Are Non-Metal Implants The Next Big Thing For Dentistry?
Updated: Apr 21
Zirconia Implants
The dental implant is certainly a great advancement for people who suffer from missing teeth. Cemented dental bridges made of porcelain and glued to the teeth in front and behind the missing tooth was the standard of care not too long ago. The longevity of this type of fix for a missing tooth varied from 10 to 30 years on average. The other option is a removable plastic plate with a plastic tooth to fill the space or even a denture when all of the teeth were missing.
Implants made of a metal called titanium have been used for over 20 years now with increasing success and application. A newer type of implant is finding increased popularity, the metal-free implant. It is made of a ceramic material called zirconia. I will list some of the notable advantages and disadvantages of metal-free zirconia dental implants.
Less discoloring around gums
The esthetic advantage is one of the first reasons people seek zirconia implants. Titanium implants are grey metal. This grey color can show through thin bone and gum tissue, especially in the front teeth area. Bone loss around the implant can occur. This can cause recession around the implant which further exposes the metal collar above the bone level of the attached crown.
Zirconia implants are and ivory, tooth-colored ceramic implants that mimic the color of teeth and roots in the bone and under the gums. Even with some recession, the show through under the gum has a more natural shade. Several studies found much lesser gum color changes with zirconia implants than with titanium implants.
Significantly Lower Bacterial Adhesion than with Titanium
Two different studies found that bacterial accumulation was far less around zirconia implants versus titanium implants. This favorable property means healthier gums and a protected bone and implant.
Less Inflammatory Infiltration In The Peri-implant Tissue Than Gold Or Titanium
How the gums and other soft tissue reacts to the dental implant is a significant factor in the cosmetic success, periodontal success and bone health of implants. Zirconia implants are biocompatible with the soft tissue that surrounds them, as is titanium. Zirconia promotes healthy gums and soft tissue. Inflammation around zirconia implants and titanium implants over time were found to be similar but the health of the tissue around the zirconia implants fared better than titanium implants. Soft tissue or gum adhesion to the material in the implant provides a barrier of protection for the implant. The effect is healthier bone, less recession of bone around the implant. Innovative Dentistry encourages our patients to adopt diligent and regular home care and keep regular dental check-ups and cleanings to ensure the optimal gum health surrounding the dental implants.
Papilla/Crown Proportion Improves Over Time
The gum tissue between the teeth and the implants has also been shown to be stable over time possibly improving the black triangles that can occur fro recession.
Stable Bone Levels Around Implant Margin
Bone levels around zirconia implants have been demonstrated to be stable in clinical trials. When using titanium implants as a control, bone integration or growth that holds the implants firmly in place around the metal-free zirconia implants was as good or even better as that of the metal implants.
High Strength Implants
Zirconia is an exceptionally high-strength material. The compression strength allows for favorable properties while chewing. Where zirconia is problematic is shearing strength, as in teeth grinding and clenching. This means the patient selection is important to the success of a zirconia dental implant. Dr. Ebner, the dentist in our phoenix dental office takes this and many other factors into account when recommending, or not recommending zirconia dental implants to her patients.
Lower Rate of Metal Sensitivity
Studies performed by the FDA have shown metal allergies, titanium migration, and inflammatory responses in some people to metal implants. The same has not been shown of zirconia implants.
Higher rate of fracture
Some studies, however, zirconia implant groups have shown irreparable implant head fractures at relatively low fracture loads. Technical failure as a result of fracture of the material is a sensitive issue and a critical factor for usage and longevity.
Limit to the size and options
Most research regarding zirconia implants is limited to single tooth replacements. The options for zirconia implant tooth replacement, therefore, are more limited than titanium implants.
Higher cost
The price for zirconia implants is higher than that for titanium implants
Limited History
Current research surrounding zirconia implants is limited that performed in more recent years while research on titanium implants spans over 40 years. It is limited to single tooth replacements.
Presently, the studies pertain to zirconia's use only as a single-piece implant, hence the nonavailability of zirconia as a multiple piece implant is an added limitation. Because of the lack of clinical reports on the long-term success rates with zirconia implants, our dentist suggests caution with regard to placing zirconia implants and recomendds thei placment when certain criteria is met to improve long term survival of the implant.
References
1. https://www.fda.gov/media/131150/download
2. A prospective clinical study to evaluate the performance of zirconium dioxide dental implants in single-tooth edentulous area: 3-year follow-up.
Kai-Hendrik Bormann, Nils-Claudius Gellrich, Heinz Kniha, Sabine Schild, Dieter Weingart, Michael Gahlert. BMC Oral Health. 2018; 18: 181.
3. A prospective clinical study to evaluate the performance of zirconium dioxide dental implants in single-tooth gaps.
Gahlert M1, Kniha H1, Weingart D2, Schild S2, Gellrich NC3, Bormann KH3,4. Clin Oral Implants Res. 2016 Dec;27(12):e176-e184.
4. Is zirconia a viable alternative to titanium for oral implant? A critical review.
Sivaraman K1, Chopra A2, Narayan AI3, Balakrishnan D3. J Prosthodont Res. 2018 Apr;62(2):121-133.
5. A systematic review of zirconia as an implant material. Prithviraj D R, Deeksha S, Regish K M, Anoop N. Indian J Dent Res 2012;23:643-9
