Zirconia Implants: Is There a Future?

New Perspectives on Zirconia Composites as Biomaterials

Zirconia–alumina composites couple the high toughness of zirconia with the peculiar properties of alumina, i.e., hardness, wear, and chemical resistance, so they are considered promising materials for orthopedic and dental implants. The design of high performance zirconia composites needs to consider different aspects, such as the type and amount of stabilizer and the sintering process, that affect the mechanics of toughening and, hence, the mechanical properties. In this study, several stabilizers (Y2O3, CuO, Ta2O5, and CeO2) were tested together with different sintering processes to analyze the in situ toughening mechanism induced by the tetragonal–monoclinic (t–m) transformation of zirconia. One of the most important outcomes is the comprehension of the opposite effect played by the grain size and the tetragonality of the zirconia lattice on mechanical properties, such as fracture toughness and bending strength. These results allow for the design of materials with customized properties and open new perspectives for the development of high-performance zirconia composites for orthopedic implants with high hydrothermal resistance. Moreover, a near-net shape forming process based on the additive manufacturing technology of digital light processing (DLP) was also studied to produce ceramic dental implants with a new type of resin–ceramic powder mixture. This represents a new frontier in the development of zirconia composites thanks to the possibility to obtain a customized component with limited consumption of material and reduced machining costs.

Reliability of an injection-moulded two-piece zirconia implant with PEKK abutment after long-term thermo-mechanical loading

Zirconia implants are appreciated in some clinical indications in light of their aesthetic appearance and good biocompatibility. The aim of this work was to evaluate the performance of a newly developed two-piece zirconia/polyether ketone ketone (PEKK) implant-abutment combination after long-term cyclic loading in a hydrothermal environment, using a new protocol adapted from two available ISO standards. Sixteen implants (n = 8/group) were embedded according to ISO 14801 and divided into two groups: implants in the Observational Group (OG) were cyclically loaded for 60 days (98 N, 10 million loading cycles, 2 Hz) in 85 °C water in a chewing simulator, while non-loaded/non-aged implants (as-received) constituted the Control Group (CG). After 4.7 million loading cycles, one OG implant fractured in the chewing simulator. The surviving implants were compared to CG implants by X-ray diffraction (XRD) to investigate potential ageing as suggested by ISO 13356, but also μ-Raman spectroscopy, Focused-Ion-Beam - Scanning-Electron-Microscopy (FIB-SEM), and load-to-fracture. Ageing was shown to have limited influence on the evaluated zirconia implant, with increased monoclinic content after loading/ageing being to a shallow transformed zone of ~2 μm at the implant surface. However, OG implants showed a significantly decreased fracture load of 751 ± 231 N (CG: 995 ± 161 N; p = .046). These values enable clinical application, but the fact that one failure was recorded during cyclic fatigue along with the significant decrease in strength after cyclic loading/ageing suggest that there may be room for further optimization of especially the PEKK abutment. Furthermore, good agreement was observed between the fracture modes of the implant that failed during the cyclic fatigue experiment and the in vivo failure of one implant during pre-clinical trials, validating the interest of the in vitro protocol used in this work to check the reliability of zirconia implant.