DT News - UK - Titanium implants may carry risk of corrosion

Dental Tribune International

Thu. 9 August 2012

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BIRMINGHAM, UK: Titanium medical implants used in dental prostheses and bone-anchored hearing aids may be less robust than commonly believed. Researchers have found evidence to suggest that in environments where there is no significant wear process, microscopic particles of titanium can be found in the surrounding tissue, which may have a negative impact on the devices, as this can potentially be pro-inflammatory.

Globally, more than 1,000 tonnes of titanium are implanted into patients in the form of biomedical devices every year. Metallic prostheses, fixation and anchoring devices are used extensively for dental, orthopaedic, and craniofacial rehabilitation and their effects on the body are widely perceived to be predictable following initial implantation.

For this study, Dr Owen Addison in the Biomaterials unit of the University of Birmingham’s School of Dentistry and his team obtained tissue from patients undergoing scheduled revision surgery associated with bone-anchored hearing aids (BAHA) at University Hospitals Birmingham NHS Foundation Trust. Soft tissue surrounding commercially pure titanium anchorage devices was examined using micro-focus synchrotron X-ray spectroscopy at the Diamond Light Source, Oxford, UK.

“The results showed, for the first time, a scattered and heterogeneous distribution of titanium in inflamed tissue taken from around failing skin-penetrating titanium implants,” the authors reported. “Wear processes and implant debris were unlikely to be major contributors to the problem. In the absence of obvious macroscopic wear or loading processes, we propose that the titanium in the tissue results from micro-motion and localised corrosion in surface crevices.”

The development of peri-implant inflammation may result in the premature loss of the implanted device or the requirement for revision/rescue surgery, which are scenarios that can “impact on patients’ well-being and economically on the health service provider,” the authors concluded in the study.

“Our results emphasise the need to understand further both the physical and chemical mechanisms leading to the dispersal of titanium species in tissue around implants and their potential to exacerbate inflammation. Similar processes are likely to contribute to the failure of other metal implants in soft tissues, where macroscopic wear is not considered to be a risk.”

Addison commented: “Titanium is still the most appropriate material to put into bone and to be used in these devices. It is the gold standard. However, these interesting findings demonstrate that improvements in these materials can be sought. Research at Birmingham is currently being conducted to look at the biological consequences of these findings and to understand the mechanisms by which the debris is produced. This should in no way alarm those with BAHA implants or similar devices.”

The study “Do ‘passive’ medical titanium surfaces deteriorate in service in the absence of wear?” was published online on 25 July in the Journal of the Royal Society Interface ahead of print.

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