Background: Advancements in therapeutic approaches and standard medical interventions have significantly improved the prognosis of patients with differentiated thyroid cancer. However, uncertainties remain regarding the optimal timing and protocols for dental implant placement in patients undergoing radioiodine-131 (I-131) therapy. Debates continue about the potential effects of radiation on osseointegration dynamics and implant viability. This in vitro study assessed the impact of radiodiodine-131 (I-131) used for differentiated thyroid cancer on the structure of zirconia and titanium implants. Methods: A total of 60 implants were utilized, with distribution into two cohorts: titanium implants (Ti, n = 30) and zirconia implants (Zr, n = 30). Subsequently, the Ti and Zr implants were immersed in I-131 solution and retrieved at specified time intervals: 0, 6, 12, 24, 48 h, and 8 days post irradiation. The analyses used to characterize the structure of the implants were radioactivity, scanning electron microscopy, atomic force microscopy, roughness, and Vickers hardness assessment. Results: The findings indicate that the zirconia implants exhibited minimal ultra-structural topographic changes after irradiation. Notable topographical changes and debris deposition on zirconia surfaces became evident after 24 h, with cumulative effects observed after 192 h. The titanium implants, on the other hand, showed surface alterations beginning at 12 h of exposure. Significant changes, including erosive patterns and substantial debris deposits, occurred after 48 and 192 h, leading to increased surface roughness by 24 h. Implants exposed for 12 and 24 h formed a statistically significant group, indicating the onset of surface alteration accumulation. The erosion debris confirmed the surface alterations induced by radioiodine-131 exposure. Conclusions: Overall, the Zr implants demonstrated greater stability compared to the Ti implants following radioiodine-131 exposure.
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