15.9.

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Anoverviewofthecorrosionaspectofdentalimplants(titaniumanditsalloys):[PAUTHORS],IndianJournalofDentalResearch(IJDR)

REVIEWARTICLE
Year:2009|Volume:20|Issue:1|Page:9198

Anoverviewofthecorrosionaspectofdentalimplants(titaniumanditsalloys)
TPChaturvedi
Professor,DivisionofOrthodonticsandGeneralDentistry,FacultyofDentalSciences,InstituteofMedicalSciences,4GFJodhpurColony,BanarasHinduUniversity,Varanasi221005,UttarPradesh,
India
CorrespondenceAddress:
TPChaturvedi
Professor,DivisionofOrthodonticsandGeneralDentistry,FacultyofDentalSciences,InstituteofMedicalSciences,4GFJodhpurColony,BanarasHinduUniversity,Varanasi221005,UttarPradesh
India

Abstract
Titaniumanditsalloysareusedindentistryforimplantsbecauseofitsuniquecombinationofchemical,physical,andbiologicalproperties.Theyareusedindentistryincastand
wrought form. The long term presence of corrosion reaction products and ongoing corrosion lead to fractures of the alloyabutment interface, abutment, or implant body. The
combinationofstress,corrosion,andbacteriacontributetoimplantfailure.Thisarticlehighlightsareviewofthevariousaspectsofcorrosionandbiocompatibilityofdentaltitanium
implantsaswellassuprastructures.Thisknowledgewillalsobehelpfulinexploringpossibleresearchstrategiesforprobingthebiologicalpropertiesofmaterials.

Howtocitethisarticle:
ChaturvediTP.Anoverviewofthecorrosionaspectofdentalimplants(titaniumanditsalloys).IndianJDentRes200920:9198

HowtocitethisURL:
ChaturvediTP.Anoverviewofthecorrosionaspectofdentalimplants(titaniumanditsalloys).IndianJDentRes[serialonline]2009[cited2016Sep15]20:9198
Availablefrom:http://www.ijdr.in/text.asp?2009/20/1/91/49068

FullText
Themouthistheportalentryofthehumanbody.Itisalsothehabitatofmicrobialspeciesthatarekeptwetbysaliva.Oraltissuesareexposedtoaveritablebombardmentofboth
chemicalandphysicalstimuliaswellasmetabolismofabout30speciesofbacteria(thetotalsalivarybacterialcountissaidtobefivethousandmillion/mlofsaliva).Yet,forthemost
part, oral tissues remain healthy. Saliva has several viruses, bacteria, yeast and fungi and their products, such as organic acids and enzymes, epithelial cells, food debris, and
componentsfromgingivalcrevicularfluid.Moreover,salivaisahypotonicsolutioncontainingbioactonate,chloride,potassium,sodium,nitrogenouscompounds,andproteins.ThepH
ofsalivavariesfrom5.2to7.8.Manygramnegativeandgrampositivebacterialspeciesformamajorpartofdentalplaquearoundtheteethandalsocolonizethemucosalsurfaces.
Teethfunctioninoneofthemostinhospitableenvironmentsinthebody.Theyaresubjecttolargertemperaturevariationthanmostotherparts,copingwithcoldofice(0C)tohot
coffeeandsoup.Factorssuchastemperature,quantityandqualityofsaliva,plaque,pH,protein,andthephysicalandchemicalpropertiesoffoodandliquidsaswellasoralhealth
conditionsmayinfluencecorrosion.Corrosion,thegradeddegradationofmaterialsbyelectrochemicalattackisofconcernparticularlywhenametallicimplant,metallicfilling,or
orthodontic appliances are placed in the hostile electrolytic environment provided by the human mouth. [1],[2] For dental implants, biocompatibility depends on mechanical and
corrosion/degradationpropertiesofthematerial,tissue,andhostfactors.Biomaterialsurfacechemistry,topography(roughness),andtypeoftissueintegration(osseous,fibrous,and
mixed)correlatewithhostresponse.Biocompatibilityoftheimplantsanditsassociatedstructureisimportantforproperfunctionoftheprosthesisinthemouth.Corrosioncanseverely
limitthefatiguelifeandultimatestrengthofthematerialleadingtomechanicalfailureofthedentalmaterials.Highnoblealloysusedindentistryaresostablechemicallythattheydo
notundergosignificantcorrosionintheoralenvironment,themajorcomponentofthesealloysaregold,palladium,andplatinum.

ClinicalSignificanceofCorrosion

It has been proven that small galvanic currents associated with electrogalvanism are continually present in the oral cavity. As long as metallic dental restorative materials are
employed,thereseemstobelittlepossibilitythatthesegalvaniccurrentscanbeeliminated.Postoperativepaincausedbygalvanicshockcanbeasourceofdiscomfortinthemetallic
restorationtoanoccasionalpatient.Resistancetocorrosioniscriticallyimportantfordentalmaterialsbecausecorrosioncanleadtorougheningofthesurface,weakeningofthe
restoration,liberationofelementsfromthemetaloralloy,andtoxicreactions.Theliberationofelementscanproducediscolorationofadjacentsofttissuesandallergicreactionssuch
asoraledema,perioralstomatitis,gingivitis,andextraoralmanifestationsuchaseczematousrashesinsusceptiblepatients.AccordingtoKirkpatric,etal.[3]thepathomechanismof
theimpairedwoundhealingismodulatedbyspecificmetalionsreleasedbycorrosion.

TheEffectofCorrosiononDentalImplants

Dentalimplanttreatmenthasbeenoneofthemostrecentsuccessstoriesofdentistry.Theuseofdentalimplantsinthetreatmentofcompleteandpartialedentulismshasbecomean
integraltreatmentmodalityindentistry.Dentalimplantsaremadeofbiocompatiblematerialsandtheyaresurgicallyinsertedintothejawboneprimarilyasaprostheticfoundation.
Titaniumandtitaniumalloysarecommonlyusedasdentalimplantmaterials.Theprocessofintegrationoftitaniumwithbonehasbeentermedas"osseointegration"byBranemark.[4]
Presently, most of the commercially available implant systems are made of pure titanium (CPTi) or titanium alloy Ti6Al4V. Titanium and its alloys provide strength, rigidity, and
ductilitysimilartothoseofotherdentalalloys.Whereas,puretitaniumcastingshavemechanicalpropertiessimilartoTypeIIIandTypeIVgoldalloys,sometitaniumalloycastings,
suchasTi6Al4VandTi15VhavepropertiesclosertoNiCrandCoCrcastingswiththeexceptionoflowermodulus.Titaniumanditsalloysgivegreaterresistancetocorrosionin
salineandacidicenvironments.EventhoughtitaniumalloyswereexceptionallycorrosionresistantbecauseofthestabilityoftheTiO2oxidelayer,theyarenotinerttocorrosive
attack.Whenthestableoxidelayerisbrokendownorremovedandisunabletoreformonpartsofthesurface,titaniumcanbeascorrosiveasmanyotherbasemetals.
Theoralcavitycansimulateanelectrochemicalcellundercertaincircumstances.Althoughtitaniumshowsbettercorrosionresistance,itmayinteractwithlivingtissueinseveral
years. This interaction results in a release of small quantities of corrosion products even though they are covered by thermodynamically stable oxide film. If a base metal alloy
superstructureisprovidedoveraTiimplant,thenalsoanelectrochemicalcellisformed.Thelessnoblemetalalloyformsanodeandthemorenobletitaniumformscathode.Electrons
aretransferredthroughmetalliccontact,andtheanodeisthesurfaceorsitesonasurfacewherepositiveionsareformed(i.e.,themetalsurfacethatisundergoinganoxidation
reactionandcorroding)withtheproductionofthefreeelectrons.

FractureofDentalImplant

Althoughafractureofdentalimplantsisnotafrequentphenomenon,itcancauseunfavorableclinicalresults.Corrosioncanseverelylimitthefatiguelifeandultimatestrengthofthe
materialleadingtomechanicalfailureoftheimplant.Ithasbeenfoundthatmetalfatiguecanleadtoimplantfracture.Titaniumisnotsufficientlystabletopreventwearandtearin
bearingsunderload.Understaticconditions,TiandTialloyareabletowithstandexposuretophysiologicchlorinesolutionsatbodytemperatureindefinitelybutaresusceptibleto
oxidechangescausedbymechanicalmicromotion.Forexample,stainlesssteelandTialloydemonstratedcracklikefeatureswhenloadedtoyieldstress.Therefore,repeatedoxide

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breakdownsuchassustainedabrasionislikelytodamagecorrosionresistance.Thesuperstructuresalsocauseareleaseofmetalions.Corrosionsetsinandresultsintheleakingof
ionsintosurroundingtissues.Green[5]reportedafractureofadentalimplant4yearsafterloading.Thefailureanalysisoftheimplantrevealedthatthefracturewascausedbymetal
fatigueandthatthecrownmetal,aNiCrMoalloy,exhibitedcorrosion.Yokoyama,etal.[6]concludedthattitaniuminabiologicalenvironmentabsorbshydrogenandthismaybethe
reasonfordelayedfractureofatitaniumimplant.

CellularResponses

Hexavalentchromiumionsarereleasedfromimplantmaterials.[7]NickelandchromiuminduceTypeIVhypersensitivityreactionsinthebodyandactashaptens,carcinogens,and
mutagens.Theycancauseseveralcytotoxicresponsesincludingadecreaseinsomeenzymeactivities,interferencewithbiochemicalpathways,carcinogenicity,andmutagenicity.
Longtermexposuretonickelcontainingdentalmaterialsmayadverselyaffectbothhumanmonocytesandoralmucosalcells.Titaniumcontainingnickelmaycauselocalizedtissue
irritationinsomepatients.Manganesefromthealloyisalsoconsumedwithsaliva,whichproducestoxicityleadingtoskeletalandnervous,systemdisorders.

BoneLossandOsteolysis

Tialloyshaveshownintegrationwithboneandsofttissueenvironments.However,thereisconcernthatTialloyscontainsignificantamountsofalloyingelementsthatexhibitdifferent
morphology and crystallization, which may affect osseointegration especially due to corrosion products containing aluminium and vanadium. According to Roynesdal, et al., [8]
marginalbonelossaroundimplantsshowedtheworstresultswithtitaniumsprayedimplants.Olmedo,etal.[9]reportedthatthepresenceofmacrophagesinperiimplantsofttissue
inducedbyacorrosionprocessplaysanimportantroleinimplantfailure.Freetitaniumionsinhibitgrowthofhydroxyapatitecrystals(mineralizationofcalcifiedtissuesattheinterface).
Theseprocessesleadtolocalosteolysisandlossofclinicalstabilityoftheimplant.

LocalReactions(Pain/Swelling)

Althoughtitaniumexhibitsbettercorrosionresistance,itmayinteractwithlivingtissuesoverseveralyears.Anincreasedlevelofcalciumandphosphoroushavebeenfoundinoxide
surface layers indicating an exchange of ions at the interface. [10] Corrosion products have been implicated in causing local pain or swelling in the region of the implant in the
absenceofinfectionanditcancausesecondaryinfection.Ahydrogenperoxideenvironmentalconditionhasbeenshowntointeractwithtitaniumandisassociatedwithlowtoxicity,
inflammation,bonemodeling,andbactericidalcharacteristics.

Corrosion

Corrosionbehaviorintheoralcavity
Manytypesofelectrochemicalcorrosionarepossibleintheoralenvironmentbecausesaliva,withsalt,actsasaweakelectrolyte.Theelectrochemicalpropertiesofsalivadependon
the concentrations of its components, pH, surface tension, and buffering capacity. Each of these factors may influence the strength of any electrolyte. Thus, the magnitude of the
resultingcorrosionprocesswillbecontrolledbythesevariables.
Thefeaturesthatdeterminehowandwhydentalmaterialscorrodeareasfollows:[11]
Oxidationandreductionreactions.Factorsthatphysicallyimpedeorpreventcorrosionfromtakingplace(processofpassivationortheformationofametaloxidepassivefilmona
metalsurface).
Typesofcorrosion
Therearetwotypesofcorrosivereactions:chemicalandelectrochemical.Inchemicalcorrosion(drycorrosion),thereisadirectcombinationofmetallicandnonmetallicelementsto
yieldachemicalcompoundthroughprocessessuchasoxidation,halogenation,orsulfurizationreactions.Electrochemicalcorrosion(wetcorrosion)requiresthepresenceofwateror
someotherfluidelectrolytes.Thisgeneralmodeofcorrosionisimportantfordentalrestorations.Variousformsofcorrosionthatmayoccurwiththeabovetypesofreactionsare
mentionedin[Figure1]and[Table1].
Thecomplexityoftheelectrochemicalprocessinvolvedintheimplantsuperstructurejointislinkedtothephenomenonofgalvaniccouplingandpittedcorrosion.ThereductioninpH
andtheincreaseintheconcentrationofchlorideionsaretwoessentialfactorsintheinitiationandpropagationofthecrevicecorrosionphenomenon.Whentheacidityofthemedium
increaseswithtime,thepassivelayerofthealloydissolvesandacceleratesthelocalcorrosionprocess.Crevicecorrosionofstainlesssteelsinaeratedsaltsolutionsiswidelyknown.
CorrosionproductsofFe,Cr,andNi,themaincomponentsofstainlesssteel,accumulateinthecreviceandformhighlyacidicchloridesolutionsinwhichcorrosionsratesarevery
high.
Galvaniccorrosion
The most common form of corrosion, which is generally present in dental implants, is galvanic corrosion. Titanium has been chosen as the material of choice for endosseous
implantation.EventhoughtitaniumalloysareexceptionallycorrosionresistantbecauseofthestabilityoftheTiO2layer,theyarenotinerttocorrosiveattack.Whenthestableoxide
layerisbrokendownorremovedandisunabletoreformonpartofsurface,titaniumcanbeascorrosiveasmanyotherbasemetals.[12]Galvaniccouplingoftitaniumtoothermetallic
restorativematerialsmayalsogeneratecorrosion.Hence,thereisagreatconcernregardingthematerialsforsuprastructuresovertheimplants.
Gold alloys are generally chosen as the superstructures because of their excellent biocompatibility, corrosion resistance, and mechanical properties. However, these are quite
expensive.Therefore,newalloyssuchasNiCr,AgPd,andCoCralloysaregenerallyused.Theyhavegoodmechanicalpropertiesandarecosteffective.Buttheirbiocompatibility
andcorrosionresistanceareofconcern.
Whentwoormoredentalprostheticdevices/restorationsmadeofdissimilaralloyscomeintocontactwhileexposedtooralfluids,thedifferencebetweentheircorrosionpotential
resultsinaflowofelectriccurrentbetweenthem.Aninvivogalvaniccellisformedandthegalvaniccurrentcausesaccelerationofcorrosionofthelessnoblemetal.Thegalvanic
currentpassesthroughthemetal/metaljunctionandalsothroughtissues,whichcausespain.Thecurrentflowsthroughtwoelectrolytes,saliva,orotherliquidsinthemouthandthe
boneandtissuefluids.
The differential surface of a metallic restoration may have small pits/crevices. Consequently, stress and pit corrosion occurs. The mechanical and notched sensitivity, [13] stress
corrosioncracking,torsional,[14]andsmoothandnotchedcorrosionfatigue[15]arepropertiesoftitaniummaterialsusedforimplant.
Theconjointactionofchemicalandmechanicalattackresultsinfrettingcorrosion.Frettingisanothertypeoferosioncorrosion,butinavaporphase.
Hydrogenattackisthereactionofthehydrogenwithcarbidesinsteeltoformmethane,resultingindecarburizationvoidsandsurfaceblisters.Itcanembrittlereactivemetalssuchas
titanium,vanadium,niobium,etc.

MicrobialCorrosion

Microbiologyrelatedcorrosionhasbeennotedinindustryformanyyears.Itiswidelyrecognizedthatmicroorganismsaffectthecorrosionofmetalandalloysimmersedinanaqueous
environment.Undersimilarconditions,theeffectofbacteriaintheoralenvironmentonthecorrosionofdentalmetallicmaterialsremainsunknown.Theeffectofenzymaticactivityand
degradationofcompositeresinshasbeenreportedearlier.Chang,etal.[16]showedthatthecorrosionbehaviorofdentalmetallicmaterialsinthepresenceofStreptococcusmutans

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and its growth byproducts is increased. Brushing and the attachment of microbes on implants may disturb the passivity of passive metal. The formation of organic acids during
glucolysispathwaysfromsugarsbybacteriamayreducepH.AlowpHcreatesafavorableenvironmentforaerobicbacteriaforcorrosion.Microbesoxidizemanganeseandironand
reactionproductsviz.MnO2,FeO,Fe2O3,MnCl2,FeCl2favorcorrosionoftheimplant.Acomplexmechanismofinteractionoccursamonganaerobicandaerobicbacteriain
variouszones,favoringcorrosionproducts.Duetothedepositionofthebiofilm,themetalsurfacebeneaththebiofilmandtheotherareasareexposedtodifferentamountsofoxygen,
which leads to the creation of differential aeration cells. Less aerated zones act as an anode, which undergoes corrosion releasing metal ions into the saliva. These metal ions
combinewiththeendproductsofthebacteria,alongwithchlorideionintheelectrolyte(saliva)toformmorecorrosiveproductslikeMnCl2,FeCl2,etc.favoringfurthercorrosion.[2]
Microbialcorrosionoccurswhentheacidicwasteproductsofmicrobesandbacteriacorrodemetalsurfaces.Theincidenceandseverityofmicrobialcorrosioncanbereducedby
keepingtheareaascleanaspossibleandbyusingantibioticspraysanddipstocontrolthepopulationofmicrobes.Maruthamuthu,etal.[2]studiedtheelectrochemicalbehaviorof
microbes on orthodontic wires in artificial saliva with or without saliva. According to him, bacteria slightly reduce the resistance and increase the corrosion current. Leaching of
manganese,chromium,nickel,andironfromthewiresmaybeduetotheavailabilityofmanganeseoxidizers,ironoxidizers,andheterotrophicbacteriainthesaliva.
Theeffectoffluorideionconcentration
Intheoralenvironment,fluoridecontainedincommercialmouthwashes,toothpaste,andprophylacticgelsarewidelyusedtopreventdentalcariesorrelievedentalsensitivityorfor
properoralcleaningafterapplicationofnormalbrusheswithtoothpaste.ThedetrimentaleffectoffluorideionsonthecorrosionresistanceofTiorTialloyshasbeenextensively
reported. Fluoride ions are very aggressive on the protective TiO 2 film formed on Ti and Ti alloys. Odontogenic fluoride gels should be avoided because they create an acidic
environmentthatleadstothedegradationofthetitaniumoxidelayerandpossiblyinhibitsosseointegration.
Invitroandinvivostudies
Aprimaryrequisiteofanymetalusedinthemouthisthatitmustnotproducecorrosionproductsthatwillbeharmfultothebody.ReedandWillman[17]demonstratedthepresenceof
galvaniccurrentsintheoralcavityprobablyforthefirsttimeindetail.Approximatevaluesforthemagnitudewereestablished.Burse,etal.[18]describedanexperimentalprotocolfor
invivotarnishevaluationsandshowedtheimportanceoftheproperelementalratioingoldalloyscompositions.Variousexperimentalinvitrostudiesregardingcorrosionareshown
in[Table2],whichcanexplorethefutureresearchstrategiesforthecorrosionstudyofimplantmaterials.
Tufekci,etal.[19]describedahighlysensitiveanalyticaltechniquethatshowedthereleaseofindividualelementsovera1monthperiod,whichappearedtobecorrelatedwithmicro
structuralphasesinthealloys.
Notable changes due to galvanic coupling have been reported in literature. Pourbaix [20] reviewed the methods of electrochemical thermodynamics (electrode potentialpH
equilibriumdiagrams)andelectrochemicalkinetics(polarizationcurves)tounderstandandpredictthecorrosionbehaviorofmetalsandalloysinthepresenceofbodyfluids.
Sutow,etal.[21]studiedtheinvitrocrevicecorrosionbehaviorofimplantmaterials.Thegalvaniccorrosionoftitaniumincontactwithamalgamandcastprosthodonticalloyshasbeen
studiedinvitro.[22],[23]NocurrentorchangeinpHwasregisteredwhengold,cobaltchromium,stainlesssteel,carboncomposite,orsilverpalladiumalloyscameinmetalliccontact
withtitanium.Changesoccurredwhenamalgamwasincontactwithtitanium.
GeisGerstorfer,etal.[24]statedthatthegalvaniccorrosionofimplant/superstructuresystemsisimportantintwoaspects:(i)thepossibilityofbiologicaleffectsthatmayresultfromthe
dissolutionofalloycomponentsand(ii)thecurrentflowthatresultsfromgalvaniccorrosionmayleadtobonedestruction.
In another study, Reclaru and Meyer [25] examined the corrosion behavior of different dental alloys, which may potentially be used for superstructures in galvanic coupling with
titanium.Cortada,etal.[7]hadreportedthatmetallicionsarereleasedintheartificialsalivaoftitaniumoralimplantscoupledwithdifferentmetalsuperstructures.Inthiswork,metallic
ionreleaseinoralimplantswithsuperstructuresofdifferentmetalsandalloysusedinclinicaldentistrywasdetermined.
ThestudyregardingthemeasurementandevaluationofgalvaniccorrosionbetweentitaniumanddentalalloyswasalsocarriedoutbyGrosgogeal,etal.[26]usingelectrochemical
techniquesandaugerspectrometry.TheresultsshowedthattheintensityofthecorrosionprocessislowincaseofTi/dentalalloys.Othertypesofcorrosion,e.g.,pittingcorrosionand
crevicecorrosionshouldalsobeconsidered.
Aparicio,etal.[27]studiedthecorrosionbehaviorofcommerciallypuretitaniumshotblastedwithdifferentmaterialsandsizesofshotparticlesfordentalimplantapplications.Itiswell
knownthattheosseointegrationofthecommerciallypuretitanium(CPTi)dentalimplantisimprovedwhenthemetalisshotblastedtoincreaseitssurfaceroughness.Thisroughness
iscolonizedbybone,whichimprovesimplantfixation.
OhandKim[28]carriedoutastudyregardingtheelectrochemicalpropertiesofsuprastructuresgalvanicallycoupledtoatitaniumimplant.Photomicrographsafterelectrochemical
testing showed crevice or pitting corrosion in the marginal gap and at the suprastructure surface. Tested samples of CoCr/Ti implant couples showed the possibility of galvanic
corrosion,butitsdegreewasnotsignificant.
KasemoandLausmaa[29]demonstratedthedissolutionofcorrosionproductsintothebioliquidandadjacenttissues.Thus,theoutermostatomiclayersofanimplantarecritical
regionsassociatedwithbiochemicalinteractionsoftheimplanttissueinterface.Thisshouldhaveatremendousinfluenceonahighdegreeofstandardizationandsurfacecontrolin
theproductionofdentalimplants.Theresponseofbonetodifferentimplantmaterialsistheprincipalfactoronwhichanimplantmaterialisselectedassuitableorunsuitablefor
osseointegration.
Siiril and Knnen [30] studied the effects of topical fluoride on commercially pure titanium and concluded that toothbrushes used in contact with titanium surfaces should be as
nonabrasiveaspossible,andthatlonglastingcontaminationwithtopicalfluoridesshouldbeavoided.Nakagawa,etal.[31]studiedtherelationshipbetweenfluorideconcentrations
andpHvaluesatwhichTicorrosionoccurredinthepresenceoffluorideions.
Fromtheabovebriefreviewofliterature,itisevidentthatmonitoringofcorrosionpotentialishelpfulinindicatingtheexistenceandtheextentofgalvaniccorrosionoccurringindental
implants.AccordingtoJose,etal.,[32]itisdifficulttopredicttheclinicalbehaviorofanalloyfrominvitrostudies,sincesuchfactorsaschangesinthequantityandqualityofsaliva,
diet,oralhygiene,polishingofalloy,theamountanddistributionofocclusalforces,orbrushingwithtoothpastecanallinfluencecorrosiontovaryingdegrees.Theincreaseinmetal
ion content in the environment may eventually prevent further corrosion. Sometimes a metal ceases corroding because its ions have saturated the immediate environment. This
situationdoesnotusuallyoccurindentalrestorationsbecausedissolvingfood,fluids,andtoothbrushesremoveions.Thus,corrosionoftherestorationswillcontinue.

Summary

Inspiteofrecentinnovativemetallurgicalandtechnologicaladvancesandremarkableprogressinthedesignanddevelopmentofsurgicalanddentalmaterials,failuresdooccur.
Oneofthereasonsforthesefailurescanbecorrosionofdentalimplants.Themostfavorablesuprastructure/implantcoupleistheonewhichiscapableofresistingthemostextreme
conditionsthatcouldpossiblybeencounteredinthemouth.Thechoiceofthematerialsusedfortheimplantaswellasimplantbornesuprastructuresbecomecrucial,andcanbe
madebywayofevaluatingtheirgalvaniccorrosionbehaviors.Whenthemechanismsthatensureimplantbioacceptanceandstructuralstabilizationarefullyunderstood,implant
failureswillbecomearareoccurrence,providedthattheyareusedproperlyandplacedinsitesforwhichtheyareindicated.[39]

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