, 1977. 16: p. 1-132.

[5] Zhou W, et al. Measurement of implant osseointegration stability and analysis of related factors. Journal of Practical Stomatology. 2006;22(6):4.

[6] Wilson, C.J., et al., Mediation of biomaterial-cell interactions by adsorbed proteins: a review. Tissue Eng, 2005. 11(1-2): p. 1-18.

[7] Howlett, C.R., et al., Mechanism of initial attachment of cells derived from human bone to commonly used prosthetic materials during cell culture. Biomaterials, 1994. 15(3): p. 213-22.

[8] Ruoslahti, E., RGD and other recognition sequences for integrins. Annu Rev Cell Dev Biol, 1996. 12: p. 697-715.

[9] Park, J.Y., C.H. Gemmell, and J.E. Davies, Platelet interactions with titanium: modulation of platelet activity by surface topography. Biomaterials, 2001. 22(19): p. 2671-82.

[10] Park, J.Y. and J.E. Davies, Red blood cell and platelet interactions with titanium implant surfaces. Clin Oral Implants Res, 2000. 11(6): p. 530-9.

[11] Barron, L. and T.A. Wynn, Fibrosis is regulated by Th2 and Th17 responses and by dynamic interactions between fibroblasts and macrophages. Am J Physiol Gastrointest Liver Physiol, 2011. 300(5): p. G723-8.

[12] Terheyden, H., et al., Osseointegration--communication of cells. Clin Oral Implants Res, 2012. 23(10): p. 1127-35.

[13] Geris, L., et al., Angiogenesis in bone fracture healing: a bioregulatory model. J Theor Biol, 2008. 251(1): p. 137-58.

[14] Rucci, N. and A. Teti, The "love-hate" relationship between osteoclasts and bone matrix. Matrix Biol, 2016. 52-54: p. 176-190.

[15] Bosshardt, D.D., V. Chappuis, and D. Buser, Osseointegration of titanium, titanium alloy and zirconia dental implants: current knowledge and open questions. Periodontol 2000, 2017. 73(1): p. 22-40.

[16] Abraham, C.M., A brief historical perspective on dental implants, their surface coatings and treatments. Open Dent J, 2014. 8: p. 50-5.

[17] Parr, G., L. Gardner, and R. Toth, Titanium: the mystery metal of implant dentistry. Dental materials aspects. The Journal of prosthetic dentistry, 1985. 54(3): p. 410-4.

[18] Jorge, J.R., et al., Titanium in dentistry: historical development, state of the art and future perspectives. J Indian Prosthodont Soc, 2013. 13(2): p. 71-7.

[19] Saini, R.S., S.A. Mosaddad, and A. Heboyan, Application of density functional theory for evaluating the mechanical properties and structural stability of dental implant materials. BMC Oral Health, 2023. 23(1): p. 958.

[20] Noumbissi, S., A. Scarano, and S. Gupta, A Literature Review Study on Atomic Ions Dissolution of Titanium and Its Alloys in Implant Dentistry. Materials (Basel), 2019. 12(3).

[21] Noronha Oliveira, M., et al., Can degradation products released from dental implants affect peri-implant tissues? J Periodontal Res, 2018. 53(1): p. 1-11.

[22] Singh, R., et al., Prevalence of Titanium Hypersensitivity in Patients with Titanium Implants: A Systematic Review and Meta-analysis. Journal of pharmacy & bioallied sciences, 2021. 13: p. S1345-S1349.

[23] Niinomi, M., Mechanical biocompatibilities of titanium alloys for biomedical applications. J Mech Behav Biomed Mater, 2008. 1(1): p. 30-42.

[24] Dias Corpa Tardelli, J., C. Bolfarini, and A. Candido Dos Reis, Comparative analysis of corrosion resistance between beta titanium and Ti-6Al-4V alloys: A systematic review. J Trace Elem Med Biol, 2020. 62: p. 126618.

[25] Zavanelli, R.A., et al., Corrosion-fatigue life of commercially pure titanium and Ti-6Al-4V alloys in different storage environments. J Prosthet Dent, 2000. 84(3): p. 274-9.

[26] Yang L, et al. Effects of porous Ti-6Al-4V medical metal implant materials on the activity and osteogenic properties of bone marrow mesenchymal stem cells. Journal of Zunyi Medical University. 2024;47(6):569–576, 586.

[27] Li, R., et al., Tantalum boride as a biocompatible coating to improve osteogenesis of the bionano interface. J Biomed Mater Res A, 2020. 108(8): p. 1726-1735.

[28] Dehurtevent, M., et al., Stereolithography: A new method for processing dental ceramics by additive computer-aided manufacturing. Dent Mater, 2017. 33(5): p. 477-485.

[29] Li, J., et al., Bone ingrowth in porous titanium implants produced by 3D fiber deposition. Biomaterials, 2007. 28(18): p. 2810-20.

[30] Ponader, S., et al., In vivo performance of selective electron beam-melted Ti-6Al-4V structures. Journal of biomedical materials research. Part A, 2010. 92(1): p. 56-62.

[31] Bassous, N., C. Jones, and T. Webster, 3-D printed Ti-6Al-4V scaffolds for supporting osteoblast and restricting bacterial functions without using drugs: Predictive equations and experiments. Acta biomaterialia, 2019. 96: p. 662-673.

[32] Wang, F., et al., Evaluation of an artificial vertebral body fabricated by a tantalum-coated porous titanium scaffold for lumbar vertebral defect repair in rabbits. Sci Rep, 2018. 8(1): p. 8927.

[33] He F, et al. Application and research progress of porous tantalum coating in dental implants. Journal of Dalian Medical University. 2019;41(5):5.

[34] Lee, J.W., et al., New bone formation and trabecular bone microarchitecture of highly porous tantalum compared to titanium implant threads: A pilot canine study. Clin Oral Implants Res, 2018. 29(2): p. 164-174.

[35] Liu, Y., et al., The physicochemical/biological properties of porous tantalum and the potential surface modification techniques to improve its clinical application in dental implantology. Mater Sci Eng C Mater Biol Appl, 2015. 49: p. 323-329.

[36] Sikora, C.L., et al., Wear and Corrosion Interactions at the Titanium/Zirconia Interface: Dental Implant Application. J Prosthodont, 2018. 27(9): p. 842-852.

[37] Malhotra, R., et al., Inhibiting Corrosion of Biomedical-Grade Ti-6Al-4V Alloys with Graphene Nanocoating. J Dent Res, 2020. 99(3): p. 285-292.

[38] Brizuela, A., et al., Influence of the Elastic Modulus on the Osseointegration of Dental Implants. Materials (Basel), 2019. 12(6).

[39] Sharma, A., et al., Is titanium-zirconium alloy a better alternative to pure titanium for oral implant? Composition, mechanical properties, and microstructure analysis. Saudi Dent J, 2021. 33(7): p. 546-553.

[40] Kobayashi, E., et al., Mechanical properties of the binary titanium-zirconium alloys and their potential for biomedical materials. J Biomed Mater Res, 1995. 29(8): p. 943-50.

[41] Altuna, P., et al., Clinical evidence on titanium-zirconium dental implants: a systematic review and meta-analysis. Int J Oral Maxillofac Surg, 2016. 45(7): p. 842-50.

[42] Frank, M.J., et al., Hydrogen content in titanium and a titanium-zirconium alloy after acid etching. Mater Sci Eng C Mater Biol Appl, 2013. 33(3): p. 1282-8.

[43] Sista, S., et al., Expression of cell adhesion and differentiation related genes in MC3T3 osteoblasts plated on titanium alloys: role of surface properties. Mater Sci Eng C Mater Biol Appl, 2013. 33(3): p. 1573-82.

[44] Gottlow, J., et al., Evaluation of a new titanium-zirconium dental implant: a biomechanical and histological comparative study in the mini pig. Clin Implant Dent Relat Res, 2012. 14(4): p. 538-45.

[45] Kämmerer, P.W., et al., Vertical osteoconductivity and early bone formation of titanium-zirconium and titanium implants in a subperiosteal rabbit animal model. Clin Oral Implants Res, 2014. 25(7): p. 774-80.

[46] Xiropaidis, A.V., et al., Bone-implant contact at calcium phosphate-coated and porous titanium oxide (TiUnite)-modified oral implants. Clin Oral Implants Res, 2005. 16(5): p. 532-9.

[47] Huang, Y.H., et al., Bone formation at titanium porous oxide (TiUnite) oral implants in type IV bone. Clin Oral Implants Res, 2005. 16(1): p. 105-11.

[48] Wang, S., et al., Surface modification of titanium implants with Mg-containing coatings to promote osseointegration. Acta Biomater, 2023. 169: p. 19-44.

[49] Guglielmotti, M.B., et al., Migration of titanium dioxide microparticles and nanoparticles through the body and deposition in the gingiva: an experimental study in rats. Eur J Oral Sci, 2015. 123(4): p. 242-8.

[50] Manicone, P.F., P. Rossi Iommetti, and L. Raffaelli, An overview of zirconia ceramics: basic properties and clinical applications. J Dent, 2007. 35(11): p. 819-26.

[51] Apratim, A., et al., Zirconia in dental implantology: A review. J Int Soc Prev Community Dent, 2015. 5(3): p. 147-56.

[52] Sivaraman, K., et al., Is zirconia a viable alternative to titanium for oral implant? A critical review. J Prosthodont Res, 2018. 62(2): p. 121-133.

[53] Al-Radha, A.S., et al., Surface properties of titanium and zirconia dental implant materials and their effect on bacterial adhesion. J Dent, 2012. 40(2): p. 146-53.

[54] Cionca, N., D. Hashim, and A. Mombelli, Zirconia dental implants: where are we now, and where are we heading? Periodontol 2000, 2017. 73(1): p. 241-258.

[55] Möller, B., et al., A comparison of biocompatibility and osseointegration of ceramic and titanium implants: an in vivo and in vitro study. Int J Oral Maxillofac Surg, 2012. 41(5): p. 638-45.

[56] Hafezeqoran, A. and R. Koodaryan, Effect of Zirconia Dental Implant Surfaces on Bone Integration: A Systematic Review and Meta-Analysis. Biomed Res Int, 2017. 2017: p. 9246721.

[57] Akagawa, Y., et al., Comparison between freestanding and tooth-connected partially stabilized zirconia implants after two years' function in monkeys: a clinical and histologic study. J Prosthet Dent, 1998. 80(5): p. 551-8.

[58] Li YX, et al. Research progress on zirconia ceramic dental implants. Medical Journal of the Chinese People's Armed Police Forces. 2015;(6):4.

[59] Yu, D., X. Lei, and H. Zhu, Modification of polyetheretherketone (PEEK) physical features to improve osteointegration. J Zhejiang Univ Sci B, 2022. 23(3): p. 189-203.

[60] Sulaya, K. and S.S. Guttal, Clinical evaluation of performance of single unit polyetheretherketone crown restoration-a pilot study. J Indian Prosthodont Soc, 2020. 20(1): p. 38-44.

[61] Tasopoulos, T., et al., PEEK Maxillary Obturator Prosthesis Fabrication Using Intraoral Scanning, 3D Printing, and CAD/CAM. Int J Prosthodont, 2020. 33(3): p. 333-340.

[62] Moon, S.M., et al., Biomechanical rigidity of an all-polyetheretherketone anterior thoracolumbar spinal reconstruction construct: an in vitro corpectomy model. Spine J, 2009. 9(4): p. 330-5.

[63] Qin, L., et al., Review on Development and Dental Applications of Polyetheretherketone-Based Biomaterials and Restorations. Materials (Basel), 2021. 14(2).

[64] Rahmitasari, F., et al., PEEK with Reinforced Materials and Modifications for Dental Implant Applications. Dent J (Basel), 2017. 5(4).

[65] Skinner, H.B., Composite technology for total hip arthroplasty. Clin Orthop Relat Res, 1988(235): p. 224-36.

[66] Yang JX, Liu Q, Yang W. Application prospects of polyetheretherketone (PEEK) in dental implantation. Ningxia Medical Journal. 2024;46(5):456–458.

[67] Peng, T.Y., et al., In Vitro Assessment of the Cell Metabolic Activity, Cytotoxicity, Cell Attachment, and Inflammatory Reaction of Human Oral Fibroblasts on Polyetheretherketone (PEEK) Implant-Abutment. Polymers (Basel), 2021. 13(17).

[68] Koch, F.P., et al., Osseointegration of one-piece zirconia implants compared with a titanium implant of identical design: a histomorphometric study in the dog. Clin Oral Implants Res, 2010. 21(3): p. 350-6.

[69] Cook, S.D. and A.M. Rust-Dawicki, Preliminary evaluation of titanium-coated PEEK dental implants. J Oral Implantol, 1995. 21(3): p. 176-81.

[70] Ourahmoune, R., et al., Surface morphology and wettability of sandblasted PEEK and its composites. Scanning, 2014. 36(1): p. 64-75.

[71] Torstrick, F.B., et al., Porous PEEK improves the bone-implant interface compared to plasma-sprayed titanium coating on PEEK. Biomaterials, 2018. 185: p. 106-116.

[72] Durham, J.W., 3rd, et al., Hydroxyapatite coating on PEEK implants: Biomechanical and histological study in a rabbit model. Mater Sci Eng C Mater Biol Appl, 2016. 68: p. 723-731.

[73] Zheng, X., et al., Zinc-doped bioactive glass-functionalized polyetheretherketone to enhance the biological response in bone regeneration. J Biomed Mater Res A, 2024. 112(9): p. 1565-1577.