|Year : 2021 | Volume
| Issue : 4 | Page : 331-335
Uses and applications of tantalum in oral implantology: A literature review
Adrián Ore1, Diego Gerónimo1, Marilyn Huaman1, Nancy Calsin1, Roman Mendoza1, Frank Mayta-Tovalino2
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 Submission||24-Jan-2021|
|Date of Decision||20-Mar-2021|
|Date of Acceptance||09-May-2021|
|Date of Web Publication||19-Aug-2021|
Dr. Frank Mayta-Tovalino
Postgraduate Department, Faculty of Health of Sciences, Universidad Científica del Sur, Lima.
Source of Support: None, Conflict of Interest: None
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|| |
A high success rate has been obtained in achieving and maintaining osseointegration in dental implants, with a survival rate of up to 90%.,, 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. 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.
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. 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. 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.
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.,,,,,
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|| |
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.”
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].
| Results|| |
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].
| Discussion|| |
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.
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.,
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.,,
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.
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.,,,,, 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. 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.
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. 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.
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.,,,,,
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. 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.
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.
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.
| Conclusions|| |
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.
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.
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
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.
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[Table 1], [Table 2], [Table 3]