Titanium implants have dominated dental implantology since its inception back in the 1960s. Subsequently, the products and solutions, the scientific and clinical research, and the development and performance of this treatment is overwhelmingly based on titanium implant systems.
For clinicians considering adding ceramic implants (specifically, zirconia) to their portfolio, an obvious question is when to choose ceramic vs. titanium implants, and why? Of course, every case and every patient is unique, but here are a number of factors you could consider if you're going to have dental implants.
Zirconia or ceramic dental implants are a one-piece design that is surgically placed at the margin of the gum line similarly to titanium implants. Because of this one-piece design, they are often easier to handle and offer a relatively seamless option for surgeons who want to place the implant and then continue on with the crown procedure itself. This prevents using metal within the procedure and can help with patients who have had issues with metal implantation in the past.
Ceramic dental implants are made using high-quality zirconia, which is a form of zirconium oxide. While zirconium is often thought of as a metal, the addition of oxide transitions its structure, name and how it behaves when used within the dental field. The resulting implant is white in color and more aesthetically-pleasing than its titanium alternative.
Clinicians and researchers are always looking for new opportunities to improve existing treatment modalities. Whether it is better durability, higher levels of predictability, more cost effective treatments or more esthetic results, dentistry is constantly changing and evolving.
An interesting and sometimes controversial development is the all-ceramic one-piece implant for areas of high esthetic concern or in cases of titanium allergies. A number of manufacturers have developed zirconia implants and all have reported success. Zirconia implants are a more esthetic option in areas of thin tissue where implant “show-through” might be a problem, and the zirconia abutment is also more esthetic in many cases.
However, multiple manufacturers have been producing zirconia implants for several years. They appear to be gaining traction in mainstream implant care.
There are promising studies showing that zirconia integrates as well as titanium implants and that torque comparisons are similar. There is even a pre-clinical trial that hints that soft-tissue response might be better with zirconia implants.
There is often some confusion amongst clinicians and patients regarding the difference between zirconium and zirconium dioxide (zirconia). Can you really call a zirconia implant “metal free” if it is derived from zirconium? Yes. ‘Zirconia’ is a ceramic material manufactured from zirconium dioxide. During the oxidation of zirconium, an irreversible chemical reaction occurs where electrons move from the zirconium to the oxygen molecules. As a result, ceramic zirconia has completely different material properties compared to the metal zirconium, including wear resistance, toughness and conductivity. This is why zirconia implants are described as ‘metal-free’.
CeraRoot implants are made from zirconia—a biocompatible, ceramic material that fosters complete assimilation into jaw bone. A recent microscopic study a confirmed optimal osseointegration of CeraRoot implants without any signs of inflammation or foreign body rejection. Other scientists have also reported that zirconia is an ideal material for dental implants.
CeraRoot zirconia implants are hypoallergenic, which is not the case with metal implants. Surprisingly, many cases of titanium implant sensitivity show up years after surgery when itchiness and inflammation develop around implant sites. It’s a perfect setup for bone loss and the potential failure of an implant.
Today, there’s a growing number of people who have allergies, skin sensitivities and compromised immune systems; therefore implantation of metal devices should be seriously scrutinized beforehand, especially since the removal of a titanium implant from jaw bone is not a simple procedure.
The inherent problem that frequently arises with titanium implants is an aesthetic one. Patients with thin, translucent gums or those who are prone to gum recession (as are many aging people) may end up with the gray gums or titanium showing around the margin of the crown. Since zirconia is non-metallic and white, it is much more natural looking than titanium. It’s a perfect base color that closely mimics what nature created in the first place.
Zirconia is biocompatible material that is resistant to chemical corrosion, nor will it conduct electricity or heat. As a bioinert material, it will never trigger chemical reactions, migrate to other sites in the body or interfere with the maintenance of optimal oral health.
Titanium is another story. It’s been scientifically proven that a titanium implant will corrode in the wet environment of a mouth, especially if there is more than one metal in the vicinity (such as amalgam fillings, alloy metal crowns, bridges or gold onlays / inlays) to trigger reactions. Metal corrosion is even more active in the presence of fluoride that is free flowing in some water supplies, toothpastes and mouthwashes. It literally attacks the surface of the titanium implants. Many scientific articles have cited that titanium will not only migrate from the implant site into surrounding tissues but even into nearby lymph nodes.
The fact that zirconia does not conduct an electrical charge is a big benefit. Bacterial growth on the surface of a zirconia implant is far less likely to adhere due to its non-conductivity, thus creating an oral environment that promotes much healthier gums.
CeraRoot implants do not interfere with the movement of energy though the body’s meridians. And since zirconia implants are bioinert, they’re a perfect tooth replacement solution for patients who adhere to holistic health principles.
The long-term success of CeraRoot implants is one of the most important features of this innovative system. Designed to withstand tremendous masticatory forces, CeraRoot zirconia implants mimic the best of nature with a variety of tooth-like contours and bioinert composition. Zirconia is well known for its durability and inflexibility under pressure…an excellent combination of traits for dental devices.
Traditional titanium implant systems consist of two metal components (the implant that’s lodged into the jaw and the abutment that sits above the gumline) joined together with a fixation screw.
Micro-movement can occur where these pieces meet when under the extreme pressure of chewing, thus creating warm, moist places where anaerobic bacteria have an opportunity to colonize. It’s a perfect setup for an unfortunate cascade of events to follow: the bacteria release toxins, inducing inflammation around the implant, which can eventually lead to bone loss and the possibility of implant failure.
Over the past decades, more ceramic components have been incorporated into dentistry due to their clinically proven strength and aesthetic benefits. Not only is there a trend to include all-ceramic crowns and implant abutments in treatment plans, but the implant itself is now available in a one-piece design made from biocompatible zirconia. CeraRoot implants set the stage for the ultimate in optimal function, superior health and natural beauty.
CeraRoot implants are designed for the immediate placement after tooth extractions. This one-stage surgical approach minimizes implantation time and maximizes comfort. Moreover, a less invasive surgery (one without incisions or suturing) may be possible when there’s no infection and sufficient bone is present at the implant site.
Overall, CeraRoot implant patients experience a shorter implant process, along with the potential for a significant increase in comfort and function afterward due to biocompatibility and the strength of zirconia. With CeraRoot, the odds are in favor of long-term success.
With traditional titanium implants, micro gaps may be present after the metal has been surgically placed underneath the gum line. Because of its one-piece design, zirconia has virtually no micro gaps for a more seamless surgical placement.
Overall osseointegration with the bone has been found to either be similar to or better than titanium implants when using ceramic. This is ideal for patients who have had failed implants and need a more stable solution to their oral health needs.
Due to its smooth finish, ceramic implants inhibit the adhesion of plaque and bacteria, lending to a healthier smile and mouth. This prevents failure of the implant due to bacteria and inflammation.
When it concerns ceramic vs metal, ceramic has a higher endurance rate than titanium. These implants can endure up to 150 pounds of force before fracturing and cracking, which is highly beneficial to people of all ages and sizes.
Because of the implant’s non-polar structure, bacteria will not adhere onto the zirconia implant as it would on titanium. This creates a healthier implant option for the mouth without the fear of bacterial growth underneath the gums.
Unlike metal, ceramic implants do not conduct heat. Titanium can and will conduct as well as hold onto heat, which could damage surrounding tissue. Once the zirconia implant has been placed, the tissue around the implant can heal and will remain unaffected.
Titanium has been shown to cause peri-implant bone loss in those who have had implants placed. Ceramic implants, on the other hand, do not cause this bone loss and are more ideal for long-term surgical use.
Ceramic implant margins are placed at the gum line, whereas titanium is placed underneath the gum line. This above gum level option helps the patient to keep the implant cleaner and preserves healthy surrounding gum tissue as a result of better oral hygiene.
Titanium is a metal that can cause corrosion and oxidation, resulting in a metallic taste in the mouth for your patients. Zirconia is clean and free of metal, preventing that unpleasant metallic taste after implantation has been complete.
Dental implants are specifically designed to replace missing teeth and have been used for decades with great success. As all dental surgeons know, titanium has been the industry standard concerning the vast majority of dental surgeries being done. However, in some cases, titanium isn’t the best option and some patients who have high failure rates with their implants may find zirconia to be the better choice. Many patients are also concerned about putting additional metal into their bodies, so they want a more realistic alternative. Ceramic implants are on the rise and are being used in thousands of surgical offices.
According to one study 97.6 percent success rate over the course of five years regarding 831 ceramic implants. It was also noted in the same study that the patients’ mouths were healthy and free of implant-related complications.
When it concerns the difference between ceramic vs metal implants, the choice is quite clear. For this reason, many surgeons are making the switch from old titanium implants to newer, cleaner and hygienic zirconia. Ceramic implants have been used for years and are gaining popularity because of their smooth and seamless finish. By offering a metal-free alternative to your patients, they will be happier and healthier as a result.
At present, the clinical indications are limited compared to titanium implants. The current use of ceramic implants as a solution for tooth loss is mainly for single tooth replacementand bridge cases. There may be additional limitations in surgical and loading protocols.
Zirconia and titanium have very different material characteristics, so ceramic implants can’t simply replicate titanium implants. Until recently, zirconia has been mainly used as one-piece, cement-retained systems, which present several drawbacks in terms of the rigidity and stability of a cemented restoration. One-piece implants are less flexible than those with two parts secured by torqued screws. This limited flexibility also creates problems during placement of the implant, in the design of the restoration, and in the types of forces that may be exerted.
The process by which dental implant fixate to the bone is called osseointegration. This process usually takes about 6 months to complete. When dental implants are surgically placed, they must have a certain torque value or primary stability. Implants that do not have a good primary stability need to be left to heal under the gums for 3-6 months following placement. Most Zirconia dental implants cannot heal under the gums because of their “one-piece” design, meaning that they do not have a removable abutment but one that is fixed to the implant.
Zirconia Implants are more prone to cracking than titanium dental implants. As it was mentioned above, zirconia is very strong in compressive forces but somewhat brittle in elastic forces. It is for this reason that small diameter zirconia implants are contraindicated. Often times in implant dentistry, the dentist must utilize a small diameter implant in the range of 3.0mm-3.75mm due to thin bone or small spaces between the teeth. One research study showed that every implant with a diameter less then 4mm had a catastrophic fracture
Many implant patients are missing all of their teeth or need all of their teeth replaced. This is a great way to restore confidence, chewing efficiency, and quality of life. Often times, this is life changing for dental implant patients. This type of treatment takes a great amount of planning and execution by the dentist to have superior esthetic and functional results. Custom abutments and screw-retained restorations are a requirement for full arch or full mouth implant treatment. Because of zirconia implants one-piece design, it would be impossible to do this.
The complex industrial process of manufacturing zirconia implants can impact the price. When selecting a ceramic implant, it is advisable to question the manufacturing method. With this brittle material, manufacturing flaws – even minute imperfections – in the production and surface treatment of a zirconia implant may compromise strength. Manufacturers should take great care with the materials for being clinically successful.