Titanium tattooing associated with zirconia implant abutments: a clinical report of two cases.

Worn particulate titanium abraded from a titanium dental implant that discolors the adjacent soft tissues has not previously been reported. Two cases of this gingival tissue "tattooing" are reported here. While the use of zirconia abutments in areas of high esthetic concern is widespread, the effects of particulate titanium being worn from the implant by the much harder abutment material and then taken up in the adjacent soft tissues should be considered as a potential complication and a consideration when selecting the type of abutment to be used.

Wear at the titanium-zirconia implant-abutment interface: a pilot study.

PURPOSE: The purpose of this study was to use a clinical simulation to determine whether wear of the internal surface of a titanium implant was greater following connection and loading of a one-piece zirconia implant abutment or a titanium implant abutment. MATERIALS AND METHODS: Two implants received zirconia abutments and two received titanium abutments. The implants were secured into four fiber-reinforced epoxy resin disks that had been prepared to receive the internal-connection implants. The assemblies were cyclically loaded off-axis for a total of 1,000,000 cycles. At various intervals, the abutments were removed, photographed, examined using scanning electron microscopy (SEM), and returned to the implants for further testing. The area of titanium transfer from the implants to the abutments observed in the SEM images was quantified using image analysis software. RESULTS: The method was able to quantify the area of material transferred to the abutments. There was considerably more wear associated with the zirconia abutments, but the rate of wear slowed after about 250,000 cycles. Parabolic curves were fit to the data. The projected mean ± standard deviation maximum area (wear) values associated with the titanium and zirconia abutments were 15.8 ± 3.3 x 10³ Μm² and 131.8 ± 14.5 x 10³ Μm², respectively, and this difference was statistically significant (P = .0081). CONCLUSIONS: The implants with the zirconia abutments showed a greater initial rate of wear and more total wear than the implants with the titanium abutments following cyclic loading. The amount of titanium transfer seen on the zirconia abutment increased with the number of loading cycles but appeared to be self-limiting. The clinical ramifications of this finding are unknown at this time; however, the potential for component loosening and subsequent fracture and/or the release of particulate titanium debris may be of concern.