This article was written by Dr. Noumbissi and published in the January 2013 edition (International Section) for the Orofacial Chronicle Journal from Bhopal, India.

Background

Since Dr. Brånemark first introduced titanium dental implants, a variety of materials have been used successfully for about 40 years. Today implants are made either of commercially pure titanium (cpTi) or titanium alloys.  In addition to its biocompatibility, titanium was also initially believed to be inert, nontoxic and nonallergenic1,2. However, several drawbacks have been documented in the literature with the use of titanium and titanium alloys as implant materials in medicine and dentistry. High concentrations of titanium have been detected in tissue surrounding dental implants mostly as a result of wear or corrosion of the titanium implant surface.  In an animal study Weingart et al.3   showed that nine months after titanium implantation, titanium particles had spread and were found in adjacent lymph nodes. This indicates the possibility that phagocytes could transport titanium particles to the lymph nodes without any initial or immediate inflammatory response and potentially cause later immunologic reactions.

The Facts

An increasing number of people who suffer some form tooth loss are choosing to replace their teeth with dental implants. For the last thirty plus years the only and highly successful option for freestanding tooth replacement available in the United States and other countries has been titanium and titanium alloy dental implants. There are increasing reports both in dentistry and medicine of individuals developing sensitivity and allergies to titanium and/or titanium alloys. Even of more concern some of these implants are corroding once exposed to body fluids such as saliva and developing electrical activity when they are coupled with prosthetic components made of other metal alloys. Titanium implants as they corrode are known to release metal ions which create low level electrical currents through the body but also weakens the structural integrity of the implants. With recent advances in implantable biomaterials research and technology, bioceramics such as zirconia (zirconium dioxide) are now available and a new generation of modern implants is made of zirconia. Zirconium Silicate (ZrSO4) is mined and is treated and transformed into zirconium dioxide which is also called zirconia. Zirconia is the crystal form of the material zirconium which is a transitional metal. After mining and processing of zirconium silicate, zirconium is isolated and further processed under high temperature and pressure. Zirconium then undergoes an oxidation and crystallization process which allows it to transition into a structurally stable and inert crystal. This bioceramic crystal is called Yttrium Stabilized Tetragonal Zirconium Polycrystal (Y-TZP) also called zirconium dioxide. Therefore zirconium dioxide is not a metal and presents exceptional physical and biological properties. Zirconia can sustain an extreme load capacity, features a very long service life, and presents no conductivity or interference in the body’s meridian systems; it is the most hygienic, non-electricity conducting and stable material for dental implantology and orthopedics. Zirconia implants also present no danger of corrosion, something that is often a serious problem with metal based dental implants. Corrosion of a titanium dental implant occurs when it is coupled with the metal framework or abutment of the crown which more often than not is a less noble metal or alloy than that of the titanium implant. The implant and crown assembly bathes in saliva which is an electrolyte and a good conductor of electricity; this leads to all sorts of chemical and electrical imbalances in the body and to a phenomenon called “battery mouth”. Another advantage of zirconia is its low affinity for plaque (picture#1). Clinical observations and studies show that zirconia implants compared to or next to titanium implants accumulate much less plaque and allow for superior gingival health (picture #2).

Radioactivity and Zirconia Implants

There is a controversial and highly misunderstood aspect of zirconium dioxide in terms of its radiological output. Zirconium Silicate (ZrSO4) depending where it is mined can be contaminated with natural radioactive isotopes including radium (226Ra) and thorium (228Th). This was a major concern in the early 1990’s because the ores selected were contaminated. Today zirconium dioxide processing plants have the technology to remove these contaminants and are able to yield and use very pure powders. For example, the radiation emitted by a 3 mol% Y2O3-ZrO2powder was the same order of magnitude as alumina powder, both of which were several orders of magnitude less than that typically measured for water, vegetables and livestock. Zirconia hip ball replacements weigh approximately 100mg and have a natural radiological output of 1mSv per year. The average weight of a zirconia dental implant is 1g, translating into a natural radiological output of roughly 0.01mSv/year. Therefore the radiation risk of zirconia bioceramics is negligible and given that the World Nuclear Association states that the typical background radiation experienced by most people in North America is 3.4mSv, there is little concern for adverse biological effects on the implant recipient.

Conclusion

Zirconia dental implants are a sensible and clearly a healthier alternative to conventional and titanium implant bridges, partials or Overdentures. Furthermore zirconia by virtue of its translucency and all-white color makes it the most aesthetically pleasing option available today for tooth replacement (picture #3 & picture #4). This is a new era in implant dentistry and the science of oral implantology.

Referrences:

1-  Rabin, Steven I., MD; Calhoun, Jason H., MD, FACS, editor: Immune Response to Implants  

2- Allauddin A Siddiqi, Alan G T AG Payne,Warwick J WJ Duncan. Titanium allergy: could it affect dental implant integration? Clin Oral Implants Res 22(7):673-80 (2011)  

3- Weingart D, Steinmann S, Schili W, Strub JR, Hellerich U, Assenmacher J, Simpson J. Titanium deposition in regional lymph nodes after insertion of titanium screw implants in the maxillofacial region. Int J Oral Maxillofac Surg.1994 Dec:23 (6Pt2): 450-2  

4- Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A. Bacterial adhesion on commercially pure titanium and   zirconium oxide disks: an in vivo human study. J Periodontol. 2004 Feb;75(2):292-6

Biocompatible Zirconium Oxide Ceramic Dental Implants

In the world of medicine, zirconium oxide is being used more consistently as the material of choice for bone related reconstruction, particularly hip prosthesis. This growing trend has led to substantial clinical reports which confirm the high biocompatibility and quality of zirconium oxide, making it an attractive component for use as dental implants. Not only does Zirconium Oxide overcome most of the pitfalls of other dental implant products (such as Titanium), but patients now have a choice of a material that is esthetic, strong, pure, corrosion-free, biocompatible and capable of being used for all dental implant and appliance applications.

Why biocompatibility is so important

The immune system will typically respond to non-compatible dental materials as if they were infections or ‘invaders’ by initiating a cascade of reactions geared toward eliminating that ‘invader’. A good analogy to this would be how your body reacts to a cold or flu by elevating levels of lymphocytes and activating the immune system, a reaction that eventually rids the body of the cold or flu. The difference is that with dental toxicity the source of the problem is permanently imbedded in the mouth, and therefore there is no way for the ‘infection’ to be eliminated by the immune system.

Using only quality biocompatible materials that are proven to have very low adverse allergic reactions and present no negative responses from the immune system is highly important for the health of our patients. It is also the reason that biological, natural and holistic dental practices strive to use only materials that are as neutral as possible. Zirconium is a very strong, inert material with very low allergic potential and therefore a higher biocompatibility than other materials used as dental implants.

What non-compatibility looks like

Considering that every person’s body and physiology is unique, some individuals will be more compatible than others with certain types of materials used in dental treatments and procedures. But ultimately, a biocompatible material will not cause:

• allergic reaction
• irritation
• inflammation
• foreign body response (rejection)
• cancer and other autoimmune disorders

An all-ceramic dental crown over an all-ceramic dental implant looks and functions very much like the missing tooth did. Ceramic implants provide metal-free tooth replacement solutions, eliminating concerns of allergies and biocompatibility issues thereby lessening concerns for damage to the immune system. Zirconium Oxide provides safe, holistic results that are comfortable, natural in appearance and biocompatible:

• Zirconia implant is the holistic dental implant for absolute metal-free dentistry
• The white color of Zirconium far surpasses the metallic appearance of Titanium
• Ceramic implants and crowns retain less plaque and calculus than Titanium and therefore promote healthier gums and mouth

Our objective is to make as many biocompatible options available to our patients as possible and it is important to us to achieve the highest level of biocompatibility, particularly in cases where patients have compromised immune systems. Whenever considering a dental restoration we strongly suggest that extensive biocompatibility and metal allergy testing be done beforehand to ensure the best results.

Cell Phones May Pose Increased Health Hazards to Patients with Metallic Dental Implants

All cell phones emit electromagnetic radiation called RF (radio frequency) and EMF (electromagnetic fields). Considering the close proximity of the cell phone to the head during use, there is clear potential for EMF emissions to be harmful to any of the 300 million healthy cell-phone users in the United States today. However, patients who have undergone metal implant surgery as well as those who may still have amalgam fillings and/or dental fixtures are potentially at a much higher risk of harm than someone who has no metallic structures in their mouth whatsoever.

The use of metallic implants and fillings in the mouth is known to have the ability to create a potentially dangerous situation called ‘galvanism’. The body’s normal electrical (bioenergetic) current fluctuates at about 450 millivolts. Galvanism occurs when saliva mixes with amalgam (or metal) fillings and/or implants resulting in a jump of the normal oral electric current up to 1,000 millivolts or higher. This jump in oral electric current is without factoring in the amplified EMF fields associated with cell phone use and other types of exposure to electromagnetic fields. This kind of highly charged electrical current can quite easily overpower the body’s normal electrical flows and potentially interfere with energy flow to the brain. It is also suspected of causing various irritations to the nervous system.

What kind of damage are we talking about?

Studies have shown that the radiation from cell phones to which the user is exposed may in fact be the culprit behind a wide range of health problems including headaches, pressure or tingling in the head, earaches, eye problems including distortion of vision, memory loss, fatigue, brain tumors, DNA alteration or damage and changes in the brains electrical activity. Some studies have shown rats to develop lymphoma from prolonged electromagnetic fields exposure. For patients who have metallic dental repairs, the risk is quantified significantly. Additional symptoms may include:

• Increased arthritis
• Skin problems
• Ear problems
• Risk to leukemia
• Childhood cancer
• Sleep problems
• Depression
• Difficulty in concentrating
• Mental conditions

For more than thirty years, research conducted at the Electric Power Research Institute (EPRI) has focused on whether EMF associated with electricity can cause biologic changes or negatively affect health. Hundreds of studies have also been reviewed in health risk evaluations by the World Health Organization and other national and international organizations concerned with public health.

While some red flags have been raised over the years, what is being debated now at the national and international level is just how much radiation should be considered ‘unsafe’, and if there are any potential long-term side effects of continued cell-phone radiation exposure. Nobody knows with certainty what long-term health consequences EMF-induced biological effects may lead to – or how co-mingling metal implants and dental repairs with EMF radiation might affect the human body. The issue remains quite controversial. However, due to the growing depth of evidence pointing to various problematic interactions, concern is justified. Regardless, research has clearly shown that electromagnetic emissions from cell phones can cause significant biological effects and we know for a fact that metallic dental implants and fillings can create an electrical resonance of their own. When you combine these two disparate elements together, you have a potential recipe for disaster – one that can pose serious challenges to the long term health and wellness of anyone who has been fitted with metallic dental materials.

How metal implants may exaggerate harmful effects posed by cell phone use

Having dissimilar metals in the teeth (e.g.-amalgam; or gold and mercury, or stainless steel and mercury and/or titanium) causes a measurable galvanic action, or electrical currents, this is what is called “battery mouth”. These types of currents cause the amalgam levels (more often than not containing mercury vapor) to rise in surrounding tissues. The average mercury levels in gum tissue near amalgam fillings is about 200 ppm, and are the result of mercury flowing directly into the mucous membrane by way of galvanic currents. Dental amalgams also release significant amounts of silver, tin and copper which have well known toxic effects of their own. Even more alarming is the fact that amalgam containing zinc produces even higher galvanic currents.

Electrical currents can harm the immune system

Among other things, the electric currents and ionic flow between various dental alloys has been shown to cause irritation in the trigeminal nerve which is the main cranial nerve system; blocking the flow of major acupuncture meridians. This blockage can lead to greater overall dysfunction throughout the body and it can significantly challenge the immune system, which in turn can lead to chronic and debilitating health issues. It doesn’t take a much of an increase in the flow of energy to create harmful effects in the human body. Scientific studies associated with oral galvanism have determined that currents of just over 5 microamps is usually enough to cause significant health problems such as headaches, migraines, dizziness, nausea, etc. Removing the amalgam filling, metal fixture or dental repair essentially eliminated the problem in patients participating in this study.

Some studies have also found persons with chronic environmental exposure to electromagnetic fields including microwaves or MRIs to have higher levels of mercury exposure and excretion. And, interestingly enough, post MRI saliva mercury levels for a sample of patients reported on average 31 percent higher after MRI than before.

What the research reveals about metallic implants and cell phone use

Researchers in one study involved two basic types of implants: metallic pins and rings in the surface layers of the human body – positioned near the mobile phone. The goal in this case was to discover ‘the worst case scenario’ with respect to energy absorption. Researchers noted that “Based on the simulations of this study, the local absorption of EM field in a limited volume may be significantly (even by a factor of 700) enhanced by a conductive implant in the surface layer of a human body. The mobile phone and the metallic implant are strongly coupled, especially when the implant is close to a mobile phone, its length is in resonance with the field, and it is aligned with the antenna. This coupling can be either conductive, magnetic or both (Troulis et al 2003).”

Immediate symptoms of heightened danger

A few recommendations for reducing exposure to harmful EMF radiation when using a cell phone might include making only short and essential calls, and always use hands-free wired kits. Some studies suggest that positioning the phone’s antenna far away from the body during the calls may also be helpful. But, how can you tell if your cell phone is causing a problem? Several topical symptoms are immediately recognizable and they include:

• Fatigue
• Headache
• Warmth behind the ear
• Warmth on the ear
• Burning skin

The long term solution

Removing any amalgam fillings, metal fixtures or dental repairs will more than likely eliminate potential and confirmed health problems in patients. Overall, ceramic dental implants and repairs are the best alternative and they are highly resistant to corrosion and superior to other implant materials such as titanium and amalgams. They also have a higher level of human biocompatibility with the added benefit of a far superior aesthetic value for patients.

Sources:

JOÓ, ERVIN, ANDRÁS SZÁSZ, AND PÉTER SZENDRÖ. “Metal-Framed Spectacles and Implants and Specific Absorption Rate Among Adults and Children Using Mobile Phones at 900/1800/2100 MHz.” Electromagnetic Biology and Medicine, 25: 103–112, 2006.

H Virtanen, J Huttunen, A Toropainen and R Lappalainen. “Interaction of mobile phones with superficial passive metallic implants.” Physics in Medicine and Biology 50 (2005) 2689–2700.

H Virtanen, J Keshvari and R Lappalainen. “The effect of authentic metallic implants on the SAR distribution of the head exposed to 900, 1800 and 2450 MHz dipole near field.” Physics in Medicine and Biology 52 (2007) 1221–1236.

Has the Dental Work in Your Mouth Turned You Into a Walking Antenna? http://www.drlinagarcia.com/view_articles.php,t=30

The prevention of occupational risks of electromagnetic fields. http://www.officiel-prevention.com/protections-collectives-organisation-ergonomie/rayonnements/detail_dossier_CHSCT.php?rub=38&ssrub=126&dossid=338

Dr. Noumbissi was invited to speak at the 28th annual meeting of the International Academy of Oral Medicine and Toxicology in Minneapolis. The topics presented were Zirconia  as a dental implant material. Zirconia is the ceramic state of the metal zirconium which has been used for over twenty years in orthopedics. For the last decade it has also been used as a metal-free dental implant material.  Unfortunately there is a lot of misunderstanding and misinformation both among dentists and the public as to the  viability and predictability of zirconia as an oral and maxillofacial implantable material.  The second presentation was focused on the clinical applications of zirconia dental implants, cases presented ranged from single tooth replacement to full arches metal-free rehabilitation.

What are the Benefits of Ceramic Dental Implants?

Well over 100 million Americans suffer some form tooth loss, and today ceramic dental implants represent the most aesthetically pleasing option available for tooth replacement. Ceramic implants are comfortable for our patients, and due to their all-white color they present the most natural looking results. Dental implants are the better alternative to bridges, partials or dentures (find out why ceramic implants are better than bridges here) and most importantly; ceramic dental implants perform just like natural teeth.

When teeth are removed or lost due to trauma or infection the underlying bone is no longer used, resulting in a weakened jaw and bone loss. This makes it difficult to smile, chew and do other things most of us take for granted. Furthermore teeth next to the lost tooth/teeth shift and and the opposing one(s)  drift into the spaces left by missing teeth. These ultimately lead to malocclusion, jaw collapse, jaw muscle pain and even chronic headaches. Dental implants provide the same function as the natural tooth root which they replace, including stimulating the bone in the most natural way possible and maintaining adjacent and opposing teeth in their place. Ceramic dental implants prevent bone deterioration and improve a patient’s ability to chew food normally.

Dental implants can last a lifetime and are placed directly into the bone where the teeth are missing. They do not adversely affect the adjacent healthy teeth as do traditional bridges. Implants bond to the jawbone and become part of it – making a connection as strong as a natural tooth root.

Some of the benefits of ceramic dental implants:

• Improve one’s ability to bite and chew
• Function exactly like natural teeth
• Do not interfere with adjacent teeth
• Provide a more youthful appearance to the face and jaw line
• Eliminate bone deterioration that can occur with tooth loss
• Do not cause unsightly metal coloring around the gums
• Are metal free and do not corrode or breakdown in the oral environment
• Easy to keep clean because they do not attract nor accumulate bacteria-loving plaque
• Do not conduct electricity or interfere with the body’s meridian energy pathways
• Provides stability without the need for messy adhesives

Whether you’re concerned about metals in the mouth or prefer to have natural looking teeth, ceramic dental implants provide the best alternative to titanium dental implants.

For more information or a free consultation, please give us a call today: 301-880-1410

Brushing our teeth is an exercise in self-care that most of us do at least twice a day but there is also something we seldom consider; the health of that toothbrush. It might shock you to realize that literally millions of microorganisms (bacteria) live on the bristles of your personal toothbrush. That comes down to millions of microscopic bugs that can potentially cause flu, colds and other illnesses.

Recent studies have confirmed that oral health is connected with overall healthfulness. For example, there is a strong correlation between heart disease, diabetes, premature delivery in pregnant women, and strokes; and gum disease. Researchers discovered there are upwards of 10 million bacteria live on the typical toothbrush and we know that tooth decay is also caused by the type of bacteria that can survive on toothbrushes.

Studies have proven that cold and flu viruses and even the viruses that cause fever blisters (Herpes Simplex I) can survive on toothbrushes for several days – infecting and re-infecting the unsuspecting owner of that toothbrush. Here are just a few viruses that thrive on toothbrushes and some of the problems they can cause:

• E. Coli: bloody diarrhea and severe abdominal pain and tenderness with no fever
• Influenza Virus: fever, cough, headache and fatigue, sore throat, vomiting and diarrhea
• Staphylococci Bacteria: abscesses, boils, and skin infections
• Herpes Simplex I: can affect the mouth, face and skin and can be present in the body without symptoms, generally causes recurring and painful blisters (cold sores or fever blisters)
• Candida Albicans: mild nasal congestion, blisters in the mouth, sore throat or abdominal pain, and/or fatigue, dizziness and mood swings
• Coliform Bacteria: usually present along other disease-causing bacteria and organisms

Some researchers also discovered bio-film thriving on toothbrushes, which is living colonies of breeding bacteria, with estimated numbers as high as 100 million microorganisms existing on individual brushes.

Protecting Your Toothbrush

Surprisingly, it isn’t the bacteria from your mouth that contributes to the worst bacterial problems on a toothbrush, it’s the fact that most people store their toothbrush unprotected in the open, on
the bathroom counter top. By far, flushing the toilet is the worst culprit for germs found on most toothbrushes. Every time you flush the toilet invisible jets of water propels germs into the air, where they can land on toothbrushes.

Family toothbrushes stored side-by-side only compound the risk of sharing germs and viruses. Bacteria, molds, and fungi love moist environments provided by most bathrooms and they also love dark enclosed spaces, so storing toothbrushes in the medicine cabinet may not be as ideal as you might think.

While most dentists recommend replacing your toothbrush every couple of months, most American’s aren’t likely to change their toothbrushes more than twice a year. Here are some steps you can take to keep your toothbrush germ free:

Storage: Store toothbrushes away from the toilet in a cool, dry place.

Rinse well: Wash off your toothbrush thoroughly with tap water every time you use it.

Dry it after use: Dry your toothbrush thoroughly between brushings and avoid using toothbrush covers, which can create a moist enclosed breeding ground for bacteria.

Store it upright. Store your toothbrush upright in a holder, rather than lying it down.

Keep it to yourself: Never share a toothbrush and avoid storing it side-by-side in the same container with other people’s brushes.

Ultraviolet Light: Studies indicate that ultraviolet light can be effective in killing germs on toothbrushes and are able to kill many of the bacteria, yeasts, and viruses. A study conducted at New York University Medical Center on countertop ultraviolet toothbrush sanitizers found that this device eliminated up to 99.9 percent of bacteria tested on toothbrushes.

Hydrogen Peroxide Rinse: Cheaper than an ultraviolet device and a measure perhaps just as effective could be the practice of rinsing your toothbrush after each use with hydrogen peroxide. Hydrogen peroxide is antibacterial, antifungal, kills mold and mildew and when used properly, it is non-toxic for humans, plants, household animals.

Best practice: keep it clean and keep on brushing

Now that you know how to keep your toothbrush truly clean and germ free as a way to protect yourself and your family from harmful bacteria, it is also important to choose a brush that will do the work of keeping your teeth clean without harming the delicate surface of the tooth or gums. Choose a brush with soft or medium bristles, as they are gentler on the gums and may actually clean better because they’re more flexible. Brush twice a day, at least two minutes each time and rinse your mouth after sugary or starchy snacks. Replace your toothbrush frequently. These practices combined with visiting your dentist regularly for check-ups and cleanings will help to ensure that you have a lifelong healthy smile.