Titanium Dental Implants

Titanium (Ti) is a shiny silver colored transitional metal with low density and high strength.

The most important property of titanium is corrosion resistance and high strength to density ratio (which is the highest amongst all the metallic elements). Titanium in unalloyed form has strength as that of stainless steel but the density is lesser.

Titanium can be alloyed with various metals like iron, aluminum, vanadium, molybdenum etc. Addition of these metals further improves the properties of the alloy, which makes it lighter but stronger.

Therefore such alloys are commonly used in aircrafts, space machineries, missiles, agricultural equipments, automobiles and also for medical purposes, such as orthopedic implants and dental implants.

Besides the strength, corrosion resistance and light weight, the two main reasons for the use of titanium in medical stream is the high biocompatibility with the body tissues and its ability to bond with bone.

Unlike many other metals, allergic reactions to titanium are rare, therefore it is considered safe to replace body parts with titanium, be it a part of your hip, the root of your tooth or some other part of your body.

The ability to bond with bone is also very important, as the implant must stay firmly in its position. Titanium needs a few months to fuse firmly with your bone. Once this healing period is over, the implant can withstand much larger forces than other metals.

These are the most important reasons that make titanium an ideal material to manufacture dental implants:

• High biocompatibility: It has a higher success rate as compared to other metals and excellent biocompatibility when placed inside a living tissue allowing the favorable response of the biologic tissues adjacent to it. This maximizes its chances of functional adaptation and durability when placed.
• Osseointegration: The ability to bond firmly with bone is very important as a dental implant has to withstand large forces while chewing, and the implant needs to stay firmly in the jaw-bone.
• High corrosion resistance: This is also an important factor as implants must not corrode inside the body (bone) where they are constantly in contact with the moisture and the body fluids may act as an electrolyte.
• High strength: High strength is no doubt a very essential requirement as a dental implant is constantly under the masticatory load (forces generated while chewing) and it not only needs to hold firmly its position but it also must not break under these forces. The lower density adds on a bonus giving a lighter weight.
• Radio-opacity: This is one the beneficial property which makes it easier to study the growth of the bone with the help of the implants on X-rays and CT scans. Radio-opacity makes implants clearly visible on X-rays and integration of the bone, implant position can easily be examined.
• Other: It is non-magnetic and can be easily shaped.

There are a lot of companies manufacturing titanium implants. Technology and research are important factors that determine the quality of an implant.

While there is no "best" brand, there are a number of companies that have been researching and manufacturing titanium implants for decades.

But what are the differences between the implants of different companies?

Strength, durability are important factors. When there is not too much bone, a smaller but stronger implant might be required.

The surface of the implant is also very important and constantly being researched.

The implant surface plays an important role in osseointegration (attachment of the implant to the bone) and also determines healing time. This also plays a major role in increasing the clinical success of the implant.

Higher quality implants might cost a bit more, but a tooth implant should be a permanent solution to replace a missing teeth, so paying a bit more for higher quality might be a good decision.

Since every case is different, it's best to consult with your dentist.

A titanium tooth implant at the dentist cost anywhere between $1,000 and $1,800, but the entire tooth restoration is usually around $3,000 and $5,000.

The implant itself costs several hundred dollars, this depends on a number of factors, the most important ones are the manufacturer of the implant and the number of implant a dentist buys.

Most manufacturers give a substantial discount for large orders. Oral surgeons usually pass on at least a part of that discount to their patients.

However as a patient the raw price of a titanium implant is probaly not the most important for you. Chances are you are more interested in the total price of a tooth restoration. This usually includes the following:

• the price of the implant
• the price of the abutment (this holds the crown or brigde to the implant)
• the price of the dental crown or bridge
• the fee your dentist charges
• additional treatment might be required (e.g. bone grafting or sinus lift), these further increase the price

The average price of a single tooth restoration with dental implants is usually around $3,000 and $5,000. If you want to restore multiple teeth, the price will be even higher.

Why the big differences in price?

If you are shopping around for dental implants, it's unlikely to get the same quote from two different dentists for the same work. There are many reasons for this:

• Experienced oral surgeons tend to charge more for their time.
• However experienced surgeons usually place a lot of implants and might get a discount from the manufacturer, so they might be able to actually offer lower prices.
• A lower quality implant usually makes the entire treatment cheaper. (Experienced implantologists generally prefer to use higher quality implants.)
• The location of the dentist also matters: city centers are usually the most expensive and going abroad for implants is the most economical (but this comes with many risks).
• The price of the prosthetic work (crown or bridge attached to the implant) also varies. An implant with a porcelain fused to base metal crown can easily be cheaper than an implant with an e-max crown.
• The prices of additional treatments you might require (e.g. bone grafting, sinus lift) can further increase the price differences.

The most important advantages:

• High strength and ductility
• Corrosion resistant
• Excellent biocompatibility with the biologic system
• Minimal thermal and electrical conductivity
• Posses no problem in MRI scanning

Some disadvantages that your dentist should consider:

• Variation in structural and chemical characteristics
• Lower attachment strengths for some coatings
• Notch sensitivity
• Vanadium used in the alloy may show systemic toxicity
• Sterilization can be done only by gamma irradiation
• Expensive

I'm worried about esthetics, should I avoid titanium implants?
Titanium implants have metallic gray color. This usually does not cause problem in a normal healthy mouth with sufficient bone levels.

In few patients, it may show poor results esthetically if there is bone loss and receding gums, especially in the anterior (front) region. The alternative is a zirconia implant, which provides excellent esthetic results.

Can I go for MRI with titanium implants?
Yes, titanium is not a ferromagnetic metal so MRI scan should cause no problems. However you should ask the dentist placing the implant, as there might be other alloys in the implant that are magnetic.

Will titanium trigger airport security?
Metal detectors at the airport actually detects metals that are magnetic. As we have discussed in the previous question, titanium is not ferromagnetic, so usually no problem arises, unless the implant is alloyed with strongly ferromagnetic metals.

Newer detectors might detect your implant, in that case simply tell the screening officer that you have a dental implant.

How long do titanium implants last?
Titanium implants last for more than a decade and even more if properly taken care of. In 95% cases, they last for at least 5 years.

The two most important factors that affects the lifetime of a titanium implant

• the manufacturer, higher quality - therefore more expensive - implants last longer
• your oral hygiene

A high quality implant with proper oral hygiene can last for a lifetime.

How do I know if I am allergic to titanium?
The MELISA test is the only scientifically proven test which can objectively diagnose titanium allergy and measure its severity.

It a single blood test. Those who test positive are advised to avoid exposure as much as possible. A zirconia implant might be a good alternative in this case.

Is it possible to remove a titanium dental implant?
Yes, it is possible to remove the implant with the help of a special kit with the instruments designed for implant removal. Dentist's skill and experience is equally important.

Can titanium implants cause autoimmune disease / cancer?
Titanium itself does not cause any cancer or any chronic disease. But may act as a contributor if a patient is susceptible.

Acute inflammations are usually seen in almost every cases for few days after implant placement, but proper oral hygiene and good health causes acute inflammation to subside and heal.