Influence of chemical composition on cell viability on titanium surfaces: A systematic review

Abstract

Statement of problem: A consensus on which dental implant alloy and surface treatment provide the best cell viability is unclear.

Purpose: The purpose of this systematic review was to provide information on the influence of surface and intrinsic titanium alloy chemical components on cell viability.

Material and methods: The PubMed, LILACS, COCHRANE library, and Science Direct databases were electronically searched for the terms dental implants AND titanium AND cytotoxicity. Inclusion criteria were research articles that studied titanium or its alloys for chemical composition and cell viability and were published in English between 1999 and 2019. Articles that did not study titanium and its alloys, articles with nondental or biomedical implants, and articles that were not found in their entirety were excluded.

Results: A total of 1226 articles selected by title or abstract according to the inclusion and exclusion criteria resulted in 51 articles that were reduced to 27 after reading in full. The treatments analyzed were arc fusion, electron beam physical deposition, plasma electrolytic oxidation, coating addition, micro arc oxidation, anodization, thermochemical process, BMP-2 immobilization, pressure-assisted sintering, and alkali heat treatment.

Conclusions: The evaluated literature did not allow a determination of the best surface treatment for cell viability because of the heterogeneity of the studies regarding the type of alloy, cell used in the MTT assay, study, and implant purpose (biomedical or dental). The cytotoxic effect of chemical components was dependent on dose, time, size, temperature, and cell type. The niobium, tantalum, zirconium, and molybdenum elements have been most often added in the development of less toxic Ti alloys with lower modulus of elasticity and increased strength.