Is There a Better Biomaterial for Dental Implants than Titanium?-A Review and Meta-Study Analysis

Abstract

This article focuses on preclinical studies and reviews the available evidence from the literature on dental implant and abutment materials in the last decade. Specifically, different peri-implantitis materials and how surface modifications may affect the peri-implant soft-tissue seal and subsequently delay or hinder peri-implantitis are examined. This review analyzed more than 30 studies that were Randomized Controlled Trials (RCTs), Controlled Clinical Trials (CCTs), or prospective case series (CS) with at least six months of follow-up. Meta-analyses were performed to make a comparison between different implant materials (titanium vs. zirconia), including impact on bone changes, probing depth, plaque levels, and peri-implant mucosal inflammation, as well as how the properties of the implant material and surface modifications would affect the peri-implant soft-tissue seal and peri-implant health conditions. However, there was no clear evidence regarding whether titanium is better than other implant materials. Clinical evidence suggests no difference between different implant materials in peri-implant bone stability. The metal analysis offered a statistically significant advantage of zirconia implants over titanium regarding developing a favorable response to the alveolar bone.

Keywords: Randomized Controlled Trials (RCTs); abutments; clinical outcome; dental implant; meta-study analysis; peri-implantitis; surface modification; zirconia.

Figure 1

Scanning electron microscopy (SEM) images of surface-modified titanium substrates. SLA: sand-blasted and acid-etched Ti, ASD: anodized Ti, Modi-ASD: sand-blasted/acid-etched and anodized Ti. Reprinted with permission from licensee MDPI, Basel, Switzerland, under the terms and conditions of the Creative Commons Attribution license CC BY 4.0 [93].

Figure 2

Coating a doxycycline layer on TiZr implants could be favorable for reducing or removing the antibiotics via oral administration after the implantation surgery. Reprinted with permission from Creative Commons License (CC BY 4.0) [99].