The systemic and local interactions related to titanium implant corrosion and hypersensitivity reactions: a narrative review of the literature

Both commercially pure titanium and titanium alloys are established biomaterials for implantation in bone and are widely used today in dentistry. Titanium particulates have been shown in some patient clusters to induce cellular immune mediators responsible for type I and IV hypersensitivity reactions, causing amplified corrosion, osteolysis, and increased odds of implant failure. Systemically, titanium particles were found to affect varying organ tissues and cause potentially harmful effects. In vivo and vitro studies have shown that titanium dental implant corrosion can be induced by factors relating to bio-tribocorrosion. In this literature review, the consequences of titanium implant corrosion and particulate dissemination are discussed and later juxtaposed against a promising novel implant material, zirconia. Zirconia offers characteristics similar to titanium along with additional advantages such as being non-corrosive and having a lower propensity for inducing immune responses. From the mounting evidence discussed in this article, metal allergy testing would be advantageous for choosing an appropriate implant material to minimize potential adverse effects on cellular functions of local and diffuse tissues. Objective: This literature review aims to elucidate and describe mechanisms in which titanium implants may become corroded and induce cellular aberrations both locally and systemically in vivo. Implications of this study provide supportive evidence regarding the selection of appropriate biomaterials for implant patients susceptible to mounting a hypersensitivity reaction to titanium.