Current findings regarding zirconia implants

Crestal bone loss and periimplant inflammatory parameters around zirconia implants: A systematic review

STATEMENT OF PROBLEM

Zirconia implants have been used for oral rehabilitation; however, evidence of their ability to maintain crestal bone and periimplant soft tissue health is not clear.

PURPOSE

The purpose of this systematic review was to evaluate crestal bone loss (CBL) around zirconia dental implants and clinical periimplant inflammatory parameters.

MATERIAL AND METHODS

The focus question addressed was, "Do zirconia implants maintain crestal bone levels and periimplant soft tissue health?" Databases were searched for articles from 1977 through September 2014 with different combinations of the following MeSH terms: "dental implants," "zirconium," "alveolar bone loss," "periodontal attachment loss," "periodontal pocket," "periodontal index." Letters to the editor, case reports, commentaries, review articles, and articles published in languages other than English were excluded.

RESULTS

Thirteen clinical studies were included. In 8 of the studies, the CBL around zirconia implants was comparable between baseline and follow-up. In the other 5 studies, the CBL around zirconia implants was significantly higher at follow-up. Among the studies that used titanium implants as controls, 2 studies showed significantly higher CBL around zirconia implants, and in 1 study, the CBL around zirconia and titanium implants was comparable. The reported implant survival rates for zirconia implants ranged between 67.6% and 100%. Eleven studies selectively reported the periimplant inflammatory parameters.

CONCLUSIONS

Because of the variations in study design and methodology, it was difficult to reach a consensus regarding the efficacy of zirconia implants in maintaining crestal bone levels and periimplant soft tissue health.

A Retrospective Clinical Study with Regard to Survival and Success Rates of Zirconia Implants up to and after 7 Years of Loading

PURPOSE

The study aims to retrospectively investigate the clinical performance of first-generation zirconia implants with a sandblasted surface up to and after 7 years of loading.

MATERIALS AND METHODS

Clinical records of patients treated with zirconia implants between 2004 and 2009 were screened. Consequently, adequate patients were invited to a clinical and radiographic investigation to classify each implant according to strict success criteria.

RESULTS

Seventy-one patients receiving 161 implants were available for the evaluation. Overall, 36 implants (22.4%) were lost due to early (n = 14) and late failures (n = 4) or fractures (n = 18). All surviving 125 implants fulfilled the success criteria. None of the investigated implants had a history of peri-implant infections. Mean values with regard to gingival index, plaque index, modified sulcus bleeding index, and probing depth were 0.03, 0.23, 0.59, and 2.80 mm, respectively. The radiographically evaluated mean crestal bone loss was 0.97 ± 0.07 mm. Diameter-reduced implants (3.25 mm) showed lower survival (58.5%) compared with implants with a diameter of 4.0 mm (88.9%) and 5.0 mm (78.6%). The overall longitudinal survival rate was 77.3%.

CONCLUSIONS

First-generation zirconia implants showed low overall survival and success rates. The evaluated clinical and radiographic parameters were consistent with healthy peri-implant tissues. Additionally, nonfractured failures were not associated with peri-implant infections.

A Critical Review of Dental Implant Materials with an Emphasis on Titanium versus Zirconia

The goal of the current publication is to provide a comprehensive literature review on the topic of dental implant materials. The following paper focuses on conventional titanium implants and more recently introduced and increasingly popular zirconia implants. Major subtopics include the material science and the clinical considerations involving both implant materials and the influence of their physical properties on the treatment outcome. Titanium remains the gold standard for the fabrication of oral implants, even though sensitivity does occur, though its clinical relevance is not yet clear. Zirconia implants may prove to be promising in the future; however, further in vitro and well-designed in vivo clinical studies are needed before such a recommendation can be made. Special considerations and technical experience are needed when dealing with zirconia implants to minimize the incidence of mechanical failure.

Color evaluation of a dielectric mirror coating using porcine tissue and prosthetic gingival material: a comparison of two models

AIM

The aim of this study was to firstly evaluate the esthetics of a dielectric multilayer coating on titanium below porcine tissue (in vitro porcine model). Secondly, a polymer model was used to investigate the same samples to compare the models to each other and discuss their validity for optical assessment of esthetic coatings for implant applications.

MATERIALS & METHODS

A dielectric mirror coating was deposited on titanium substrates (Ti- Bragg) and tested below porcine tissue and polymer platelets of three test thicknesses (1 mm, 2 mm and 3 mm). Titanium without coating (Ti) was used as a negative control. Furthermore, the substrates were subjected to three different surface treatments (polished, machined and sand-blasted). The color difference values ΔL, Δa, Δb and ΔE were calculated for each sample. In total, six samples were tested in both models. Statistical analysis of the data (one sample Wilcoxon test, Kruskal-Wallis with Bonferroni-Holm corrected Mann-Whitney post hoc tests for multiple testing) was conducted for each sample in both evaluation methods.

RESULTS

In the in vitro porcine model, sand-blasted Ti-Bragg and Ti samples showed ΔE values significantly above the threshold value of 3.70, indicating a dark appearance of the 1 mm thick covering tissue. As the test thickness increased, polished and machined Ti-Bragg samples were significantly invisible (ΔE < 3.70 with P < 0.05). Excessive brightening effects from Ti-Bragg samples were not observed from the in vitro porcine model, but below polymer platelets the samples exhibited significantly high ΔL values, which also resulted in a significant and visible color change (ΔE >> 3.70 with P < 0.05).

CONCLUSION

Ti-Bragg was suggested to be an appropriate coating system for dental implants to improve the soft tissue esthetics. The design of this coating system can be adjusted by varying different parameters to satisfy the requirements of an esthetic coating. The polymer model is valid for test thicknesses of 2 and 3 mm, however, one might have to increase the thickness to 1.5 mm or alter the composition of the resin for 1 mm thick platelets to increase the opacity and therefore adapt to the soft tissue situation.

Two-piece zirconia implants supporting all-ceramic crowns: a prospective clinical study

Objectives

The aim of this prospective clinical study is to evaluate the safety and efficacy of a new all-ceramic implant system to replace missing teeth in partially edentulous patients.

Material and methods

Thirty-two partially edentulous, systemically healthy patients were treated with 49 two-piece zirconia implants (ZERAMEX® T Implant System). Zirconia abutments were connected with adhesive resin cement. Single-unit full-ceramic crowns were cemented. The cases have been followed for 588±174 days after loading (range 369–889 days). All patients have been re-evaluated 1 year after loading.

Results

The cumulative survival rate 1 year after loading was 87% implants. All failures were the result of aseptic loosening, and no implants were lost after the first year. The results of the other cases were good, and the patients were very satisfied. The cumulative soft tissue complication rate was 0%, the cumulative technical complication rate was 4% implants, the cumulative complication rate for bone loss >2 mm was 0%, and the cumulative esthetic complication rate was 0%. Including the data from 20 patients treated with an earlier version of the system, an over-all 2-year cumulative survival rate of 86% was calculated for a total of 76 two-piece zirconia implants supporting all-ceramic crowns in 52 patients.

Conclusions

Replacement of single teeth in the posterior area was possible with this new full-ceramic implant system. Failures were due to aseptic loosening.

Evaluation of the success criteria for zirconia dental implants: a four-year clinical and radiological study

Objectives. The aim was to evaluate survival and success rates, soft tissue health, and radiographic marginal bone loss (MBL) of zirconia implants placed in the esthetic and posterior areas of the jaws and in association with multiple or single implant restorations after at least 6 months of definitive restoration. Material and Methods. 35 one-piece zirconium implants were utilized for single or partially edentulous ridges rehabilitation. All implants received immediate temporary restorations and six months after surgery were definitively restored. Every 6 months after implant placement, a clinical-radiographic evaluation was performed. For each radiograph, the measurements of MBL were calculated. Results. The results showed that the mean MBL at 48-month followup was 1.631 mm. The mean MBL during the first year of loading was not more significant for implants placed in the first molar regions than for those positioned in other areas. Moreover, no differences in marginal bone level changes were revealed for multiple and single implants, whereas MBL in the first year was observed to be slightly greater for implants placed in the maxilla than for those placed in the mandible. Conclusion. Zirconia showed a good marginal bone preservation that could be correlated with one-piece morphology and characteristics of zirconia implants.