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Titanium incompatibility with dental implants

Titanium implant with tapered connection

For a long time, titanium was considered the ultimate when it came to artificial hips or perfect dentures. Unfortunately, more and more patients react sensitively to titanium. With the help of a test, you can get clarity in advance.

For 40 years, titanium has been the material par excellence for implants, but in practice it has been shown that up to 15 percent of patients have an "immunological reaction". In the past, there was no way to determine in advance whether test subjects would react "hyper-inflammatory" to titanium. A new study now shows that it is possible to identify these risk patients with simple laboratory tests. For these people, the metal is not suitable and ceramic implants or bio implants are an excellent substitute.


Titanium intolerance - now what?


Even though titanium does not cause allergies in the classical sense, it is not suitable as a material for implants for some people affected. Because "non-allergenic" does not mean "no intolerance". Titanium intolerance can lead to inflammation, so that the implants have to be surgically removed again. Despite the relatively high tolerance rate, it was important for the medical experts to identify the risk patients in advance.

A scientific institute from Berlin has developed laboratory tests, the results of which show that the group of people who cannot tolerate titanium is relatively large. It should be taken into account that titanium is used for dental and bone implants in over 90 percent of cases.

Dr Jacobi-Gresser, a dentist from Mainz, was in charge of the study. She herself had some patients who rejected their titanium implants. If the doctors know this in advance, it is possible to use either a zirconium-coated implant made of titanium or a pure zirconium implant.

In the future, before an operation, two laboratory procedures should be used to rule out over-inflammability to titanium. This is because titanium introduced into the body constantly oxidises. The human immune system recognises foreign bodies in these oxidised particles, which are enclosed and destroyed by macrophages. This results in the release of messenger substances that provoke an inflammatory response, as if an infection were present.

That the immune system reacts in this way makes sense against bacteria, but is fatal in the case of implants. Patients with titanium intolerance permanently secrete the messenger substances that are responsible for inflammatory reactions in increased quantities.


The genetic test brings the result


With the help of a first genetic test, it can be clarified whether a patient could belong to the risk group. A second test then provides certainty as to whether there is an overreaction of the phagocytes. These tests cost about 120 euros and are rather low compared to the general costs for dentures, but are not covered by the statutory health insurance funds. For privately insured patients, some insurance companies already pay. The head of the study recommends that all patients take advantage of the tests.

In orthopaedic medicine, the problems that implants made of titanium can cause have long been known. Dr Tilman Steinmeier, a sports physician from Hamburg, thinks it is irresponsible for patients to have implants made of titanium inserted without first checking whether there might be any intolerance. The implants are often also coated with polyethylene. These coatings can also lead to intolerance in patients. After an operation, it is then very difficult to help those affected appropriately, says the doctor.


Quellen:
1. Jacobi-Gresser E, Huesker K. Schutt S. Genetic and immunological markers predict titanium implant failure: a retrospective study. International Journal of Oral and Maxillofacial Surgery. 2013;42:537–543. [PubMed]

2. Institut für Medizinische Diagnostik Berlin–Potsdam MVZ Gbr Diagnostik-Info 210

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