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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 4  |  Page : 331-335

Uses and applications of tantalum in oral implantology: A literature review


1 Academic Department, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
2 Postgraduate Department, CHANGE Research Working Group, Faculty of Health Sciences, Universidad Científica del Sur, Lima, Peru

Date of Submission24-Jan-2021
Date of Decision20-Mar-2021
Date of Acceptance09-May-2021
Date of Web Publication19-Aug-2021

Correspondence Address:
Dr. Frank Mayta-Tovalino
Postgraduate Department, Faculty of Health of Sciences, Universidad Científica del Sur, Lima.
Peru
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JIOH.JIOH_18_21

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  Abstract 

Aim: To review the literature associated with porous tantalum and discuss their uses in health science. Materials and Methods: The main search engines used for literature review were PubMed and Scopus. Articles were limited to those published within the past five years in English and Portuguese. Observational studies, reviews, animal studies, in vitro studies, and clinical studies were included. Case reports and simulation studies were excluded. Results: The initial search retrieved 85 articles. Thirty articles were selected for full-text review. After a full-text review of all the manuscripts, only 15 were included, matching the exclusion criteria. Tantalum is considered in the rehabilitation medicine due to various mechanical and biological properties, such as a high degree of osseointegration, biocompatibility, bio-inertness, and noncorrosive material. Conclusion: In contrast, the high degree of elasticity and high manufacturing cost of tantalum limits its use in different fields. Hence, alloys are generated to improve their properties. Implants containing tantalum can modify bone structure, which leads to bone remodeling and induction of osteogenesis.

Keywords: Dental Implant, Osseointegration, Tantalum


How to cite this article:
Ore A, Gerónimo D, Huaman M, Calsin N, Mendoza R, Mayta-Tovalino F. Uses and applications of tantalum in oral implantology: A literature review. J Int Oral Health 2021;13:331-5

How to cite this URL:
Ore A, Gerónimo D, Huaman M, Calsin N, Mendoza R, Mayta-Tovalino F. Uses and applications of tantalum in oral implantology: A literature review. J Int Oral Health [serial online] 2021 [cited 2021 Oct 26];13:331-5. Available from: https://www.jioh.org/text.asp?2021/13/4/331/324137


  Introduction Top


A high success rate has been obtained in achieving and maintaining osseointegration in dental implants, with a survival rate of up to 90%.[1],[2],[3] Although there is a certain risk of failure, the probability of implant failure is low; therefore, new ways to improve the integration of the dental implant with the bone tissue continue to be investigated. Several studies have observed an improvement in the integration of dental implants into the bone when the characteristics of the bone surface are altered.[4] One of these alterations in the design of the implants is the incorporation of a porous surface, which allows regeneration of the osseous tissue through these structures in the implant.[5]

Tantalum is a material that is characterized by its porosity, rigidity, and resistance, and it does not have any adverse effects on patients. An implant with these properties allows critical vascularization to give way to the formation, maturation, and maintenance of new bone.[6] For example, an experiment on rabbits that underwent a discectomy with or without intervertebral lumbar arthrodesis showed that tantalum was nontoxic and had good biocompatibility. Rabbits with tantalum dental implants achieved complete fusion with the surrounding bone tissue.[7] This metal has a structure similar to that of the cancellous bone, which allows the stress shield to be reduced, and supports the maintenance of the bone. The formation of new bone is essential to establish the biomechanical stability of the implant.[6]

Moreover, tantalum presents disadvantages, such as a high modulus of elasticity and high manufacturing cost. Therefore, it is not considered as the first choice of material for fabricating implants and another alternative is sought, such as porous tantalum or certain alloys, to improve its physical properties.[7],[8],[9],[10],[11],[12]

Therefore, the purpose of this literature review was to describe the uses and applications of tantalum in oral implantology, with a special emphasis on the process of integration of this biomaterial with the bone tissue.


  Materials and Methods Top


The articles reviewed were retrieved from reliable scientific sources, between October 2020 and January 2021. The search engines used were Scopus and PubMed. The keywords used were as follows: “Tantalum,” “Tantalum dentistry,” “Implantology tantalum,” “Osseointegration tantalum,” “Porous trabecular implant,” and “Dental implant tantalum.”

Search strategy

The following search terms were used: (“tantalum”[MeSH Terms] OR “tantalum”[All Fields]) AND (“osseointegrate”[All Fields] OR “osseointegrated”[All Fields] OR “osseointegrates”[All Fields] OR “osseointegrating”[All Fields] OR “osseointegration”[MeSH Terms] OR “osseointegration”[All Fields] OR “osseointegrative”[All Fields]) AND (“dental implants”[MeSH Terms] OR (“dental”[All Fields] AND “implants”[All Fields]) OR “dental implants”[All Fields] OR (“dental”[All Fields] AND “implant”[All Fields]) OR “dental implant”[All Fields]).

The following research question was established:

  • P (problem): Patients with dental implants


  • I (Intervention): Use of tantalum


  • C (Comparison): Other materials


  • O (Result of interest): osseointegration


Inclusion and exclusion criteria

  • Articles not related to the topic


  • Articles more than five years old


  • Articles belonging to engineering journals, case reports


  • Studies in a language other than English


The following study does not include literature reviews, systematic reviews, controlled studies, and studies in English and Portuguese.

Data extraction and risk of bias

The search of the articles was carried out independently by two researchers. Only a narrative review of the literature found was carried out. As it is a literature review, the study presents information collection bias [Figure 1].
Figure 1: Flow chart

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  Results Top


Fifty articles were found in Scopus and 35 articles in PubMed. Given the heterogeneity of the results, the selected articles were divided into three domains according to the topic discussed: degree of osseointegration of different tantalum alloys [Table 1], applications of tantalum in various areas of orthopedics [Table 2], and the use of tantalum in the manufacture of dental implants [Table 3].
Table 1: Degree of osseointegration of different tantalum alloys

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Table 2: Applications of tantalum in various areas of orthopedics

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Table 3: Uses of tantalum in the manufacture of dental implants

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  Discussion Top


Degree of osseointegration of different tantalum alloys

Correct osseointegration of dental implants requires a low modulus of elasticity of the implant material, which favors an increase in the osteogenic activity and restricts the inflammatory response. Tantalum has a high modulus of elasticity; therefore, we searched for alloys that do not cause treatment failure. Ou et al. manufactured a porous Ta-Nb alloy, which was reported to have excellent osteogenic activity. However, its mechanical resistance was not the highest among all alloys, and mechanical factors such as this are indispensable for implants; nevertheless, the alloy could be successfully used.[12]

With good osseointegration, the implant would not loosen or fail. Implants fabricated by 3D printing can achieve a favorable design and a low elastic modulus, matching that of the bone, which can contribute to treatment success. However, for 3D printing of implants, not only must the design be prioritized but also the material to be used. Implants made with Mg promote osteogenic propagation and improve osseointegration. Owing to their therapeutic value, it is beneficial to introduce Mg ions into the surface of the porous 3D-printed tantalum implants, thus significantly improving its osteogenic and angiogenic characteristics.[13],[14]

Uses of tantalum in the manufacture of dental implants

Advances in technology have allowed us to find new ways to rehabilitate the edentulous areas caused by missing teeth. The use of dental implants offers different advantages compared with conventional rehabilitation methods, such as preservation of the natural teeth and surrounding bone tissues, as well as greater esthetics and patient comfort. The material of choice for the manufacture of dental implants has long been titanium; however, several studies have shown that this material presents certain complications, such as a high modulus of elasticity, low resistance to friction, and cytotoxicity. Moreover, products derived from the corrosion of titanium due to exposure to the oral environment could lead to inflammation and, consequently, treatment failure.[15],[16],[17]

For this reason, tantalum was proposed as an optimal material in the search for a new material for fabrication of dental implants. Tantalum has been demonstrated to be a promising biomaterial owing to its characteristics and biomechanical applications, as well as its lower cytotoxicity and higher corrosion resistance than titanium. In addition to this microarchitecture, tantalum would be the material of choice in the manufacture of dental implants. The articles reviewed showed that, relative to titanium implants, dental implants made with tantalum had higher indexes of osseointegration, a shorter time for the regeneration of bone tissue through the microarchitecture of these implants, and a better response of the organism, in general, to this biomaterial.[17]

Applications of tantalum in various areas of orthopedics

Tantalum has been used in clinical settings for several years because of its wide range of implant-related applications and for the manufacture of radiographic markers, vascular clips, endovascular stenting, cranioplasty plates, and orthopedic and dental implants.[18],[19],[20],[21],[22],[23] Tantalum is used in orthopedic devices because of its excellent properties.

Orthopedic applications, including different types of surgery, such as arthroplasty, have incorporated Ta into both acrylic and glass polyalkenoate bone cements.[22] The clinical use of tantalum has significantly changed the technique to address bone loss therapy, which is why it is increasingly used in arthroplasty surgeries.[20]

Mechanism of contribution of tantalum in osteogenesis

There is insufficient evidence on the mechanisms by which tantalum can contribute to osteogenesis. Therefore, lately, recent discussions are arising regarding the subsequent studies on its use, providing novel proposals for its study and application.[24] Hu et al. performed a review of the diverse osteogenic signaling pathways that are activated by tantalum. Among the indicators that were integrated in this review were type I collagen, osteocalcin, osteopontin, alkaline phosphatase, mitogen-activate protein kinases, and cellular mineralization.[25]

Recently, it has been demonstrated that tantalum is associated with many classical osteogenic pathways, including those of the transforming growth factor, catenin signaling, and bone morphogenetic protein signaling. Thus, it can be stated that tantalum can modulate osteogenesis by regulating osteogenic pathways. Further, the evidence from these studies shows that tantalum, through various phenomena, can incite osteogenesis.[25],[26],[27],[28],[29],[30]

Uses of tantalum in trabecular reconstruction

During the past few years, the application of trabecular metals in hip reconstructions has been increasing. These metallic structures produced by state-of-the-art technologies, with tantalum, attempt to imitate the bone architecture, with porosities of varying sizes that allow their integration into the host bone.[18] Likewise, other factors, such as the type of defect, also play a role in implant success. Contained defects are those in which structures such as the wall, ceiling, or bottom of the alveolus are preserved.[18]

Some studies used augmentation wedges combined with homologous bone grafting in several cases, obtaining an adequate evolution in most of the patients evaluated. It was observed that when comparing tantalum acetabulum with the tantalum wedges, there was evidently less bone contact. This has generated concern among researchers regarding osseointegration and stability when using this material in rehabilitation medicine.[15]

In addition, it has been observed that the use of tantalum increased after its application in the implantation of porous tantalum was reported, specifically in review studies. However, it has been reported that tantalum implants cannot activate a complete cellular response, especially in immune cells, such as T cells.[15]


  Conclusions Top


Tantalum is continuously considered in the rehabilitation area; however, its application in orthopedics is predominant because of its diverse mechanical and biological properties, such as a high degree of osseointegration, biocompatibility, bio-inertness, and non-corrosiveness. In contrast, its high degree of elasticity and its high manufacturing cost limits its access in different medical areas. Hence, alloys have been generated to improve its properties. Implants containing tantalum can modify the bone structure, which leads to bone remodeling and osteogenesis induction. Further, the biomechanical stability of the tantalum-based dental implant is being established and seems to favor treatment success. However, further studies are needed on the use of tantalum in dental implantology.

Acknowledgment

We want to thank the Faculty of Medicine of the Universidad Cientifica del Sur.

Financial support and sponsorship

None to declare.

Conflicts of interest

The authors have no conflicts of interest.

Authors’ contributions

Study conception (AO, DG, PC, MH, NC), data collection (AO, DG, MH,CV, FMT), data collection and analysis (RM, FMT), data interpretation (FMT, RM), and manuscript writing (AO, DG, MH, NC, PC, FMT, RM).

Ethical policy and institutional review board statement

Not applicable because it worked with a secondary database.

Patient declaration of consent

Not applicable.

Data availability statement

All data that support the study results are available from the corresponding author (Dr. Frank Mayta-Tovalino, e-mail: [email protected]) on request.

 
  References Top

1.
Harel N, Piek D, Livne S, Palti A, Ormianer Z. A 10-year retrospective clinical evaluation of immediately loaded tapered maxillary implants. Int J Prosthodont 2013;26:244-9.  Back to cited text no. 1
    
2.
Ormianer Z, Patel A. The use of tapered implants in the maxillae of periodontally susceptible patients: 10-year outcomes. Int J Oral Maxillofac Implants 2012;27:442-8.  Back to cited text no. 2
    
3.
Ormianer Z, Piek D, Livne S, Lavi D, Zafrir G, Palti A, et al. Retrospective clinical evaluation of tapered implants: 10-year follow-up of delayed and immediate placement of maxillary implants. Implant Dent 2012;21:350-6.  Back to cited text no. 3
    
4.
Goldman M, Juodzbalys G, Vilkinis V. Titanium surfaces with nanostructures influence on osteoblasts proliferation: A systematic review. J Oral Maxillofac Res 2014;5:e1.  Back to cited text no. 4
    
5.
Spector M. Historical review of porous-coated implants. J Arthroplasty 1987;2:163-77.  Back to cited text no. 5
    
6.
Fraser D, Funkenbusch P, Ercoli C, Meirelles L. Biomechanical analysis of the osseointegration of porous tantalum implants. J Prosthet Dent 2020;123:811-20.  Back to cited text no. 6
    
7.
Kang C, Wei L, Song B, Chen L, Liu J, Deng B, et al. Involvement of autophagy in tantalum nanoparticle-induced osteoblast proliferation. Int J Nanomed China 2017;12:4323-33.  Back to cited text no. 7
    
8.
Lu M, Xu S, Lei ZX, Lu D, Cao W, Huttula M, et al. Application of a novel porous tantalum implant in rabbit anterior lumbar spine fusion model: In vitro and in vivo experiments. Chin Med J (Engl)2019;132:51-62.  Back to cited text no. 8
    
9.
Dimaira M. Immediate placement of trabecular implants in sites of failed implants. Int J Oral Maxillofac Implants 2019;34:e77-83.  Back to cited text no. 9
    
10.
Temponi EF, Souza PEA, Souto GR, Magalhães LMD, Dutra WO, Gollob KJ, et al. Effect of porous tantalum on the biological response of human peripheral mononuclear cells exposed to Porphyromonas gingivalis. J Invest Clin Dent 2019;10:e12472.  Back to cited text no. 10
    
11.
Brüggemann A, Mallmin H, Bengtsson M, Hailer NP. Safety of use of tantalum in total hip arthroplasty. J Bone Joint Surg Am 2020;102:368-74.  Back to cited text no. 11
    
12.
Ou P, Liu J, Hao C, He R, Chang L, Ruan J. Cytocompatibility, stability and osteogenic activity of powder metallurgy Ta-xZr alloys as dental implant materials. J Biomater Appl 2021;35:790-8.  Back to cited text no. 12
    
13.
Vaidulycha M, Pleskunov P, Kratochvíl J, Maskova H, Kocova P, Nikitin D, et al. Convex vs concave surface nano-curvature of Ta2O5 thin films for tailoring the osteoblast adhesion. Surf Coat Technol 2020;393:125805.  Back to cited text no. 13
    
14.
Ma L, Cheng S, Ji X, Zhou Y, Zhang Y, Li Q, et al. Immobilizing magnesium ions on 3D printed porous tantalum scaffolds with polydopamine for improved vascularization and osteogenesis. Mater Sci Eng C Mater Biol Appl 2020;117:111303.  Back to cited text no. 14
    
15.
Löchel J, Janz V, Hipfl C, Perka C, Wassilew GI. Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up. Bone Joint J 2019;101-B:311-6.  Back to cited text no. 15
    
16.
Fraser D, Mendonca G, Sartori E, Funkenbusch P, Ercoli C, Meirelles L. Bone response to porous tantalum implants in a gap-healing model. Clin Oral Impl Res 2019;30:156-68.  Back to cited text no. 16
    
17.
Edelmann AR, Patel D, Allen RK, Gibson CJ, Best AM, Bencharit S. Retrospective analysis of porous tantalum trabecular metal-enhanced titanium dental implants. J Prosthet Dent 2019;121:404-10.  Back to cited text no. 17
    
18.
Diesel CV, Ribeiro TA, Guimarães MR, Macedo CAS, Galia CR. Acetabular revision in total hip arthroplasty with tantalum augmentation and lyophilized bovine xenograft. Rev Bras Ortop 2017;52:46-51.  Back to cited text no. 18
    
19.
Brüggemann A, Mallmin H, Bengtsson M, Hailer NP. Safety of use of tantalum in total hip arthroplasty. J Bone Joint Surg Am 2020;102:368-74.  Back to cited text no. 19
    
20.
Hailer N. 20 years of porous tantalum in primary and revision hip arthroplasty-time for a critical appraisal. Acta Orthop 2018;89:254-5.  Back to cited text no. 20
    
21.
Alhalawani AM, Towler MR. A novel tantalum-containing bioglass. Part I. Structure and solubility. Mater Sci Eng C Mater Biol Appl 2017;72:202-11.  Back to cited text no. 21
    
22.
Alhalawani AM, Mehrvar C, Stone W, Waldman SD, Towler MR. A novel tantalum-containing bioglass. Part II. Development of a bioadhesive for sternal fixation and repair. Mater Sci Eng C Mater Biol Appl 2017;71:401-11.  Back to cited text no. 22
    
23.
Kannan A, Nesappan T, Ganapathy D, Jain A. A Systematic review on surface treatment of tantalum. Drug Intervent Today 2018;10:2423-33.  Back to cited text no. 23
    
24.
Mitran V, Vasilescu C, Drob SI, Osiceanu P, Calderon-Moreno JM, Tabirca MC, et al. Biological behaviour and enhanced anticorrosive performance of the nitrided superelastic Ti-23Nb-0.7Ta-2Zr-0.5 N alloy. Biomed Res Int 2015;2015: 261802.  Back to cited text no. 24
    
25.
Qian H, Lei T, Ye Z, Hu Y, Lei P. From the performance to the essence: The biological mechanisms of how tantalum contributes to osteogenesis. Biomed Res Int 2020;2020:5162524.  Back to cited text no. 25
    
26.
An R, Fan PP, Zhou MJ, Wang Y, Goel S, Zhou XF, et al. Nanolamellar tantalum interfaces in the osteoblast adhesion. Langmuir 2019;35:2480-9.  Back to cited text no. 26
    
27.
Wu L, Dong Y, Yao L, Liu C, Al-Bishari AM, Yie KHR, et al. Nanoporous tantalum coated zirconia implant improves osseointegration. Ceram Int 2020;46:17437-48.  Back to cited text no. 27
    
28.
Lee JW, Wen HB, Gubbi P, Romanos GE. New bone formation and trabecular bone microarchitecture of highly porous tantalum compared to titanium implant threads: A pilot canine study. Clin Oral Implants Res 2018;29:164-74.  Back to cited text no. 28
    
29.
de Arriba CC, Alobera Gracia MA, Coelho PG, Neiva R, Tarnow DP, Del Canto Pingarron M, et al. Osseoincorporation of porous tantalum trabecular-structured metal: A histologic and histomorphometric study in humans. Int J Periodontics Restorative Dent 2018;38: 879-85.  Back to cited text no. 29
    
30.
Witek L, Alifarag AM, Tovar N, Lopez CD, Gil LF, Gorbonosov M, et al. Osteogenic parameters surrounding trabecular tantalum metal implants in osteotomies prepared via osseodensification drilling. Med Oral Patol Oral Cir Bucal 2019;24:e764-9.  Back to cited text no. 30
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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