MATERIALS USED FOR

DENTAL IMPLANT

Dr.Sampath Kumar
Dept. of
Prosthodontics
SDMCDS

Contents:
Introduction
History
Physical And Mechanical Properties
Corrosion And Biodegradation
Classification of dental implant materials
Metals and alloys used :
Ti-6Al-4V
Cobalt-Chromium-Molybdenum based alloys
Iron-Chromium-Nickel-based alloys

OTHER MATERIALS USED

Ceramics and carbon
Polymers and composites
Surface characteristics
Tissue interactions
Surface energy
Passivation and Chemical cleaning
Sterilization
Summary

INTRODUCTION

The physical,mechanical,chemical and

electrical properties of the basic material
components must always be fully evaluated for
any biomaterial application,as these properties
provide key inputs into the biomechanical and
biologic analysis of function.
Therefore the desire to positively
influence tissue responses and to minimize
biodegradation often places restrictions on which
materials can be safely used within the oral and
tissue environment

History
Ancient Implants:

Implanted animal & Carved ivory teeth cited

in ancient Egyptian writings are the oldest
examples of primitive implantology.
Attempts to replace lost teeth with endosteal
implants have been traced to early Egyptian &
South American civilizations.
A skull from Pre-Columbian era in Peabody
museum of Harvard Univ in which an artificial
tooth carved from dark stone replaced a lower left
lateral incisor.

 The earliest dental implants were of stone & ivory in

16th century.
Root replacement was by allogenic tooth

transplantation which became popular in 17th century.

Metal implant devices of gold, lead, irridium,

tantalum, stainless steel were developed in 20th

century.
Co-Cr, molybdenum sub-periosteal & Ti blade

implants were introduced in 1940s.

Non metal bio-materials such as Vitreous & pyrolytic

carbon, aluminum oxide, HA were introduced in

1970s.

PHYSICAL AND MECHANICAL

PROPERTIES
The fatigue limit of metallic implant materials
reaches 50% of their ultimate tensile
strength.However this relationship is only
applicable to metallic and polymeric systems.
Ceramic materials are weak under shear
forces due to the combination of lack of fracture
toughness and no ductility which can lead to
brittle fracture.According to ASTM metals should
have minimum ductility of 8% to minimize brittle

CORROSION & BIODEGRADATION

Corrosion is a special concern for metallic
materials in dental implantalogy because
implants protrude into the oral cavity where
electrolyte and oxygen compositions differ from
those of tissue fluids.In addition the pH can
change significantly in areas below plaque and
within the oral cavity.
Plenk and Zitter (1996) stated that galvanic
corrosion can be greater for dental implants than
for orthopedic implants
Galvanic process depends on the passivity
of oxide layers which is only a few nanometers
thick and is usually made up of oxides or
hydroxides of the metallic elements that have

According to Williams three types of

corrosion are most relevant to dental implants:

Stress corrosion cracking
Galvanic corrosion cracking
Fretting corrosion cracking
Even ceramic oxide materials are not fully
degradation resistant.The corrosion resistance of
synthetic polymers on the other hand depends
not only on their composition but also on their
degree of polymerization.

CLASSIFICATION
Biodynamic
Activity

Chemical Composition
Metals

Biotolerant

Gold
Co-Cr alloys
Stainless Steel
Zirconium

Bioinert

Commercially
Pure Ti
Ti alloy(Ti-6AI4V)

Bioactive

Ceramics

Polymers
Polyethylene
Polyamide
Polymethylmeth
acrylate
Polytetrafluoroe
thylene

Al2O3,Zr2O3

HA,Ca3PO4,
FA,Brushite,
Bioglass

BIOTOLERANT:Biotolerant materials are those

that are not necessarily rejected when implanted
into the living tissue,but are surrounded by a
fibrous layer in the form of capsule.
BIOINERT:These allow close apposition of bone
on their surface,leading to contact osteogenesis.
BIOACTIVE:These materials also allow the
formation of new bone onto their surface,but ion
exchange with host tissue leads to the formation
of a chemical bond along the interface(bonding
osteogenesis).

TITANIUM AND Ti-6Al-4V

This reactive group of metals and alloys
form tenacious oxides in air or oxygenated
solutions.
This passivated surface minimizes the biocorrosion phenomenon.
In situations where the implant would be
placed within a closely fitting receptor site in
bone,areas scratched or abraded during
placement would re-passivate in vivo.

Titanium shows relatively low modulus of

elasticity and tensile strength when compared
with most other alloys.Yet its modulus of
elasticity is 5 times greater than that of the
compact bone,and this property places emphasis
on the importance of design in the proper
distribution of mechanical stress transfer.
The strength values for wrought soft and
ductile metallurgic condition are approximately
1.5 times greater than the strength of compact
bone.
In most designs where the bulk dimensions
and shapes are simple strength of this magnitude
is adequate.
Sharp corners or thin sections must be
avoided for regions loaded under tension or shear

Classification of commercially pure

titanium:
Grade I 0.18% Oxygen
Grade IV-0.4% Oxygen
Traces of other elements such as
nitrogen,carbon,hydrogen,iron and vanadium
added for stability or improvement of mechanical
and physicochemical properties.
Pure titanium is mechanically much more
ductile than Ti alloys.
The need for adjustment or bending to
provide parallel abutments for prosthetic
treatment has caused manufacturers to optimize
microstructure and residual strain conditions.

Classification of commercially pure

titanium:
Grade I 0.18% Oxygen
Grade IV-0.4% Oxygen
Traces of other elements such as
nitrogen,carbon,hydrogen,iron and vanadium
added for stability or improvement of mechanical
and physicochemical properties.
Commercially pure Ti is mechanically much
more ductile than Ti alloy.

The need for adjustment or bending to

provide parallel abutments for prosthetic
treatments has caused manufacturers to optimize
microstructure and residual strain conditions.
However if an implant abutment is bent at
the time of implantation, the metal is strained
locally at the neck region and the local strain is
both cumulative and dependent on the total
amount of deformation introduced during the
procedure.

COBALT CHROMIUM
MOLYBDENUM BASED ALLOY
COMPOSITION:
Cobalt
Chromium
Molybdenum
Carbon
Nickel
Manganese

IRON CHROMIUM NICKEL BASED

ALLOYS
This alloy as with Ti systems is used most often
in wrought and heat treated metallurgic
conditions,which results in a high strength and high
ductility alloy.
The ramus blade,ramus frame,stabilizer fins and
some mucosal insert systems have been made from
the iron based alloy.
Because this alloy contains nickel as major
elements,use in patients allergic or hypersensitive to
nickel should be avoided.
If a stainless steel implant is modified before
surgery, procedures for repassivation to obtain
oxidized surface is recommended.

Iron based alloys have galvanic potentials

and corrosion characteristics that could result in
concerns about galvanic coupling and biocorrosion if interconnected with Ti,Co,Zr or C
implant biomaterials.

OTHER METALS AND ALLOYS

Tantalum,Platinum,Iridium,Gold,Palladium
and alloys of these metals.More recently devices
made from Zirconium,Hafnium and Tungsten have
been evaluated.
Gold,Platinum and Palladium are metals of
relatively low strength which places limits on
implant design. But still Gold is used because of
nobility and availability.

CERAMICS AND CARBON

Ceramics are inorganic non metallic, non
polymeric materials manufactured by compacting
and sintering at elevated temperatures.
Because of their inertness to
biodegradation,high strength, physical
characteristics such as color and minimal thermal
and electrical conductivity,and a wide range
material specific elastic properties they are in use.
However the low ductility or inherent
brittleness has resulted in limitations.Ceramics
have been used in bulk forms and more recently
as coatings on metals and alloys.

ALUMINA,TITANIUM & ZIRCONIUM

OXIDES
High ceramics from aluminum,titanium and
zirconium oxides have been used for root
form,endosteal plate form and pin type dental
implants.
The compressive,tensile and bending
strength exceed the strength of the compact bone
by 3-5 times.These properties combined with high
moduli of elasticity and especially with fatigue
and fracture strength have resulted in specialized
design requirements.
The Al, Ti and Zr oxide ceramics have a
clear white,cream or light gray color which is
beneficial for applications in anterior root form

In early studies of dental and orthopedic

devices in laboratory animals and humans
ceramics have exhibited direct interphases with
bone similar to an Osseo integrated condition with
Ti.
One series of root form and plate form
devices used during the 1970s resulted in intra
oral fractures after several years of function.The
fractures were initiated by fatigue cycling where
biomechanical stresses were along regions of
localized bending and tensile loading.

BIOACTIVE AND BIODEGRADABLE

CERAMICS BASED ON CALCIUM
PHOSPHATE
The CaPO4 ceramics used in dental
reconstructive surgery include a wide range of
implant types and thereby a wide range of clinical
implications .
The laboratory and clinical results for CaPO4
particulates were most promising and led to
expansions for implant application.
In general these classes of bio-ceramics have
lower strength,hardness and modulus of elasticity
than the more chemically inert forms previously
discussed .
Calcium aluminates,sodium lithium inert
glasses with CaPO4 and glass ceramics provide a
wide range of properties and have found extended

BIOACTIVE CERAMIC
PROPERTIES
Physical properties are specific to surface area or
form of the product,porosity and
crystallinity.Chemical properties are related to
CaPO4 ratio,composition and elemental impurities
such as carbonate ionic substitution in atomic
structure forms can exist with exposure to water.this
has caused some confusion in the literature,in that
some CaPO4 ceramics have been steam autoclaved
for sterilization purposes before surgical
implantation.
Steam or water autoclaving can significantly
change the basic structure and properties of CaPO4
ceramics & thereby provide an unknown biomaterial
condition at the time of implantation.

Forms,Microstructure & Mechanical

Properties.
Hydroxyapatite provided in a non-porous form

as a spherical or angular shaped particles, is an

example of crystalline, high purity HA
biomaterial.
These particles can have relatively high
compressive strength up to 500mPa,with tensile
strength in the range of 50-70mPa.
Ceramics are brittle materials and exhibit high
compressive strength compared with tensile
strength.However,less resistance to tensile and
shear stresses limit their application as dental
implants because of mechanical constraints of
implant form & volume.

 Non-resorbable, bio inert ceramics exhibiting

satisfactory load bearing capacity are limited

to dense mono and poly crystalline Al, Zr & Ti
oxide ceramics.
These same mechanical characteristics exist
for the solid portions of several porous HA
particulates and blocks.
The macroporous or microporous particulates
have an increased surface area/unit vol. This
provides more surface area for solution and
cell ,mediated resorption under static
conditions and a significant reduction in
compressive & tensile strength.

 The porous materials also provide additional regions for

tissue in growth & integration & thereby minimization of

interfacial motion and dynamic interfacial breakdown.
Bulk form implant designs made from CaPO4

ceramics,which were shown to be contraindicated for

some implant designs because of poor mechanical
performance, have found a wide range of indications as
coatings of stronger implant materials.
These coatings for the most part are applied by Plasma

spraying, have average thickness between 50 &

70micrometers are mixtures of crystalline and
amorphous phases and have a variable micro structure
compared with the solid portions of the particulate forms
of HA and Ca3PO4

Density, Conductivity & Solubility

Bioactive ceramics are especially interesting for

implant dentistry because the inorganic portion of the

recipient bone is likely to grow next to a more a
chemically similar material.
Under the bioactive categorization:CaPO4 materials

such as TCP, HA, CaCO3 ,Ca2SO4 & ceramics are

included.
Their limitations have been associated wit material

forms that have lower strength.

Dissolution characteristics of bioactive ceramics have

been determined for both particulates and coatings.

In general, solubility is greater for TCP than for HA.The

solubility profiles depends on the environment.

 The larger the particle size, the longer the

material will remain at the site.

The porosity of the product also impacts the

resorption rate.
The porous or the holes are regions where blood

components and organic materials can reside

when placed within the bone and represent the
regions where living material existed before the
exploration and processing of implant material.
The greater the porosity, the more rapid the

resorption of the graft material.

 The hard & soft tissues of the body are more able

to degrade the components & resorb the

amorphous forms of grafting materials.
Thus, crystalline forms of HA are found to be very
stable over a long term under normal conditions,
whereas, amorphous structures are more likely to
exhibit resorption and susceptibility to enzymes
or cell mediated breakdown.
The pH in the region in which the bone
substitutes are placed also affects the rate of
resorption. As the pH decreases the components
of living bone primarily the CaPO4 resorb by
solution mediated activity.
Since CaPO4 is a non conductor of heat, it can be
used as a coating for implants when mixture of
conductive materials are included in the overall
prosthetic reconstruction.
In addition to its color, the above mentioned
properties are considered to be advantageous.

Carbon & Carbon Silicon Compounds

Carbon compounds are often classified under

ceramics because of their chemical inertness &

absence of ductility,however they are conductors
of heat & electricity.
Ceramic & carbonatic substances continue to be
used as coatings on metallic & ceramic materials.
Advantages:
Tissue attachment
Opportunities for the attachment of active biomolecules/synthetic compounds.

Disadvantage:
Lack of mechanical strength properties

Polymers & Composites

Advantages of Fiber reinforced polymers:

Can be designed to match tissue properties

Can be anisotropic wrt mechanical

characteristics

Can be coated for attachment to tissues &

Can be fabricated at relatively low cost

Structural Biomaterial Polymers

In general, polymers have low strength & elastic

moduli and higher elongations to fracture

compared with other classes of biomaterials
They are thermal & electrical insulators.
They are relatively resistant to bio degradation
Polymers have been fabricated in porous and

solid forms for tissue attachment, replacement,

augmentation & as coatings for force transfer to
soft & hard tissue region

 Cold flow characteristics,creep & fatigue strengths

are relatively low for some classes of polymers.

ex: SR
PMMA
In contrast some are extremely tough and fatigue

cycle resistant.
ex:PP
UHMW-PE
PTFE
The indications for PTFE have grown exponentially

in the last decade because of the development of

membranes for guided tissue regeneration
technique.

COMPOSITES
Most of the inert polymers have been

combined with particulate or fibers of carbon,

Aluminum oxide, HA & glass ceramics.
In some cases, bio degradable polymers such

as Poly Vinyl Alcohol,Poly Lactides or

Glycolides,Cyanoacralates or other Hydra table
forms have been combined with bio
degradable CaPO4 particulate or fibers.
These are intended as structural scaffolds,

plates, screws or other such applications.

Surface characteristics
The biomaterial characteristics can be separated

into 2 categories associated either with

Surface
Bulk properties
In general, the biomaterial surface chemistry,
topography & type of tissue integration can be
correlated with shorter & longer term in vivo host
responses.
The host environment has been shown to directly
influence the biomaterial to tissue inter facial
zone specific to the local biochemical &
biomechanical circumstances of healing and long
term clinical aspects of load bearing function.

Surface Characterization & Tissue

Interaction-Metal & Alloy Surfaces
There is a formation of thin oxide due to a

reaction with oxygen or other mechanisms such

as oxygen or metal ions diffusion from and to
the metallic surface, especially for Ti.
This thin layer of amorphous oxide will rapidly
reform if removed mechanically.
Surface properties are due to this oxide layer
and differ fundamentally from metallic
substrate.
Therefore the oxidation parameters such as
temperature, type & concentration of oxidizing
elements & eventual contaminants- all influence
the physical & chemical properties of the final
implant product.

 The surgical implant is primarily amorphous in

atomic structure if formed in normal

temperature, air or tissue fluid environments
and is very adherent & thin in thickness
(<20nm)
In contrast, if unalloyed Ti substrates are
processed at elevated temperatures, the oxide
forms a crystalline atomic structure & can be
10-100 time thicker.
Low temperatures thermal oxides are relatively
homogenous & dense.
The role of alloying elements in Ti alloys & how
these elemental compositions may influence
oxide properties & host tissue compatibilityis
dependent on the amount of ions available to
the tissues & relative rates of ion transfers

Tissue Interactions
Oxide modifications during in vivo exposure has

been shown to result in increased Ti oxide layer

thickness of up to 200nm.
The highest growth area corresponded to a bone
marrow site while the lowest growth was associated
with Ti, in contact with cortical regions of bone.
Increased levels of Ca & Phosphorous were found in
oxide surface layers and seemed to indicate an
active exchange of ions at the interface.
The surface bio interaction process maybe slow or
activated by local reactions and may cause ion
release and oxide alteration of the substrate
Especially high rates of ion release were observed
in EDTA & sodium citrate solutions & varied as a
function of the corroding media.

Integration with Titanium

Although Ti is known to exhibit better corrosion

resistance, independent of the surface preparation,in

vivo & in vitro, studies have shown that Ti may interact
with recipient living tissues over several years.
Bundy (1993) exposed implant alloys simultaneously to
tensile stress & corrosive environments. In vivo,
stainless & Ti alloy demonstrated cracks when loaded to
yield stress & re-implanted under lab conditions for 8
weeks. Crack like features were also seen in stainless
steel & TI alloys loaded to or beyond the yield stress &
subsequently electrochemically polarized for 38 weeks
in the in-vitro part of the study
None of the samples actually failed by completely
cracking but the author presumed that it would have
occurred with a longer exposure time as previously
suggested.

 Lemons (1977) studied single staged solid

implants modified by bending or cutting &

showed that damage could increase corrosion.
Cohen & Burdairon (1978) showed that

odontogenic fluoride gels which create an

acidic environment can lead to the
degradation of the Ti oxide layer & possibly
inhibit the Osseo-integration process.

Cobalt & Iron Alloys

The alloys of Co & Fe exhibit oxides of chromium under

normal implant surface finishing conditions after acid or

electro-chemical passivation.
These chromium oxides as with Ti alloys result in

significant reduction in chemical activity & environmental

iron transfer.
In general, if stainless steel implant surfaces are

mechanically altered during implantation or if the

construct induces an interface that is subjected to
biomechanical fretting, the iron alloy will biodegrade.
However, in the absence of surface damage, the

chromium oxide on stainless steel biomaterials have

shown excellent resistance to breakdown & multiple
examples of tissue & host compatibility have been shown
for implants removed after long term implantation.

Ceramics
Aluminum oxide ceramics have been extensively

investigated related to surface properties and how

those properties relate to bone and soft tissue
integration.
Ceramic coatings have been shown to enhance the

corrosion resistance & biocompatibility of metal

implants,in particular, surgical stainless steel, ni-cr,
co-cr alloys.
However, studies in orthopedics cautioned that the

Al2O3 may cause demineralization phenomenon

caused by a high local concentration of substrate
ions in the presence of metallic bone disease.

Hydroxy Apatite
In addition to bulk, aluminum oxide

biomaterials, CaPO4 based ceramic or ceramic

like coatings have been added to Ti & Co alloy
substrates to enhance tissue integration.
These coatings for the most part are applied

by plasma spraying small size particles of

crystalline HA ceramic powders.
Surface roughening by particulate blasting can

be achieved by different media.

Sandblasting provides irregular, rough surface

of 10microns.

 Ti implants maybe etched with a solution of

Nitric acid and Hydrochloric acid.

The acids very rapidly attack metals other

than Ti & these processes are electrochemical

in nature.
Proponents of this technique argue that

implants treated by sandblasting and acid-etch

provide superior radiographic bone densities
along implant inter phases compared with TPS

Titanium Plasma Spray

Porous or rough Ti surfaces have been fabricated by a

plasma spraying a powder form of molten droplets at

high temperatures.
At temperatures of 15000 deg centigrade an argon

plasma is associated with a nozzle to provide very high

velocity 600m/s partially molten particles of Ti powder
projected onto a metal or an alloy substrate.
Schroeder et al in animal experiments and histologic

studies, concluded that the rough and porous surfaces

showed a 3D interconnected configuration likely to
achieve bone-implant attachment for stable anchorage.
Another animal study showed that attachment is

enhanced by increasing ionic interactions introduced a

dual physical & chemical anchor system.

Hydroxy Apatite Coating

HA coating by plasma spray was brought to

the dental profession by DeGroot.

Key et al showed with SEM & Spectrographic
analysis that plasma sprayed HA coating could
be crystalline and could offer chemical &
mechanical properties compatible with dental
implant applications.
Cook et al measured the HA coating thickness
after retrieval from specimens inserted in
animals for 32weeks & showed a consistent
thickness of 50microns which is in the range of
advocated for manufacturing.

Other Surface Modifications

Methods include controlled clinical reactions

with nitrogen or other elements or surface ion

implantation procedures.
The reaction of Nitrogen with Ti alloys at

elevated temperatures results in Ti-Nitride

compounds being formed along the surface.
Most Ti-Nitride surfaces are Gold in color & this

process has been extensively used for

enhancing the surface properties of industrial
& surgical instruments.

 Electrochemically the Ti-Nitrides are similar to

the oxides and no adverse electrochemical

behavior has been noted if the Nitride is lost
regionally.
The Ti substrate re-oxidizes when the surface

layer of nitride is removed.

Nitrogen implantation & carbon doped layer

deposition have been recommended to improve

the physical properties of stainless steel
without affecting its bio compatibility.

Surface Energy
Measurements of surface property, values of

an implants ability to integrate within bone

include contact angle with fluids, local PH and
surface topography.
An intrinsically high surface energy is said to
be most desirable. High surface energy
implants showed a 3fold increase in fibroblast
adhesion and higher surface energy surfaces
such as metals, alloys & ceramics are best
suited to achieve cell adhesion.
Surface tension values of 40 dyne/cm & higher
are characteristic of very clean surfaces and
excellent biologic integration conditions.

 The shift in contact angle is related to contamination

of the surface by hydrophobic contaminants &

decreases the surface tension parameters.
A spontaneously deposited host dependent

conditioning film is pre-requisite to the adhesion of

any biologic element
It is suggested that the wetting of the surface by

blood at the time of placement can be a good

indication of the high surface energy of the implant.

Passivation & Chemical Cleaning

The ASTM specifications for final surface

treatment of surgical Ti implants require pickling

and descaling with molten alkaline base salts.
This is often followed by treatment with a

solution of nitric or hydroflouric acid to decrease

& eliminate contaminants such as iron.

Sterilization
Manipulation with bare fingers, powdered

gloves, tap water can contaminate implant

surfaces.
Today, most of the implants are available in
pre-sterilized form.
Proteinaceous deposits & their action as films
can be best eliminated by RFGDT
UV light sterilization after further evaluation
may be good alternative.
Adequate sterilization of clean, pre-packed
dental implants & related surgical components
had resulted in an ever expanding use of
Gamma Radiation procedures.

Summary & Conclusion

Dental Implantology in the 1960s was judged

to be rather disorganized. Treatments provided

were said to be often not as successful as in
other specialty procedures like Orthopedic &
Cardiovascular Surgeries.
This discipline evolved in 1970s. The basis for
this was the successful use of synthetic bio
materials.
Hence, the synthetic biomaterials have
evolved & are now constituted, fabricated &
provided to health care professionals as
mechanically & chemically clean devices that
have high predictability of success when used
appropriately within surgical disciplines.

References:
Carl E Misch: Implant dentistry ( 2nd

edition)

THANK YOU