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Metal Misconceptions: Separating Fact from Fiction in Dental Implant Safety


Dental implants are widely used in dental restoration. They are permanent and can provide long term benefits to oral and overall health. However, some have raised concerns regarding the use of metals used in dental implants and their potential health implications. It's crucial to separate fact from fiction and understand the realities associated with these concerns. 

 

History of Titanium in Medical Applications 

 

As early as the 1940’s, research had already shown titanium to be an inert metal which could be used to hold broken bones together. In the 1950’s, the Swedish surgeon, Per-Ingvar Brånemark, placed a titanium rod in the bone of a rabbit. When he later attempted to remove the rod, he discovered that it had fused to the bone and could not be removed. It was previously believed that titanium could only connect mechanically to bone. Brånemark called this newly discovered phenomenon of metal fusing to bone, osseointegration. 


Dr. Brånemark and x-ray of rabbit leg
Dr. Brånemark and the x-ray of the rabbit's leg

The potential applications in dentistry were exciting, but the dental community was skeptical. After over a decade of further research and documentation, Brånemark  placed the first titanium dental implant in 1965 in a Swedish man named Gösta Larsson. The surgery was a success, and the dental community began to more broadly recognize and apply the benefits of titanium. Larsson died in 2006, having benefited from his dental implants for over 40 years.  

 

During this same time, orthopedic surgeons began to recognize the advantages of titanium over other materials used in bone surgeries. Titanium was biocompatible, meaning, it integrated with the body and surrounding tissue and the body did not have adverse reactions to it. It was resistant to corrosion and had a very high strength to weight ratio. Its popularity amongst the medical community continued to grow and by the 1990’s it was a widely accepted material for orthopedic implants. Today, titanium is a cornerstone of orthopedic surgery and is used to treat fractures, joint degeneration, spinal disorders, and other orthopedic conditions. 


titanium rod used in surgery
Titanium rod being used in orthopedic surgery

Over the last 60 years, researchers have found ways to improve dental implants. This includes everything from thread design to surface treatments to create better osseointegration. One of the main developments was the use of alloys to improve the properties of titanium. 

 

Today, most dental implants are not pure titanium (Ti), but titanium alloys. While there are various alloys available, the most predominant is Ti-6Al-4V. This designation means that the titanium alloy has roughly 6% aluminum, 4% vanadium, along with trace amounts of iron, oxygen, carbon, nitrogen, and hydrogen. The aluminum adds strength while the vanadium works to prevent corrosion.  

 

Addressing the Common Concerns 

 

While widely accepted in the medical and dental community as a safe material to use, some have raised concerns about adverse effects from the use of titanium implants. Such opinions can cause alarm, especially if sensationalized and not grounded in science and research. 

 

The most common concern that patients have is the possibility of an allergic reaction to the metals. While it's true that some individuals may have allergies to certain metals, such as nickel, decades of research and use have shown that titanium implants are biocompatible. The surface of the implant forms a protective oxide layer which helps prevent the release of nickel ions into the surrounding tissues. While roughly 17% of women and 3% of men are allergic to nickel, it is estimated that only .6% of patients have a complication from a metal allergy. Allergic reactions to titanium implants are extremely rare, making them a safe option for the majority of patients. 

 

Some patients have expressed concerns about potential corrosion or metal release into the surrounding tissue. In reality, the protective oxide layer of titanium prevents the release of metal ions and ensures long-term stability. As previously stated, titanium is highly resistant to corrosion with over 60 years of documented research.  

 

Another common concern is how dental implants will react to magnetic effects such as x-rays or MRI scans. While some metals can cause artifacts to appear in imaging results from x-rays and MRI scans, titanium implants are not magnetic and do not pose any risks during imaging procedures. 

 

Alternatives to Titanium Implants 

 

If a patient is still concerned about titanium implants, there are alternative options such as zirconia implants. These ceramic implants are free of metal and biocompatible just like titanium but do present other challenges. Zirconia is not as strong as titanium, so the possibility of fractures is increased. These implants are usually wider to reduce the chance of fracturing, requiring more bone to place them or changes to typical surgical planning.  

 

Conclusion


While concerns about metals in dental implants are understandable, the reality is that titanium implants have a proven track record of safety and efficacy. Extensive research and clinical experience support the use of titanium as a biocompatible material for dental implants. By addressing these concerns with facts and evidence-based information, patients can make informed decisions about their dental health and feel confident in the benefits of dental implant therapy.

1 Comment


I am miffed at this approach to metals. If dental history has taught patients anything about the ADA is that it was founded specifically by a group of dentists in 1832 because at the time the Prevailing American Dental Surgical Society did not allow the use of Mercury. As told in his book, "The Toxic Dental Office", Dr. Donald Robbins outlines how at the time, many dentists did not have enough work so in an alignment with the industry, they formed the ADA so mercury could be used on patients. At the time, the empirical evidence of madness among hatters and tanners was not sufficient to stop this group from committing potential harm to patients. In the ensuing 120 ye…

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