Osseointegration, inflammatory process and foreign body reaction of dental titanium implants

There has yet to be a consensus among researchers, professionals, companies, regulatory agencies, and technical standards regarding the definition of osseointegration. The divergence is conceptual and occurs due to explanations of the mechanisms of interactions among cells and proteins with the implant. In medicine, osseointegration is assessed visually in radiographic examinations by the absence of implant-bone space or by mechanical stability and absence of pain. In the medical field, it is mentioned that there is osseointegration of cemented orthopedic prostheses, stainless steel prostheses, Co-Cr-Mo alloys, and zirconia. In dentistry, osseointegration occurs only with titanium implants and is characterized by bonding bone cells with the implant surface through proteins. Titanium implants are chemically, physically, and mechanically linked to the bone through proteins adhered to their surface without a fibrous connective tissue interface. The protein-titanium connection has mechanical strength and can withstand functional loads on dental implants. Given the divergences in the understanding of osseointegration of titanium and zirconia implants, concepts are presented that explain the differences in biocompatibility and applications of biomaterials, inflammatory processes, osseointegration, foreign body reaction, and the mechanisms of protein interactions with surfaces of titanium and zirconia implants.