Mark, there are many advantages to zirconia as a dental implant material. One the top of that list is the fact that we can use a one-piece implant. If we could use a one piece titanium implant with no connection, I think that most people in this forum would agree that would be ideal. But we know it is hard to make look good in the mouth. With zirconia this is easy. The zirconia is also healthier against tissue, oxidation products from titanium implants, which nowaday are alloys mixed with other non inert metals, accumulate in the tissue. Finally, simplicity, I would rather have simple solutions to solve simple problems.
As for long term data, how long do you think the data on any new product that comes to market in our field is? How long was the data present for Nobel Replace implants before use? We rely on data from other products (machines titanium) to support our use of similar products. There is published 5 year data (PDF Link) that was published in 2010. The yet unpublished 10 year study will be coming soon, and having seen the results, you are going to be blown away. So the data is out there, we just need to open our eyes and see.
What is the shear strength of a 1.5mm abutment screw compared to a 4mm+ zirconia, because this is what we should be comparing. If you have a lateral shear force on an implant, you have a problem, but I would trust CeraRoot over the little prosthetic abutment screws.
M.P. Hemisection was an option, so was a three unit bridge, so was a flipper, so was no tooth at all, the patients usually want the longest lasting, most cost effective option. I don't need 2-3mm of bone around my implants. IF i have 1-2mm I am quite happy, which means I need a 10mm ridge, not so hard in the posterior mandible. Lets take this further and assume I had buccal bone lost and some tissue recession, what is the consequence? With titanium, I would start to see threads maybe? with zirconia, am i going to see some white? maybe I will have to replace the crown, prep a little margin, what if it were a tooth??
This is a little bit of a paradigm shift. Once the zirconia implant integrates it is a tooth, what do you do to a tooth in that situation, do teeth come with angled abutments?
Great feedback guys, I'm going to post another case, an anterior... lets see what you guys think.