What metal is used for dental implants?

Dental Implants Metal Allergy

For the past several decades, titanium has been the material of choice for placement of dental implants. The reason titanium has been the go-to choice is because it is the only metal that naturally fuses with jawbone, through a process called osseointegration. Additionally, titanium implants have had a very high success rate and are supported by decades of research. While titanium implants can be a highly effective solution for most patients, there is a small percentage of individual’s who have metal allergies so sensitive that their body will reject the implant.

Allergies are your body’s immune system overreacting to a foreign substance, which can cause a range of issues to develop, such as something minor, like a rash, or something life-threatening, like your body’s organ systems shutting down. Metal allergies are not all that uncommon, with approximately 3% of men and 17% of women being allergic to nickel. While most metal allergies occur due to external contact, say from a piece of jewelry, more serious reactions can occur when the metal is used as a body replacement part.

There are a number of different metals that may be used in dental procedures, most commonly with tooth fillings, such as silver, gold, tin, copper, and mercury. Though most patients do not have any issues with these materials, there are cases where rashes and/or inflammation have occurred. Even rarer than this is patients being allergic to titanium. To learn more about titanium allergies, what steps you can take to determine if you have a titanium allergy, and alternative treatment options to traditional titanium dental implants, please refer to the following.

Titanium Allergy Symptoms & Tests

The best way to determine if you have a titanium allergy is to be tested with a MELISA test, which isolates and exposes your white blood cells to titanium. Once your cells have been exposed, the lab technician will measure your body’s immune response. A skin test is also available, but is not as accurate, which is why a MELISA test is typically what is performed. If you have not been tested for a titanium allergy, any of the following symptoms may be an indication that you have a metal allergy:

• Swelling or sores in the oral soft tissues
• Gum inflammation or inflammation around the implant
• Dry patches of gum tissue
• Bumps and hives in the mouth

Can I Get Dental Implants if I Have a Metal Allergy?

If you have a metal allergy and are concerned that you are not a viable candidate for dental implants, please know that there are alternative treatment options available. It is also important to be aware that not all metal allergies apply to every metal. While titanium allergies can occur, they only show up in approximately .6% of the population, whereas approximately 13% of the population have sensitivity to chromium, cobalt, or nickel. If you have been tested positive for an allergy to titanium, or if you are concerned at the prospect of having metal put into your body, you may be a good candidate for Zirconia dental implants. Zirconia (or porcelain) implants are made of a metal oxidized structure, which means it will not provoke an allergic reaction among patients with metal sensitivities. In addition to being a very low allergic reaction risk, other benefits of zirconia dental implants include:

• Strong, durable solution with solid fracture resistance
• Will not corrode
• Less likely to accumulate plaque compared to titanium dental implants
• Improved aesthetic appearance, especially among patients with thinner gums or for patients having a front tooth replaced

While these are all appealing benefits, there are some drawbacks to zirconia dental implants, which include:

• Liable to develop tiny cracks and deteriorate over time
• Unlike titanium implants, which are comprised of multiple parts, zirconia implants are one-piece implants. This increases the complexity of the procedure and may not be a suitable option for angled abutment
• Zirconia implants are much newer on the market than titanium implants, so there is not nearly the same level of longitudinal data to support their efficacy
• Patients with bruxism or who need adjustment after their implant is fitted may want to avoid zirconia implants, as these can cause its fracture resistance to weaken

Alternative Treatment Options

On the unlikely event that you are allergic to titanium and zirconia, you may be a good candidate for alternative treatment options, such as the following:

• Dental bridge: A dental bridge can be a good option for patients who are missing one or more teeth. The dental bridge attaches to surrounding natural teeth to support the replacement crown/crowns. The biggest drawback to dental bridges is that they are not as strong as dental implants and require special maintenance.
• Temporary partial denture: One of the most cost affordable treatment options for missing teeth, a temporary partial denture work in a fashion similar to a retainer, in that they are removable and contain one or more replacement teeth. While a temporary partial denture can restore the appearance of your smile and are easy to remove to clean, they are not durable and will need to be replaced with some frequency.
• Snap-in denture: Snap in dentures are a hybrid of implants and dentures. Snap in dentures are designed with a few snaps which can attach to implants that are placed into the jawbone. Although snap-in dentures are more expensive than temporary partial dentures, they are also more expensive, though not as expensive as permanent dental implants.

Schedule an Appointment Today!

If you are considering dental implants but are concerned that you may have a metal allergy or would like to learn more about other implant options, such as bridges or zirconia implants, schedule an appointment with your periodontist today. They will perform a thorough evaluation, take diagnostic tests, and discuss your treatment goals, which will allow them to provide their professional recommendation as to which treatment option is best suited for you. This appointment will also be a good opportunity to ask any additional questions you may have about the procedure, such as the cost involved, whether their office has financing options available, and what types of dental sedation are available to ensure you are as comfortable as possible while the procedure is being performed.

BEST MATERIALS FOR DENTAL IMPLANTS

Implants can be made from titanium or from zirconium. They must demonstrate adequate toughness and strength, and the design of the implant needs to be compatible with its physical properties.

Apr 11, 2017

Over the past few decades, dental implants have become a reliable way to restore missing teeth. During this period, the materials used for dental implants have been extensively researched and the understanding of how the physical and chemical properties affect the clinical outcome of treatment has considerably improved. These properties include the surface composition and the microstructure of an implant. Ideally, implant materials should be biocompatible and resistant to both corrosion and to fracturing. Implants can be made from titanium or from zirconium. They must demonstrate adequate toughness and strength, and the design of the implant needs to be compatible with its physical properties.

Titanium and Titanium Alloys

Titanium is often regarded as being the ‘gold standard’ for fabricating dental implants and may be commercially pure or an alloy. Commercially pure titanium will usually have trace elements that include iron, nitrogen, oxygen and carbon which improves the mechanical qualities. Titanium alloys are mixed with elements that include aluminum and vanadium. The most common titanium alloy has 6% aluminum and 4% vanadium, and is heat treated to improve its strength, resulting in a low-density material that is resistant to corrosion and fatigue.

There have been some concerns over titanium sensitivity, possibly associated with surface corrosion of implants but much of the literature relates to orthopedic implants. There is little evidence to show allergies towards titanium although some people may have a sensitivity or an allergy to other metals used in alloys. Also, some patients prefer to not have any form of metal in their body. With regards to reactions, it is possible for titanium to cause hypersensitivity in some patients and this can play a role in implant failure. Titanium implant failure due to fracturing is rare and potential causes include the implant design or a manufacturing defect, or non-passive fit of the framework.

Zirconium

Zirconium is a material that can integrate with bone equally as well as titanium and its use eliminates patient concerns about metal allergies or sensitivities. Potential advantages of choosing zirconium include zero risk of corrosion and its use eliminates the possibility of metal showing through the gums or becoming exposed due to gum or bone recession. Zirconium is also thermally non-conductive but it is debatable if a person could actually feel thermal conductivity from a titanium implant. Zirconium has been in use for a relatively short period so its potential for longevity is not yet proven and less is known about the way it is Osseointegrated.

Zirconium implants are made as one piece incorporating the post and the abutment which leaves very little room for error. Healing can be more complicated because the implant cannot be buried underneath the gum tissue and any movement could impede Osseo integration. The implant must be surgically placed at the correct location and angle, and bone volume is critical. Often where bone volume is less than optimal, it is possible to place a titanium implant and a bone graft at the same time, a procedure that would be riskier with a zirconium implant. Zirconium implants, particularly smaller diameter implants, may not be the best choice for patients with heavy function as they have been known to fracture.

The most popular implant components are made of titanium or a titanium alloy, and there are now many people worldwide who have had their titanium implants for many years. That said, some people do have sensitivities or metal allergies and do not wish to take any chances with their implant treatment. For patients in this position, zirconium can be a good option when used in the right clinical situation.

We are here to help. Should you have any questions or want to discuss a specific case, please schedule a call with one of our expert technicians.

Metal Allergies To Dental Implants

Studies reveal a very small risk when compared to other metals

A Consultation with Dr. Jack Lemons

This article is endorsed by the

Dear Doctor,
I am interested in getting a dental implant to replace a missing tooth. However, I have metal allergies so I’m not sure if this is possible. What should I do?

Dear Bart,
Allergies to metals (elements) and metallics (alloys – compounds of two or more metals) can cover a lot of ground and really can open the proverbial can of worms. So let’s give you a short overview for the sake of clarity. Allergy is a response of the body’s immune (resistance) system that recognizes substances, whether living or non-living. Four types of allergic reactions are known which includes initiation of a specific (antibody) response to the offending entity. When the normally protective immune system, which defends us from bacteria, viruses, pollens and more causes an exaggerated response that is not protective, it is known as allergy. Allergic responses can be as minimal as a mild rash to, in rare cases, death from a multi-system shutdown known as anaphylaxis (“ana” – without; “phylaxis” – protection). You can become allergic to virtually anything, and at any time, including metals.

It has been reported previously that more than 5% of the population experiences allergic reactions to metallics. More recently, it has been reported that 17% of women and 3% of men are allergic to nickel and that 1% to 3% of the people are allergic to cobalt and chromium. Among dermatitis patients, (“dermat” – skin; “itis” – inflammation), the prevalence of metal allergy is even higher. Environmental exposures to metallics include jewelry, buttons, clothing fasteners, dental restorations, mobile phones, and more. Consumer exposure is responsible for most cases of metal allergy, even more than occupational exposure. Traditionally, nickel, cobalt, and chromium have been the most important contact allergens. However, recently, gold and palladium (primarily alloys that contain more than one metal) have drawn more attention, as the prevalence of contact allergy to these alloys is recognized. In the United States, studies show that the prevalence of nickel allergy is increasing. Furthermore, metal allergy has been associated with some device failures following placement of stents into coronary (heart) blood vessels, hip and knee prostheses, as well as other implants. These numbers are relatively small when compared with numbers of applications, however more research is needed in this area.

The above illustration shows the assembly necessary to restore an implant with a crown. The assembly consists of an abutment with a screw that fits into the implant and a permanent crown, which is then cemented onto the abutment.

The American Dental Association (ADA) reports that, for many years, the only available choices for dental fillings were metals and alloys. Traditionally, these were gold alloy or “amalgam,” a mix of approximately 43% to 54% mercury with other metals, including silver, copper and tin. Because of the development of other “tooth colored” materials today, amalgam is used most commonly in the back teeth. It is one of the oldest filling materials, used and improved upon for more than 150 years, and is the most thoroughly researched and tested filling material. In rare cases, a localized allergic reaction such as inflammation or rash may occur with its use.

That gets us to the topic of dental implants. Dental implants are generally made of commercially pure titanium or titanium alloy. One aspect of titanium and alloy is that they are osteophilic (“osteo” – bone; “philic” – loving) and therefore very biocompatible. Because of this, dental implants have had a truly amazing track record of success. A recent study in Clinical Oral Implants Research reported that in dentistry, allergic reactions to titanium implants and the associated intraoral prostheses have not been studied in great detail. However, placing metallic dental implants and associated restorations can potentially provoke allergic reactions. The study, involving 1,500 patients, reported that titanium allergy could be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients who had lost implants for no other known reason other than that they had a higher incidence of allergy, in which case testing could be recommended. However, this issue is confounded by the use of many different metallics and other materials as a part of the overall implant construction.

As for replacing your missing tooth, a dental implant is an excellent long-term option, given today’s advanced knowledge about dental and oral health. The ADA states that, whenever something foreign is put into your body, there is a chance of side effects. Thus all biomaterials (implants) and other dental materials used in the mouth may cause localized allergic reactions in a very small number of individuals. This is why your dentist needs to know about your allergies. It may be an important part of determining what the right material is for you. We hope that you receive the tooth you want and deserve without any fear of metal allergies.

Review Date: 2/1/2011
Authored By: Dr. Jack Lemons
Reviewed By: Dr. Garry A. Rayant, Editor-in-Chief, Dear Doctor, Inc.