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Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
Department of Mechanical Engineering and Center of advanced Material, University of Malaya, Kuala Lumpur 50603,
Malaysia
employ throughout the world. Generally, FGM and FGM porous biomaterials are more difficult to fabricate than uniform or homogenous biomaterials. Therefore, our
discussion is intended to give the readers about successful
and obstacles fabrication of FGM and porous FGM in dental
implants that will bring state-of-the-art technology to the
bedside and develop quality of life and present standards of
C 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A:
care. V
101A: 30463057, 2013.
How to cite this article: Mehrali M, Shirazi FS, Mehrali M, Metselaar HSC, Kadri NAB, Osman NAA. 2013. Dental implants from
functionally graded materials. J Biomed Mater Res Part A 2013:101A:30463057.
INTRODUCTION
produced both from conventional engineering and tissue engineering. Nowadays, bone implant research is mainly
focused on four areas: (1) composites, (2) polymeric coatings on metallic implants, (3) tissue engineering, and
recently (4), functionally graded material (FGM).6
FGMs, rst proposed in 1986 in Japan, represent a novel
idea for the realization of innovative properties and/or functions that conventional homogeneous materials cannot accomplish.7,8 One extraordinary feature of biomaterials is the
formation of gradable structures. Therefore, FGMs are useful
as the composition of tissue shows a continuous change
from one composition to another.9 For example, the suitable
design of porous bone with a porosity gradient from a
dense, stiff external structure (the cortical bone) to a porous
internal one (the cancellous bone), and with an adequate
degree of interconnectivity exhibits that functional gradation
is applied by biological adaptation.1012
In the case of dental implants, the components are usually much smaller and used to reconstruct the masticatory
3046
REVIEW ARTICLE
FIGURE 1. View of an FGM dental implant with graded material composition in the maxilla.13 [Color figure can be viewed in the online issue,
which is available at wileyonlinelibrary.com.]
design of functionally graded dental implants and optimization is also a subject of this review.
THE STRUCTURE OF FUNCTIONALLY GRADED DENTAL
IMPLANTS
3047
Youngs
Modulus (GPa)
Poissons
Ratio
Density
(kg/m3)
Cortical bone
Cancellous bone
Enamel
Dentin
Ti
HA
TiN
14
3
10.5
19.7
110
40
251
0.3
0.3
0.33
0.33
0.35
0.27
0.29
1700
270
2906
1800
4500
3219
5300
Co
ZrO2
SiO2
210
200
75
0.31
0.31
0.17
8900
6000
2200
In the last few years, a variety of biomaterials and bioceramics were investigated for FGM dental implants such as
Ti/HA,16,17,38 titanium/cobalt (Ti/Co),39 Ti/ZrO2,40 titanium/silica (Ti/SiO2),41 and TiN/HA.42,43 Table I summarizes the Youngs modulus, Poissons ratio, mass density of
bone, and material densities for reference.19,31,4453 Studies
have shown that Ti and its alloys are among the most successful metallic biomaterials for dental and orthopedic
applications because of their good mechanical properties
(elastic modulus, toughness and fatigue, strength), excellent
corrosion resistance, and good biocompatibility.5860 However, Ti and Ti alloys are bioinert and cannot promote tissue
bonding to the implants. Generally, a dental implant should
have sufcient mechanical strength to maintain integrity;
for this reason, Ti and Ti alloys were used along the longitudinal direction from Ti, which is rich in the upper parts
where occlusal force is directly applied to ceramics or metals rich in the other material that is implanted inside the
jawbone.
Watari et al.39 investigated Ti/Co FGMs. They evaluated
the mechanical properties and biocompatibility for implants.
They reported that in the implantation analysis of Ti/Co
into the soft tissue, a thin brous connective tissue was
formed in the pure Ti region while the thickness of the brous tissue layer increased with the Co concentration, leading to inammation problems at the Co-rich part. Therefore,
the COs change of concentration seemed to affect the biocompatibility of implant material. Other clinical studies also
indicated that epithelial cells as well as broblasts have a
stronger negative response to a Co-chrome alloy than to
Ti.61 In this context, Co exhibited several advantages in mechanical properties, wear resistance, and good corrosion
resistance.
Takahashi40 studied the use of Ti/ZrO2 FGM for dental
implants. Zirconia appears to be an appropriate dental
implant material because of its tooth-like color, biocompatibility, and good mechanical properties in strength and fracture toughness.62 The inammatory reaction and bone
resorption provoked by zirconia particles are less than
those inuenced by Ti particles; therefore, ZrO2 is suitable
3048
MEHRALI ET AL.
Reference
44
Rho et al.
Rho et al.44
Dowker et al.45 and Kitagawa et al.46
Kitagawa et al.47 and Angker et al.48
Benzing et al.49 and Lin et al.50
Hedia and Mahmoud19
Stone et al.51, Sherif El-Eskandarany et al.52,
and Namazu et al.53
Marti54
Gahlert et al.55 and Andreiotelli and Kohal56
Zhou et al.57
REVIEW ARTICLE
to the HA 40 wt % Y-TZP layer across the HA/Y-TZP functionally graded composites as shown in Figure 4(a,b).
Besides the FGM dental implants discussed above, porous functionally graded biomaterial such as Ti and its
alloys also work. Nowadays, most oral implants are fabricated from Ti-6Al-4V (90% Ti, 6% aluminum, and 4% vanadium) and pure Ti. Although Ti and its alloys have good
physical, mechanical properties, corrosion resistance, and
biocompatibility,89,90 the stiffness of metallic dental implants
is not well-adapted to bone. This situation leads to stress
shielding from the residual bone, which may result in detrimental resorptive bone remodeling.91 The stiffness of a
metal is determined by the Youngs modulus of the material
used as well as its area of moment inertia. In the case of Ti
dental implants, the Youngs modulus is far higher than that
of cortical bone as summarized in Table I.44 Therefore, it is
proposed that the level of porosity is gradable, from a more
porous surface layer to a denser core, giving the potential
to have the same stiffness of the bone tissue at the
implantbone interface.92,93
Hirschhorn94 in the 1970s used the concept of functionally graded porous biomaterials to fabricate femoral stems.
However, the study appeared abandoned owing to the
FIGURE 3. BSE
composite.88
image
of
the
HA/Y-TZP
functionally
graded
3049
FIGURE 4. (a) Microhardness and (b) Youngs modulus as a function of Y-TZP content for the HA/Y-TZP functionally graded composites by
SPS.88
In this section, we discuss the processing methods to fabricate FGM dental implants and their mechanical behavior.
There are several methods for the fabrication of FGM and
porous FGM dental implants as summarized in Table II.
Functionally graded dental implants containing
Ti and TiN
Ti/HA FGM can make a promising material for tissue implantation, orthopedic, and dental applications because of
its outstanding biocompatibility and bioactivity. As mentioned above, different fabrication methods are used such as
cold isostatic pressing (CIP), spark plasma sintering (SPS),
hot pressing, and powder metallurgy (PM). Watari et al.17 in
1997 showed the synthesis of HA/Ti as an FGM dental
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MEHRALI ET AL.
Fabrication Methods
CIPEF, CIPHF, SPS,
PM, hot pressing
SPS
PM
CIPHF
CIPHF, hot pressing
SPS, hot pressing
PM, one-step microwave,
PECS, LENSTM, and DLMS
References
16
REVIEW ARTICLE
3051
Watari et al.39 produced Ti/Co FGM by powder metallurgy using both a wet technique to produce a gradient by
differentiated sedimentation in a solvent liquid and a dry
method to pack mixed powders gradiently into a mold, followed by CIP, and sintering at 1300 C. The Ti/Co FGM
specimens were implanted in the subcutaneous tissue of
dorsal part of rat and after implantation were evaluated
from histological observation by optical microscopy. One of
the evidences of infection is pus formation that is a result
of macrophages and neutrophils, which die after killing the
foreign parasites. To avoid the spread of infection, brous
tissues usually form around the pus.110 The thickness and
texture of brous tissues created around the implant can
depend on the type of implant material, shape and size of
the implant, site of surgery in terms of functionality, and
type of tissue that needs to be healed.111 Watari et al.39
have found that the thickness of the brous connective layer
is small in the pure Ti region. However, the thickness of the
brous connective layer increased with Co concentration
along the longitudinal direction of the FGM. It was also
observed that more inammatory tissue and necrosis
occurred near some Co-rich parts.
Takahashi et al.41 manufactured Ti/SiO2 FGM dental
implants by CIP method and then sintered in argon gas by
high-frequency induction heating at a temperature of
1300 C. This group reported that the fracture stress
changed from 2000 MPa in pure Ti to 100 MPa at the ceramic content. In their research, they also used Ti/ZrO2
FGM for dental implants40 by following the same method as
mentioned above for Ti/SiO2. It was found that at the same
volumetric content, the Tizirconia composite showed the
same exural strength as the Tiapatite composite and
higher values of elastic modulus and strain. It was shown
that the sintering at higher ceramic contents could improve
by adding 5% of Pd to the Ti.
Recently, Fujii et al.66 developed Ti and PSZ FGM using
hot pressing. The Youngs modulus and Vickers hardness
were higher in the full range of Ti than predicted from the
rule of mixture, and the bending strength decreased with
increasing Ti content as the strength of pure PSZ is much
higher than that of pure Ti. According to the X-ray diffraction (XRD) analysis, the sintering process created reaction
products such as Ti oxide, and these reactions inuenced
the mechanical properties.66 It is often stated that there are
different stoichiometrics in Ti oxide which are TiO2, TiO,
Ti2O3, Ti3O2, Ti3O5, TiO0.325, and TiO0.5, and it seems that
the Youngs modulus depends on the stoichiometrics.112
Hence, various Youngs modulus of Ti oxide have been
reported.67,113 Hence, the mechanical properties of the Ti/
PSZ FGM could not be explained by the rule of mixture.
Teng et al.114 reported that there was no reaction product
in the Ti/ZrO2 interfaces fabricated by hot pressing,
whereas according to the thermodynamic analysis, it is predictable that Ti can react with ZrO2 in the synthesis processes of Ti/ZrO2 FGM, and the bonding state between Ti
and ZrO2 is physical in the composite. The XRD results were
demonstrated that the volume fraction of Ti in the composites has remarkable effect on the phase transformation
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MEHRALI ET AL.
REVIEW ARTICLE
3053
FIGURE 8. SEM images at 500 magnification of surfaces fabricated disks after different treatments. (a) Untreated disk; (b) disk treated with
hydrofluoric acid; and (c) disk treated with organic acid.93
replaced particles. The SEM images of the surfaces DLMSfabricated disks after different treatments are shown in
Figure 8. Moreover, they assessed the variation of surface
roughness by use of a Chi-square test. It is important to
control the surface morphology of the dental implants to
obtain the desired surface roughness and the wettability to
allow the absorption of plasma proteins on the implant surface.124 Youngs modulus of the exterior porous Ti was 77
6 3.5 GPa, but the mean of porosity was 28.7% of the metal
surface, and that of the inner core Ti was 104 6 7.7 GPa.
The fracture face indicated a dimpled appearance typical of
ductile fracture. However, the method is also limited in the
arrangement and the control of pore size that can be
fabricated.
FUTURE CONSIDERATIONS
For nearly all dental implants, the main goals are rapid
return to function (i.e., mastication), stronger, safer osseointegration, and long-term xation of implants to bone. To
achieve these goals, designers of dental implants must confront biomechanical and biomaterials subproblems, including in vitro and in vivo performances on implants, mechanical compatibility to smooth transfer the stress between the
placed implant root and the receiving hard tissue, and interfacial tissue response. As a promising candidature, FGM can
be applied to improve the success of dental implants while
there are no many examples of actual FGM dental implants
that have been used in clinical applications. The hurdle may
be the producing cost and transferring the techniques to
shape of a dental implant, which will prevent the realization
of the potential of functionally graded dental implants. In
our research to create the ideal implant designed with
FGMs approaches, we are required to close key gaps in our
basic knowledge and make a series of prototype dental
implants with increasing functionality. We must start by distinguishing the specic gaps, in our present knowledge, and
then look widely for advances that will facilitate us to link
them. We must try to uncover the relationships linking composition and biomaterials architecture in functionally graded
dental implants with mechanical behavior, length scales, and
the capability for osteogenesis. Finally, these relationships
should be tested and evaluated systematically in vivo and
nally in clinical studies.
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MEHRALI ET AL.
CONCLUSIONS
REVIEW ARTICLE
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17.
18.
19.
20.
ACKNOWLEDGMENTS
21.
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