TITANIUM INTOLERANCE

Titanium is a metal commonly used in dental and body prosthetics. Although it is a material that is usually considered safe, some patients may develop titanium intolerance or allergy.

Due to corrosion, dental implants made of titanium or titanium alloys deposit titanium particles or ions into the surrounding tissue. This process leads to inflammatory reactions in the gums or bone loss. In these cases, the implants must be removed. Dental implants made of other materials, such as zirconium oxide (ceramic) can be considered a safer alternative with fewer complications.

1. Uses of titanium

Titanium is one of the most widely used materials for dental implants due to its strength, biocompatibility, and long history of use [1]. However, reports of adverse effects have increased over the years. At first, poor oral hygiene was identified as the main cause leading to uncontrolled plaque and tartar accumulation around the titanium implant. However, new studies have reported that allergic reactions or intolerance are directly caused by corrosion of this metal in the mouth.

Titanium is also widely used in the manufacturing and pharmaceutical industries. In the medical field, titanium and titanium alloys are used to manufacture implants and orthopedic fixation systems. Given the widespread use of titanium, there are concerns about the harmful effects of titanium accumulation and its toxic effects on the human body [2].

2. Titanium toxicity

The most commonly used form of titanium is TiO2 powder. As the production of TiO2 powder continues to increase, there is growing concern about its impact on humans and the environment [3]. Studies have reported liver damage after oral administration of various doses of TiO2 particles. Cytotoxicity tests also showed accumulation of TiO2 in the liver, kidney, spleen, and lung, indicating its property to be transported to other organs after oral absorption [4].

Titanium intolerance can cause inflammation to the tissues surrounding a titanium implant. This inflammation causes an acidic oral pH and the corrosion of the titanium implant, creating further toxicity.

Not only pure titanium causes complications, but also titanium alloys.

Titanium alloys are mainly made with nickel, aluminum, and vanadium and are widely used in medical implants, including orthopedic prostheses and dental implants. Regarding orthopedic prostheses, these alloys have been found to cause osteoporosis [5].

It has also been reported that systemic diseases may occur due to titanium. For example, titanium may cause yellow nail syndrome. This rare syndrome is characterized by a change in the color of the nails and causes cough, rhinitis or sinusitis, and lymphatic edema. 

3. Titanium intolerance signs or symptoms

Titanium implants can also cause various reactions. The most common reactions are erythema, urticaria, eczema, swelling, pain, necrosis, and bone loss [6]. The lymphocyte transformation test (LTT) is especially recommended to check titanium intolerance.

Intolerances to titanium alloys are more frequent than to pure titanium. From an immunological point of view, titanium can be a hypoallergenic material; however, allergies are not the only cause of immunologically induced intolerances. The most common cause of individual hypersensitivity to titanium is excessive inflammation of the dental implant’s soft tissues. The LTT test is best suited to determine an increased concentration of titanium and other metals in the body by detecting elevated lymphocytes [7].

An acidic oral pH and a high fluoride concentration (often contained in conventional toothpaste) increase the risk of titanium corrosion and its alloys [8].

4. Ceramic implants: a viable alternative to titanium implants

Alternative implant materials are currently being investigated to reduce the risks of titanium. Zirconium oxide is a clinically viable material for dental implants. It is considered an alternative material that improves aesthetics and avoids toxicity problems. It has better osseointegration and good durability [9].

Zirconium oxide (also known as zirconia) is a ceramic material that is increasingly in demand in dentistry to fabricate dental restorations, especially implant-supported veneers and crowns.

Zirconium oxide is one of the best options for dental patients because of its excellent aesthetics and functionality. It is a relatively new material that offers significant advantages over materials traditionally used by dental technicians. In addition, it prevents inflammation of the oral mucosa and reduces the risk of alveolar bone loss.

5. Conclusions

In addition to its use in dental implants, titanium is used in many other areas. However, as the use of titanium increases, so does concern about its safety for human health.

Titanium dental implants are subject to corrosion. Titanium particles, ions, and titanium alloy components can deposit in the implant surrounding tissue due to corrosion and cause inflammatory reactions. The accumulation can occur both in the surrounding tissue or systemically, leading to toxic reactions in other tissues, such as yellow nail syndrome. Today, zirconium implants are considered an excellent alternative with fewer health risks.

Although titanium is known to cause fewer allergic reactions than other metals such as nickel and palladium, the diagnosis of titanium allergies is less clear; therefore, a more detailed blood test such as LTT is required.

6. Reference list

[1] Sidambe A. T. (2014). Biocompatibility of Advanced Manufactured Titanium Implants-A Review. Materials (Basel, Switzerland) 7 (12), 8168–8188. https://doi.org/10.3390/ma7128168

[2] Skocaj, M., Filipic, M., Petkovic, J., & Novak, S. (2011). Titanium dioxide in our everyday life; is it safe? Radiology and Oncology, 45 (4), 227–247.

[3] Grande, F., & Tucci, P. (2016). Titanium Dioxide Nanoparticles: a Risk for Human Health? Mini-reviews in medicinal chemistry, 16(9), 762-769. https://doi.org/10.2174/1389557516666160321114341

[4] Wang, J. et al. (2007). Acute toxicity and biodistribution of different sized titanium dioxide particles in mice after oral administration. Toxicology Letters, 168(2), 176–185. https://doi.org/10.1016/j.toxlet.2006.12.001

[5] Haynes, D. R., Rogers, S. D., Hay, S., Pearcy, M. J., & Howie, D. W. (1993). The differences in toxicity and release of bone-resorbing mediators induced by titanium and cobalt-chromium-alloy wear particles. The Journal of bone and joint surgery, 75 (6), 825–834. https://doi.org/10.2106/00004623-199306000-00004

[6] Titanium allergy: fact or fiction? (2014). British Dental Journal, 216(6), 355-355. doi:10.1038/sj.bdj.2014.222

[7] Fretwurst, T., Buzanich, G., Nahles, S., Woelber, J. P., Riesemeier, H., & Nelson, K. (2016). Metal elements in tissue with dental peri-implantitis: a pilot study. Clinical oral implants research, 27(9), 1178–1186. https://pubmed.ncbi.nlm.nih.gov/26508041/

[8] Strietzel, R., Hösch, A., Kalbfleisch, H., & Buch, D. (1998). In vitro corrosion of titanium. Biomaterials, 19(16), 1495–1499. https://doi.org/10.1016/s0142-9612(98)00065-9

[9] Siddiqi, A., Kieser, J. A., De Silva, R. K., Thomson, W. M., & Duncan, W. J. (2015). Soft and Hard Tissue Response to Zirconia versus Titanium One-Piece Implants Placed in Alveolar and Palatal Sites: A Randomized Control Trial. Clinical implant dentistry and related research, 17(3), 483–496. https://pubmed.ncbi.nlm.nih.gov/24112624/