Sathyanarayanan Sridhar

Titanium Corrosion Mechanisms in the Oral Environment: A Retrieval Study

Corrosion of titanium dental implants has been associated with implant failure and is considered one of the triggering factors for peri-implantitis. This corrosion is concerning, because a large amount of metal ions and debris are generated in this process, the accumulation of which may lead to adverse tissue reactions in vivo. The goal of this study is to investigate the mechanisms for implant degradation by evaluating the surface of five titanium dental implants retrieved due to peri-implantitis. The results demonstrated that all the implants were subjected to very acidic environments, which, in combination with normal implant loading, led to cases of severe implant discoloration, pitting attack, cracking and fretting-crevice corrosion. The results suggest that acidic environments induced by bacterial biofilms and/or inflammatory processes may trigger oxidation of the surface of titanium dental implants. The corrosive process can lead to permanent breakdown of the oxide film, which, besides releasing metal ions and debris in vivo, may also hinder re-integration of the implant surface with surrounding bone.

In Vitro Investigation of the Effect of Oral Bacteria in the Surface Oxidation of Dental Implants

BACKGROUND Bacteria are major contributors to the rising number of dental implant failures. Inflammation secondary to bacterial colonization and bacterial biofilm is a major etiological factor associated with early and late implant failure (peri-implantitis). Even though there is a strong association between bacteria and bacterial biofilm and failure of dental implants, their effect on the surface of implants is yet not clear. PURPOSE To develop and establish an in vitro testing methodology to investigate the effect of early planktonic bacterial colonization on the surface of dental implants for a period of 60 days. MATERIALS AND METHODS Commercial dental implants were immersed in bacterial (Streptococcus mutans in brain-heart infusion broth) and control (broth only) media. Immersion testing was performed for a period of 60 days. During testing, optical density and pH of immersion media were monitored. The implant surface was surveyed with different microscopy techniques post-immersion. Metal ion release in solution was detected with an electrochemical impedance spectroscopy sensor platform called metal ion electrochemical biosensor (MIEB). RESULTS Bacteria grew in the implant-containing medium and provided a sustained acidic environment. Implants immersed in bacterial culture displayed various corrosion features, including surface discoloration, deformation of rough and smooth interfaces, pitting attack, and severe surface rusting. The surface features were confirmed by microscopic techniques, and metal particle generation was detected by the MIEB. CONCLUSION Implant surface oxidation occurred in bacteria-containing medium even at early stages of immersion (2 days). The incremental corrosion resulted in dissolution of metal ions and debris into the testing solution. Dissolution of metal ions and particles in the oral environment can trigger or contribute to the development of peri-implantitis at later stages.

In Vitro Evaluation of the Effects of Multiple Oral Factors on Dental Implants Surfaces

Presence of metal ions and debris resulting from corrosion processes of dental implants in vivo can elicit adverse tissue reactions, possibly leading to peri-implant bone loss and eventually implant failure. This study hypothesized that the synergistic effects of bacterial biofilm and micromotion can cause corrosion of dental implants and release of metal ions in vivo. The goal is to simulate the oral environment where an implant will be exposed to a combination of acidic electrochemical environment and mechanical forces. Four conditions were developed to understand the individual and synergistic effects of mechanical forces and bacterial biofilm on the surface of dental implants; In condition 1, it was found that torsional forces during surgical insertion did not generate wear particle debris or metal ions. In condition 2, fatigue tests were performed in a wet environment to evaluate the effect of cyclic occlusal forces. The mechanical forces applied on the implants were able to cause implant fracture as well as surface corrosion features such as discoloration, delamination, and fatigue cracks. Immersion testing (condition 3) showed that bacteria ( Streptococcus mutans ) were able to create an acidic condition that triggered surface damage such as discoloration, rusting, and pitting. A novel testing setup was developed to understand the conjoint effects of micromotion and bacterial biofilm (condition 4). Surface damage initiated by acidic condition due to bacteria (condition 3), can be accelerated in tandem with mechanical forces through fretting-crevice corrosion. Permanent damage to surface layers can affect osseointegration and deposition of metal ions in the surrounding tissues can trigger inflammation.

In Vitro Evaluation of Titanium Exfoliation During Simulated Surgical Insertion of Dental Implants

Dissolution of titanium wear particles in the oral environment, and their accumulation in the surrounding tissues have been associated with failure of dental implants (DI). The goal of this study is to investigate the effect of mechanical forces involved in surgical insertion of DI on surface wear and metal particle generation. It was hypothesized that mechanical factors associated with implant placement can lead to the generation of titanium particles in the oral environment. The testing methodology for surface evaluation employed simulated surgical insertion, followed by removal of DI in different densities of simulated bone material. Torsional forces were monitored for the insertion and removal of DI. The surface of the simulated bone materials was inspected with optical microscopy to detect traces of metallic particles that may have been generated during the procedure. Further characterization of the composition of powders collected from osteotomy cavities was conducted with powder X-ray diffraction. The results showed that the different densities of simulated bone material affected the torsional forces associated with implant insertion. However, the mechanical factors involved in the implant insertion/removal procedure did not generate wear particles, as confirmed by powder X-ray experiments.

Corrosion behavior of zirconia in acidulated phosphate fluoride

ABSTRACT Objective The corrosion behavior of zirconia in acidulated phosphate fluoride (APF) representing acidic environments and fluoride treatments was studied. Material and Methods Zirconia rods were immersed in 1.23% and 0.123% APF solutions and maintained at 37°C for determined periods of time. Surfaces of all specimens were imaged using digital microscopy and scanning electron microscopy (SEM). Sample mass and dimensions were measured for mass loss determination. Samples were characterized by powder X-ray diffraction (XRD) to detect changes in crystallinity. A biosensor based on electrochemical impedance spectroscopy (EIS) was used to detect ion dissolution of material into the immersion media. Results Digital microscopy revealed diminishing luster of the materials and SEM showed increased superficial corrosion of zirconia submerged in 1.23% APF. Although no structural change was found, the absorption of salts (sodium phosphate) onto the surface of the materials bathed in 0.123% APF was significant. EIS indicated a greater change of impedance for the immersion solutions with increasing bathing time. Conclusion Immersion of zirconia in APF solutions showed deterioration limited to the surface, not extending to the bulk of the material. Inferences on zirconia performance in acidic oral environment can be elucidated from the study.

Detoxification of Titanium Implant Surfaces: Evaluation of Surface Morphology and Bone-Forming Cell Compatibility

Peri-implantitis is one of the major clinical conditions associated with dental implant failure. Adhesion of bacterial biofilm is considered as the primary etiological factor for this condition. A commonly used therapeutic method for surgical removal of adhered biofilm is mechanical debridement, which may cause detrimental effects on the implant surface. Post-treatment, implants are expected to re-osseointegrate with bone tissue, providing mechanical stability. However, it is important to understand that both bacterial adhesion and detoxification procedures can affect the titanium surface, which is vital for growth of bone-forming cells, osteoblasts. The goal of this study was to evaluate the synergistic effect of bacterial adhesion and detoxification treatment method on subsequent bone cell growth on implant surface. Polished titanium specimens underwent bacterial contamination and debridement/detoxification treatment with acidic and neutral chemicals to model a treatment for a peri-implantitis-infected dental implant. Subsequently, bone cell activity and surface morphology were evaluated using standard cell viability/differentiation assays, scanning electron and optical microscopies, respectively. The synergistic activity of bacterial contamination and detoxification with acidic chemicals generally lowered cell viability and proliferation rates. This suggested higher toxicity of titanium surfaces imparted by detoxification methods on osteoblasts. Electrochemical testing corroborated visual signs of corrosion attack and revealed that immersion-treated specimens had higher corrosion resistance than their corresponding rubbing-treated counterparts, excluding saline. Overall, surface damage induced by detoxification methods must be considered when selecting the most appropriate therapy to increase the probability of re-osseointegration of titanium substrates.

Investigation of the Corrosive Effects of Dental Cements on Titanium

Biocompatibility, strength, and corrosion resistance make titanium the material of choice for dental implants and abutment components. In cemented implant restorations, dental cement is used to provide retention of the crown to the abutment and to create access to the implant. Reported problems in the literature associated with dental cement cite inflammation, and in some cases peri-implantitis, due to its residual presence in subgingival tissues. It has been recently suggested that particular components of dental cement may play a role in promoting corrosion while in contact with titanium surfaces. The goal of this study was to understand the electrochemical behavior of commercially pure titanium (cpTi) in contact with various commercially available dental cements. Open-circuit potential, linear polarization resistance, and corrosion rates were measured for cpTi disks cemented with resin, eugenol, zinc phosphate, and bioceramic cements. Results determined that the bioceramic cement investigated induced significantly lower polarization resistance values and a higher corrosion rate relative to noncemented cpTi. Resin, eugenol, and zinc phosphate cements exhibited corrosion behavior between that of control and bioceramic-cemented cpTi. Overall, fluoride-containing cements were observed to increase the corrosion rate of cpTi.

Multifaceted roles of environmental factors toward dental implant performance: Observations from clinical retrievals and in vitro testing

OBJECTIVE Oral bacteria and periodontal pathogen have been predominantly linked with early- and late- stage failures of titanium (Ti) dental implants (DI) respectively. This study is based on the hypothesis that bacterial colonization can damage the surface oxide (TiO2) layer. Early-failed DI were compared with DI post-in vitro immersion in early colonizing oral bacteria; late failed DI were weighed against DI immersed in late colonizing anaerobic pathogens. METHODS Retrieval analysis: Seven early- stage failed implants with five of them connected to healing abutments (HAs), and ten late- stage failed retrievals were subjected to surface analysis. Bacteria immersion test: Three dental implants each were immersed in polycultures containing (i) early colonizers (Streptococcus mutans, S. salivarius, S. sanguinis) (ii) late colonizers (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans). The implants were immersed for 30 days to simulate the healing period and bacterial biofilm adhesion. Optical microscope, x-ray photoelectron spectroscopy (XPS), and electrochemical test were performed to analyze the surface- morphology, chemistry, and potential respectively. RESULTS Early colonizers inflicted surface morphological damage (discoloration and pitting). Even though, XPS detected thinner oxide layer in 2/3 early retrievals, XPS and electrochemical tests illustrated that the TiO2 layer was intact in HAs, and in DI post- immersion. Late colonizers also caused similar morphological damage (discoloration and pitting), while mechanical wear was evident with scratches, cracks, and mechanical fracture observed in late-stage retrievals. XPS indicated thinner oxide layer in late-stage retrievals (3/4), and in DI post-immersion in late colonizers. This was reflected in electrochemical test results post-immersion but not in the late-stage retrievals, which suggested an intact surface with corrosion resistance. SIGNIFICANCE This study concluded that bacteria could negatively affect implant surface with late colonizers demonstrating more pronounced damage on the surface morphology and chemistry.