Zirconia Dental Implants

Titanium, a base metal, has become the gold standard for the fabrication of dental implants during the last 50 or more years. Titanium is relatively soft, so various metals are blended with it to increase its strength. This is necessary to accommodate the load bearing forces that the oral structures place upon the material. In addition, titanium's affinity with the alveolar structures of the jaw has been well documented in the dental literature.

However, concerns do exist regarding the use of titanium as an implantable material. Compromised esthetics, peri-implant mucositis, peri-implantitis, and advanced bone loss resulting from the premature failure of titanium dental implants have become definite concerns for the dental implant team. The rising incidence of peri-implant mucositis and peri-implantitis has become a particularly significant issue affecting the long-term success of dental implants. Generally, these conditions originate from the formation of a plaque biofilm, which adheres to the coronal portion of the dental implant/abutment complex and initiates a disease process that is very difficult to contain and eliminate. This process is primarily attributed to surface alterations or design features of the affected implant itself, issues related to the implant/abutment junction, a lack of and/or poorly attached keratinized tissue, iatrogenic factors, and potential toxicity caused by leaching of the metals blended with the titanium. Various techniques have been developed to reverse the process of infection around dental implants, and their success rates have demonstrated a large range of variability.

In an attempt to provide more pleasing implant restorations in the esthetic zone, zirconia abutments were introduced. Beyond improving the optical properties of their restorations, they have been shown to enhance the response and appearance of the surrounding soft tissue, addressing some of the concerns related to titanium. The expansion of zirconia into an implantable material for the development of metal-free implant options allowed for even more of the concerns related to titanium to be addressed. Zirconia has demonstrated a high success rate of osseointegration. In addition, its lack of affinity for bacterial biofilm formation and its benefits as a white-colored material result in a natural appearance of the gingival tissues. Due to its composition and its ability to be altered if needed to achieve a desired result, zirconia offers benefits unparalleled by titanium as a base implantable material.

With 30 years of clinical experience, including the placement of more than 20,000 titanium dental implants, I did not initially think that incorporating an "alternative" material was a priority. However, after I came to understand some of the pitfalls of titanium, I considered integrating zirconia implants into our practices. I consulted trusted colleagues regarding their opinions and experiences with zirconia implants and ultimately decided to place several in situations where I felt the benefits of zirconia outweighed those of titanium. To my pleasant surprise, the results in these clinical situations were excellent and on par with what I would have expected from titanium. During the last 4 years or so, I have very successfully integrated the use of zirconia implants into our practices, and in the esthetic zone, we only place zirconia implants. They are becoming more sought after as the health-consciousness of our society continues to grow.

Improving oral health and quality of life for our patients is what we are all about, and hopefully, as we undertake the challenges that implant dentistry faces going forward, we can continue to keep an open mind regarding new materials, procedures, and techniques.

Paul S. Petrungaro, DDS, MS, a diplomate of the International Congress of Oral Implantologists, is the founder and clinical director of Start Smiling Dental Implant Centers in Chicago, Illinois, and the founder and educational director of Implant Live.