Discussion Topic: Ceramic Dental Implants

That's what people said about asbestos and DDT. we should challenge and move science forward. Some patients prefer metal free or have a metal allergy, we should be able to serve them too

After 37 years in implantology,I still have to see a proven allergy against titanium implants

I've seen 3 cases. Out of interest what does titanium allergy like like?

We have been using ceramic implants for a long time. Posted a presentation about the science and application here on OsseoNews. I'm my hands the success rates are the same or better than metal. The demand is there and the reasons for using them outweigh the reasons not to. For me it's the ideal tooth replacement option. Bottom line is that the material and technology has been proven. Penetration into the titanium alloy market is starting as we see with Straumann taking the leap forward soon to be followed by other major players. I'm excited about what is yet to come.

Thanks for the reminder Dr. Hagi. If anyone is interested in viewing the webinar, Dr. Hagi did a few years back, you can watch it below: https://www.youtube.com/watch?v=Tc7dUPeEmCs&t=303s

"Plus they are one piece right now which is very limiting." This is no longer true. Zeramex P6 Ceramic Implant are two-piece, reversible screw-retained.

I concur w/95%. Bottom line is the service and value delivered and to what extent you want or need customer support.

Zirconium is a metal. Zirconium dioxide, which these implants are made from, is a ceramic, which chemically is not a metal. When you combine elements you form compounds with new properties that don't share the properties of the individual elements. So of course, Zirconium dioxide has a metal element in it. But, because the compound has a metal in it, doesn't make the compound a metal, nor does it have the same properties as a metal. In fact, these implants should actually be called nonmetallic implants, but that doesn't sound as good as metal free, which I agree is a misnomer. Either way, they are not metals, and have different properties, and that's what is important and interesting. http://ceramics.org/learn-about-ceramics/structure-and-properties-of-ceramics http://www.chemistryexplained.com/Bo-Ce/Ceramics.html

Not sure what you mean, but Zirconia implants are ceramic. Zirconia is just another name of Zirconium dioxide, which is a ceramic, which is what these implants are made from. But other than that, I agree 100% with your main point, that the potential benefits of ceramics is in how they treat the soft tissues. Everyone sees this in restorations, and the same concept applies to the implant material, which is why I think ceramic implants will continue to grow in implant dentistry, as the technology continues to improve, especially with regards to the new 2 piece ceramic systems. I highly recommend reading this article, Zirconia dental implants: where are we now, and where are we heading? Here is the Link: http://onlinelibrary.wiley.com/doi/10.1111/prd.12180/full

I don't want veer the discussion away from the actual topic here which is the clinical experience with ceramic implants, but your comment requires a response. So I apologize for the diversion...but, as stated previously modern science understands that a compound will have different properties than the elements it is made of, when elements are combined, due to the nature of atomic bonding. This is chemistry 101 and basic atomic theory, and has nothing to do with dentistry or marketing or business. You are free to deny atomic theory, because you find it difficult to accept, for whatever reason, but in the real world, ceramics are not considered metals, even if one of the elements in a ceramic compound is a metal. The addition of an oxygen, or other non-metal element, does in fact change the nature and properties of the compound as a whole due to atomic bonding. Yes, I agree this is an amazing fact, and it challenges our basic intuition, but, modern science is full of new facts that challenge our basic intuitions and understanding of the universe. Ever hear of relativity theory? So sorry to break the news to you, but a ceramic is not a metal. That is a fact whether you want to believe it or not. Won't bother to post about this anymore, or debate anyone who denies modern science. The point here is to discuss the clinical experience with ceramic implants, so if you can't accept that ceramics are not metals, that's fine. It's not really relevant. For those who want to read about this further, feel free to read the selection of links below which were written by chemists, and not dentists (I assure you there is no grand conspiracy of dentists influencing these chemistry websites): http://ceramics.org/learn-about-ceramics/structure-and-properties-of-ceramics http://www.chemistryexplained.com/Bo-Ce/Ceramics.html https://en.wikipedia.org/wiki/Ceramic

I just want to agree with everything "docs" said and the lengthy and structured explanation. Just thought about a simple example to illustrate that: Imagine Carbon (C) and Carbon Dioxide (CO2). carbon is what your pencil is made of (a solid) and Carbon Dioxide is a gas we all know. And that only took the "addition of oxygen" as Cliff states...

I have a degree in chemistry and one in dentistry and this is very simple: something being a metal practically speaking has to do with the property of a material to conduct electricity. Titanium conducts electricity and Ceramic and Zirconia do not conduct electricity. The concern over metal is one of Galvanism and Hypersensitivity. In this regard, Zirconia has advantages. It is also tooth colored which is an advantage over titanium.

Gary, What about the soft tissue effects? Why would ceramic seem to have different effects on the soft tissue vs titanium? Doesn't ceramic show less bacterial adhesion and plaque accumulation?

It's all about the$ not modern science, that's a joke. But your not gonna let that stop you. I wish Zirconium was everything people believe it to be. But when the next latest and greatest arrives on the market The same people will be touted it without adequate trials. It's always about the $ disguised as Biocompatability!

Too many statements made in this thread are inaccurate related to current science articles on dental implants and zirconia. The ceramics of today are head and shoulders above those of the past. Many reasons to add ceramics to the treatment mix. Titanium is not the whole show and certainly not the most biocompatible. Read the research and move forward as you see fit.

Cliff... I'm not sure I understand everything you are trying to say here but the one message I am getting is that attempts to progress and advance the knowledge base and our materials has no place in daily dental practice. We have now over 15 years of data for Zirconia used as an implant material. The Nobel implants you are using in practice likely have about the same data behind them or likely less. You don't question the validity of new connections, new surfaces, new screws, new abutments, new aPRF. Yet you draw the line in the sand when it gets to a new implant material. I just find that odd with a progressive guy like yourself. I believe in progress and welcome it and I think that its time to stop pretending that titanium is not a great material that has no problems.

Thank you Dan, very well said. I completely agree however as you know there are 2 sure things in dentistry: 1/ if dentists are asked to form a firing squad they will most certainly form a circle. 2/ All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

Who is pretending? Where did I say titanium has no problems? I would love it , if we could place white implants, but the literature is poor at best. Check out the literature for eMax is no screaming hell for biocompatibility either, but I use it and like it., but never tell people is more biocompatible because than existing porcelains, because it is not! Just to say its not a metal therefore its biocompatible is foolish. I have been watching from the sidelines and still not impressed with the literature. However we are seeing studies showing Zirc abutments wearing out the inside of titanium implants, which should give us all cause for concern. There are benefits and risks to both, I still believe the risks are far too high with Zirc implants and biocompatibility is the ultimate red herring....

The problem with literature is that most people who publish stuff are hell bent on publishing. You will find it hard pressed to publish with no conclusive data so most authors will gather their data and apply whichever statistical principal allows for their data to become published. I'm not saying everyone does this but a majority do. I most certainly do not believe everything I read and I can definitely find evidence to prove or disprove any issue or theory with a literature search. Furthermore, you say we have evidence of Zr abutments eroding the internals of an implant, perhaps the abutment or connection/micromovement needs to be analysed. Was the abutment from a third party? Was it treated correctly? Was it sandblasted? Many questions but I'll be supposed if you get all the answers. Don't be blinded by the literature as much of it is as the name suggests litter

Very well said Dr.Sammy... I do agree with you...

What cements are you talking about? You are aware there are cement retained crowns for both Titanium and Zirconia implants, right? But if you are talking about a cemented implant crown, the same cements used for titanium crowns can be used for zirconia crowns. Please explain your question Gary omfs. There are still a few of us who believe the earth is flat?

And were those types of large randomly controlled trial studies available for titanium implants early on? Did dentists wait for ten-year studies to be completed before placing titanium implants? In fact, there are few such studies available of the size/scale you mention even for titanium implants, and at least 2 of the major ones I know of (from Europe) were only finished sometime in the last 10 years! Large scale studies over a decade take time and are obviously impossible when specific implants systems are only a few years old. That being said, of course, continued studies are vital and they must inform clinical treatment. And I think studies have already informed the direction of ceramic implants, based on the newer designs that have come out recently. But, demanding the type of studies you cite, is completely unrealistic and impractical at this point in time.

Greg, I agree with you we need studies, we need good quality studies. Our charge is do no harm and yet we see 20-30% peri-implant disease in the "literature" and 10-15% prosthetic complication rates and 1-4% screw fracture rates and about 1% implant fracture rates at 10 years. So roughly 40-60% complication rates at 10 years... let me know what heart valve or aneurism clip or other medical device would be used with such long term "success"? Have you ever met an oral surgeon in their 50's with a missing tooth, not replaced? Wonder why? In fact.. ask the random implantologist to tell you if they would do an implant in their own mouths, you might get surprised at the results of real life "data". Zirconia is not infallible. However it seems to preform better than titanium in some circumstances... the data is there and will continue to expand. We can all choose to use what we want to use for our patients and none should be judged for it as long as things are being done with full disclosure and with the patients best interests first.

Hello Greg, I have stopped blindly believing that all that comes out of universities is gospel. Most Universities in North America are private or underfunded so they conduct research that's funded by manufacturers hence and unfortunately far too many skewed results. I am personally and privately coming up on 9 years of clinical data with 5 different ceramic implant systems and I am above 95%. Now there is a study published out of Univ of Wash this past May by Safioti et al where it is confirmed once again that Ti is not as biocompatible as we think. It is now proven that it is vulnerable to corrosion, releases ions in surrounding tissue leading to osteolysis , bone loss and implant failure. So all cases of periimplantitis are not of bacterial or biomechanical origin. In closing do not limit yourself to dental journals and articles because the issue of corrosion of Ti is known and was first investigated and published in the 70's. So yes things are changing fast and no one is forced to change, change will take care of things.