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Zuercher AN, Balmer M, Brügger LV, Thoma DS, Jung RE, Bienz SP. Clinical, radiographic and patient-reported outcomes of zirconia and titanium implants in the posterior zone after 1 year of loading-A randomized controlled trial. Clin Oral Implants Res 2024. [PMID: 39056305 DOI: 10.1111/clr.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE To assess the clinical, radiographic and patient-reported outcomes (PROMs) of posterior zirconia and titanium implants at 1 year of implant loading. MATERIALS AND METHODS Forty-two patients with two adjacent missing teeth were enrolled in a randomized controlled trial with a within-subject controlled design. Each patient received one zirconia (Zr) and one titanium (Ti) implant, with the mesial and distal positions randomized. The implant restoration consisted of multiple layered zirconia, with the buccal aspect veneered. In group Zr, the restoration was intraorally cemented onto the one-piece Zr implant, whereas in group Ti, the restoration was extraorally cemented onto the titanium base abutment and intraorally screw-retained onto the Ti implant. Examinations were performed following restoration delivery at baseline (BL) and at 1 year. Measurements included clinical parameters, radiographic outcomes (MBL) and PROMs. RESULTS Bleeding on probing showed an increase from BL to 1 year (34 ± 30% for Zr; 25 ± 21% for Ti). MBL remained stable with minimal changes from BL to 1 year, measuring 0.1 ± 0.4 mm (mean ± SD) for Zr and -0.1 ± 0.7 mm for Ti. Veneering fractures were the most frequent technical complication and amounted to 17.5% in group Zr and 5% in group Ti (p = .100). Patients preferred Zr implants for their soft tissue color, with a significant difference in perception between patients and clinicians (p < .017). CONCLUSION The study showed that both Zr and Ti implants had similar clinical outcomes, despite a high prevalence of mucositis and a few technical complications. Both implant types demonstrated stable marginal bone levels and similar patient-reported outcome measures.
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Affiliation(s)
- Anina N Zuercher
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Lily V Brügger
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Stefan P Bienz
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
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Graf T, Lyko A, Dahmer I, Stimmelmayr M, Dieterich H, Aggstaller H, Güth JF. Clinical performance and risk factors of all-ceramic screw-retained implant crowns in the posterior region based on a retrospective investigation. Clin Oral Implants Res 2024; 35:685-693. [PMID: 38594815 DOI: 10.1111/clr.14264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Clinical data on all-ceramic screw-retained implant crowns (SICs) luted on titanium base abutments (TBAs) over more than 3 years are sparse. This study aimed to evaluate the clinical performance and potential risk factors for these restorations. MATERIALS AND METHODS Analysis took place based on the medical patient-records of three dental offices. Implant survival and prosthetic complications over time were evaluated. The study included SICs in premolar and molar regions made from monolithic lithium disilicate ceramic (M_LiDi) or veneered zirconia (V_ZiO) luted on a TBA documented over an observation time of at least 3 years. Survival and complication rates were calculated and compared by a log-rank test. Cox-Regressions were used to check potential predictors for the survival (p < .05). RESULTS Six hundred and one crowns out of 371 patients met the inclusion criteria and follow-up period was between 3.0 and 12.9 (mean: 6.4 (SD: 2.1)) years. Over time, six implants had to be removed and 16 restorations had to be refabricated. The estimated survival rates over 10 years were 93.5% for M_LiDi and 95.9% for V_ZiO and did not differ significantly among each other (p = .80). However, V_ZiO showed significantly higher complication rates (p = .003). Material selection, sex, age, and implant diameter did not affect the survival of investigated SICs but crown height influences significantly the survival rate (hazard ratio, HR = 1.26 (95%CI: 1.08, 1.49); p = .043). CONCLUSIONS Screw-retained SICs luted on TBAs that were fabricated from monolithic lithium disilicate ceramic or veneered zirconia showed reliable and similar survival rates. Increasing crown heights reduced survival over the years.
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Affiliation(s)
- Tobias Graf
- Department of Prosthetic Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Iulia Dahmer
- Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Michael Stimmelmayr
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Jan-Frederik Güth
- Department of Prosthetic Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Ruiz Henao PA, Magrin GL, Caneiro-Queija L, Benfatti CAM, Leira Y, Liñares-González A, Blanco-Carrión J. Single-piece zirconia versus single-piece titanium, narrow-diameter dental implants in the anterior maxilla: 5-year post-loading results of a randomized clinical trial. Clin Oral Implants Res 2024. [PMID: 38940623 DOI: 10.1111/clr.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate esthetic parameters in the anterior maxillary region by comparing single-piece zirconia versus titanium narrow-diameter implants. Additionally, clinical, radiological and patient-reported outcome measures (PROMs) were analyzed. MATERIALS AND METHODS Thirty implants (tissue level implant) were placed in 30 patients in the maxillary esthetic sector. Depending on randomization, a zirconia (test) or titanium implant (control) was placed. Esthetic, clinical, and radiological parameters, including the implant crown esthetic index (ICAI), pink esthetic score (PES), probing pocket depth, bleeding on probing, plaque index, and marginal bone levels, were evaluated at 12, 36 and 60 months after loading. RESULTS Sixty months after crown placement, no significant differences were found between groups. The ICAI values were 5.25 ± 4.21 and 4.50 ± 2.98 for the test and control groups, respectively. The corresponding PES values were 7.44 ± 1.93 and 7.43 ± 1.74 for the test and control groups, respectively. There were no significant intergroup differences for the rest of the parameters evaluated. CONCLUSION It can be suggested that monotype zirconia implants may serve as a potential alternative to titanium implants in selected clinical scenarios. While the results demonstrated comparable esthetic, clinical, and radiological aspects for zirconia implants as compared to titanium implants after a 5-year follow-up period, further research with larger sample sizes and longer-term follow-up is recommended.
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Affiliation(s)
- Paula Andrea Ruiz Henao
- Unit of Periodontology, Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Leonardo Magrin
- Unit of Periodontology, Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- Center for Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Leticia Caneiro-Queija
- Unit of Periodontology, Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Cesar Augusto Magalhães Benfatti
- Center for Education and Research on Dental Implants (CEPID), Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Yago Leira
- Unit of Periodontology, Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Liñares-González
- Unit of Periodontology, Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Blanco-Carrión
- Unit of Periodontology, Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
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Schubert O, Goob J, Schweiger J, Güth JF, Edelhoff D, Graf T. Clinical performance of monolithic lithium disilicate hybrid abutment crowns over at least 3.5 years. J Prosthodont 2024; 33:34-40. [PMID: 37243453 DOI: 10.1111/jopr.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Hybrid abutment crowns (HACs) made from monolithic ceramics represent an efficient option for single restorations on implants. However, long-term data are scarce. The purpose of this clinical trial was to evaluate the survival and complication rates of CAD-CAM fabricated HACs over a time period of at least 3.5 years. MATERIALS AND METHODS Twenty-five patients with a total of 40 HACs made of monolithic lithium disilicate ceramic bonded to a titanium base CAD-CAM abutment were retrospectively evaluated. All implants and screw-retained restorations were placed and manufactured in the same department of a university hospital. Only crowns that had been in service for more than 3.5 years were included in the study. HACs were evaluated regarding technical and biological complications. Functional Implant Prosthodontic Scores (FIPS) were obtained. RESULTS The mean observation time was 5.9 ± 1.4 years. Implant survival was 100%, and HAC survival was 97.5%. Over the observation period, one crown fracture was observed, necessitating refabricating of the restoration. Three minor biological complications were found. The overall mean FIPS score was 8.69 ± 1.12 points. CONCLUSIONS Within the limitations of this study, monolithic screw-retained HACs milled from lithium disilicate ceramics and bonded to titanium bases appeared to be a reliable treatment option over more than 3.5 years due to their low biological and technical complication rates.
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Affiliation(s)
- Oliver Schubert
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Janosch Goob
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Josef Schweiger
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Jan-Frederik Güth
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Graf
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
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Mohseni P, Soufi A, Chrcanovic BR. Clinical outcomes of zirconia implants: a systematic review and meta-analysis. Clin Oral Investig 2023; 28:15. [PMID: 38135804 PMCID: PMC10746607 DOI: 10.1007/s00784-023-05401-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To assess the clinical outcomes of zirconia dental implants based on an updated systematic literature review. METHODS An electronic search was performed in three databases, last updated in June 2023, supplemented by hand searching. The eligibility criteria were clinical studies reporting patients rehabilitated with zirconia implants. The cumulative survival rate (CSR) of implants was calculated. A meta-analysis for marginal bone loss (MBL) under different follow-up times and a meta-regression assessing the relationship between mean MBL and follow-up were done. RESULTS Twenty-five studies were included (4017 implants, 2083 patients). Seven studies had follow-up longer than 60 months. 172 implants failed, after a mean of 12.0 ± 16.1 months (min-max 0.3-86.0), of which 47 early failures, and 26 due to implant fracture, the majority in narrow-diameter implants. The 10-year CSR was 95.1%. Implants with coronal part prepared by drills presented statistically significant lower survival than non-prepared implants (p < 0.001). Two-piece implants presented lower survival than one-piece implants (p = 0.017). Implants discontinued from the market presented lower survival than the commercially available ones (p < 0.001). The difference in survival was not significant between implants in maxilla and mandible (p = 0.637). The mean MBL fluctuated between 0.632 and 2.060 mm over long periods of observation (up until 132 months). There was an estimated MBL increase of 0.005 mm per additional month of follow-up. CONCLUSION Zirconia implants present high 10-year CSR and short-term low MBL. The review was registered in PROSPERO (CRD42022342055). CLINICAL RELEVANCE The clinical outcomes observed for zirconia dental implants are very promising, although these have not yet been extensively studied as titanium alloy implants.
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Affiliation(s)
| | - Ahmad Soufi
- Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Bruno Ramos Chrcanovic
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Carl Gustafs Väg 34, 214 21, Malmö, Sweden.
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Padhye NM, Calciolari E, Zuercher AN, Tagliaferri S, Donos N. Survival and success of zirconia compared with titanium implants: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:6279-6290. [PMID: 37740825 PMCID: PMC10630218 DOI: 10.1007/s00784-023-05242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic and clinical parameters, as well as biological and mechanical complications, were considered. MATERIALS AND METHODS A systematic search was performed up to March 2022 to identify CCTs/RCTs comparing zirconia and titanium implants with a minimum of 12 months of follow-up. Meta-analysis was performed when ≥ 2 articles with similar characteristics were retrieved. RESULTS Four published articles with two RCTs (2 different patient populations) with 100 zirconia and 99 titanium implants that were followed up over 12-80 months were selected out of the 6040 articles. A non-statistically significant difference between zirconia and titanium implant survival at 12 months was suggested (P = 0.0938). The success rates were 57.5-93.3% and 57.1-100% for zirconia and titanium implants, respectively. The pink aesthetic score (PES) was higher for zirconia (10.33 ± 2.06 to 11.38 ± 0.92) compared to titanium implants (8.14 ± 3.58 to 11.56 ± 1.0). CONCLUSION Based on the 2 RCTs retrieved in the literature, similar survival rates were reported for zirconia and titanium implants in the short term (12 months of follow-up). Future RCTs are warranted to evaluate the long-term outcomes of zirconia implants. CLINICAL RELEVANCE Zirconia implants may be the procedure of choice, particularly in the aesthetic zone, since they show a similar survival and success rate as titanium implants on a short-term follow-up. TRIAL REGISTRATION Systematic review registration number-CRD42021288704 (PROSPERO).
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Affiliation(s)
- Ninad Milind Padhye
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
- Department of Medicine and Surgery, Centre of Dentistry, University of Parma, Parma, Italy
| | - Anina Nives Zuercher
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
- Clinic of Reconstructive Dentistry, Centre of Dental Medicine, Zurich, Switzerland
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Center of Excellence for Toxicological Research, CERT, University of Parma, Parma, Italy
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK.
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Pesce P, Del Fabbro M, Menini M, De Giovanni E, Annunziata M, Khijmatgar S, Canullo L. Effects of abutment materials on peri-implant soft tissue health and stability: A network meta-analysis. J Prosthodont Res 2023; 67:506-517. [PMID: 37081626 DOI: 10.2186/jpr.jpr_d_22_00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
PURPOSE This systematic review aimed to evaluate the effect of the abutment material on peri-implant soft tissue health and stability. STUDY SELECTION An electronic and hand search was conducted until February 2022. Only prospective randomized trials (RCTs) and controlled clinical trials (CCTs) comparing titanium abutments with abutments made of different materials, with a follow-up of at least 6 months, were selected by two independent reviewers. Data on marginal bone loss (MBL) and peri-implant tissue indexes, i.e., plaque index (PI), bleeding on probing (BOP), probing depth (PD), and recession (REC), were collected. The risk of bias for RCTs and non-RCTs was evaluated according to the tool reported in the Cochrane Handbook for Systematic Reviews of Interventions and the ROBINS-I tool, respectively. Both pairwise and network meta-analyses (NMA) were performed. RESULTS We included 18 relevant studies from 1,437 identified studies. Overall, 612 patients were treated, and 848 abutments were inserted. Five studies presented a low risk of bias. Pairwise meta-analysis showed that, as compared to titanium, zirconia abutments presented a significantly reduced MBL (0.20 mm, 95% Confidence Interval CI [0.14-0.26], P < 0.00001). No significant differences were found for the other outcomes. In the NMA, zirconia abutments demonstrated an 83.3% probability of achieving the highest rank in PI, an 87.0% in BOP, and a 65.0% in PD outcome, suggesting that zirconia abutments generally performed better than titanium and alumina abutments. CONCLUSIONS Within the limits of the present study, zirconia abutments seem a viable alternative to titanium ones.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Emanuele De Giovanni
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Marco Annunziata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Luigi Canullo
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
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Larsson A, Manuh J, Chrcanovic BR. Risk Factors Associated with Failure and Technical Complications of Implant-Supported Single Crowns: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1603. [PMID: 37763722 PMCID: PMC10535933 DOI: 10.3390/medicina59091603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Implant-supported single crowns have become a routine approach for the replacement of missing single teeth, being considered as one of the most common ways of rehabilitation when adjacent teeth are healthy. The present retrospective study aimed to investigate the risk factors possibly associated with failure and technical complications of implant-supported single crowns and their supporting implants. Materials and Methods: Patients treated at one faculty (2009-2019) were considered for inclusion. Complications investigated included ceramic fracture/chipping, crown loss of retention/mobility, crown failure/fracture, loosening/loss/fracture of prosthetic screw, and implant failure/fracture. Any condition/situation that led to the removal/replacement of crowns (implant failure not included) was considered prosthesis failure. Univariate/multivariate Cox regression models were used to evaluate the associations between clinical covariates and failure. Results: 278 patients (358 crowns) were included. Mean ± SD follow-up was 56.5 ± 29.7 months. Seven implants (after a mean of 76.5 ± 43.7 months) and twenty crowns (21.3 ± 23.5 months) failed. The cumulative survival rate (CSR) for crowns was 93.5% after 5, remaining at 92.2% between 6 and 11 years. The most common reasons for crown failure were porcelain large fracture (n = 6), crown repeatedly loose (n = 6), and porcelain chipping (n = 5). Men and probable bruxism were identified in the Cox regression model as being associated with crown failure. The most common observed technical complications were mobility of the crown and chipping of the ceramic material, with the latter being observed even in crowns manufactured of monolithic zirconia. Cases with at least one technical complication (not considering loss of screw hole sealing) were more common among probable bruxers than in non-bruxers (p = 0.002). Cases of ceramic chipping were more common among bruxers than in non-bruxers (p = 0.014, log-rank test). Conclusions: Probable bruxism and patient's sex (men) were factors associated with a higher risk of failure of implant-supported single crowns.
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Affiliation(s)
- Adam Larsson
- Faculty of Odontology, Malmö University, 214 21 Malmö, Sweden; (A.L.); (J.M.)
| | - Justice Manuh
- Faculty of Odontology, Malmö University, 214 21 Malmö, Sweden; (A.L.); (J.M.)
| | - Bruno Ramos Chrcanovic
- Department of Prosthodontics, Faculty of Odontology, Malmö University, 214 21 Malmö, Sweden
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9
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Roehling S, Gahlert M, Bacevic M, Woelfler H, Laleman I. Clinical and radiographic outcomes of zirconia dental implants-A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:112-124. [PMID: 37750521 DOI: 10.1111/clr.14133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other materials than titanium (alloy) on implant survival, marginal bone loss (MBL), and technical and biological complications after at least 5 years. MATERIALS AND METHODS An electronic (Medline, Embase, Web of Science) search was performed to identify observational clinical studies published from January 2000 investigating a minimum of 20 commercially available zirconia implants with a mean follow-up of at least 60 months. Primary outcome was implant survival, secondary outcomes included peri-implant MBL, probing depths (PDs), and technical and biological complications. Meta-analyses were performed to evaluate implant survival, MBL, and PD. RESULTS From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 4 prospective and 2 retrospective observational clinical cohort studies were included for data extraction. Meta-analyses estimated after 5 years of loading mean values of 97.2% (95% CI 94.7-99.1) for survival (277 implants, 221 patients), 1.1 mm (95% CI: 0.9-1.3) for MBL (229 implants, 173 patients), and 3.0 mm (95% CI 2.5-3.4) for PDs (231 implants, 175 patients). CONCLUSIONS After 5 years, commercially available zirconia implants showed reliable clinical performance based on survival rates, MBL, and PD values. However, more well-designed prospective clinical studies and randomized clinical trials investigating titanium and zirconia implants are needed to confirm the presently evaluated promising outcomes.
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Affiliation(s)
- S Roehling
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Clinic for Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
| | - M Gahlert
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- Sigmund Freud Private University, Vienna, Austria
| | - M Bacevic
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Centre for Oral Clinical Research, Institute of Dentistry, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | | | - I Laleman
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liège, Liège, Belgium
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Haimov E, Sarikov R, Haimov H, Juodzbalys G. Differences in Titanium, Titanium-Zirconium, Zirconia Implants Treatment Outcomes: a Systematic Literature Review and Meta-Analysis. J Oral Maxillofac Res 2023; 14:e1. [PMID: 37969951 PMCID: PMC10645476 DOI: 10.5037/jomr.2023.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 11/17/2023]
Abstract
Objectives The objective of this systematic review is to test the hypothesis that treatment with titanium, titanium-zirconium and zirconia dental implants has different clinical outcomes in survival rate, marginal bone loss, bleeding on probing, plaque control record, and probing depth. Material and Methods A systematic electronic search through the PubMed (MEDLINE) and Cochrane Library databases was performed to identify studies published between January 1, 2013 and January 1, 2023 containing a minimum of 10 patients per study comparing titanium (Ti), titanium-zirconium (Ti-Zr), and zirconia (Zr) dental implants. Ti, Ti-Zr, and Zr dental implant clinical outcomes were determined by evaluating survival rate, marginal bone level, bleeding on probing, probing depth, plaque control record. Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool. Results A total of 1361 articles were screened, with 10 meeting the inclusion criteria and being utilized for this systematic review and meta-analysis. A total of 301 patients with 637 implants (304 Ti, 134 Ti-Zr, and 199 Zr) were evaluated, showing a survival rate of 97.7% for Ti, 98.6% for Ti-Zr, and 93.8% for Zr implants respectively. In a meta-analysis, no difference in marginal bone level was found between Ti, Ti-Zr, and Zr implants (P = 0.84). Conclusions Dental implant survival rate was lower in zirconia group. Assessment of marginal bone loss and bleeding on probing showed better results with titanium-zirconium dental implants. Plaque control result was similar in all groups. Due to limited sample size assessed it was not possible to obtain conclusion on probing depth parameter.
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Affiliation(s)
- Eliezer Haimov
- Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Rafael Sarikov
- Oral and Maxillofacial Rehabilitation Department and the Temporomandibular Joint Diseases Unit, Rambam Medical Center, HaifaIsrael.
| | - Haim Haimov
- Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
| | - Gintaras Juodzbalys
- Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, KaunasLithuania.
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Sales PHDH, Barros AWP, Oliveira-Neto OBD, de Lima FJC, Carvalho ADAT, Leão JC. Do zirconia dental implants present better clinical results than titanium dental implants? A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101324. [PMID: 36330865 DOI: 10.1016/j.jormas.2022.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The purpose of this systematic review is to determine if the zirconia implants present better clinical results when compared to titanium implants. METHODS Searches were conducted in 5 databases including, until March 2022, by 2 independent reviewers, according to the inclusion and exclusion criteria established in the study and according whit this question: Do zirconia dental implants present better clinical results than titanium dental implants? RESULTS 3235 studies were initially found in the researched databases. 03 randomized clinical trials were included in this systematic review and meta-analysis. A total of 71 patients with 192 implants (87 titanium and 105 zirconia) were evaluated, showing an effectiveness of 87,4% and 78,1% respectively and there was no statistically significant difference in terms of survival rate in the meta-analysis (P = 0.70; I2 = 0%). Still in the meta-analysis, there was no statistically significant difference between titanium and zirconia implants in relation to the pink esthetich score or bleeding on probing, however, a favorable difference was observed for titanium in relation to marginal bone loss (P = 0.001; I2 = 0%). None of the studies evaluated had a low risk of bias. CONCLUSION Oral rehabilitation with zirconia implants showed no advantages over titanium in this systematic review. However, the small number of studies included and the uncertain risk of bias may raise doubts in this interpretation and the results should be analyzed with caution. New studies with greater methodological rigor, follow-up time and number of interventions should be performed in order to safely determine the indication for the use of zirconia implants.
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Affiliation(s)
- Pedro Henrique da Hora Sales
- Post-Graduated Program in Dentistry, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235 - Cidade Universitária, Recife, PE 50670-901, Brazil.
| | - Ana Waleska Pessoa Barros
- Post-Graduated Program in Dentistry, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235 - Cidade Universitária, Recife, PE 50670-901, Brazil
| | | | | | | | - Jair Carneiro Leão
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
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Kohal RJ, Vach K, Butz F, Spies BC, Patzelt SBM, Burkhardt F. One-Piece Zirconia Oral Implants for the Support of Three-Unit Fixed Dental Prostheses: Three-Year Results from a Prospective Case Series. J Funct Biomater 2023; 14:jfb14010045. [PMID: 36662092 PMCID: PMC9864364 DOI: 10.3390/jfb14010045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The objective was to investigate the clinical and radiological outcome of one-piece zirconia oral implants to support three-unit fixed dental prostheses (FDP) after three years in function. Twenty-seven patients were treated with a total of 54 implants in a one-stage surgery and immediate provisionalization. Standardized radiographs were taken at implant placement, after one year and after three years, to evaluate peri-implant bone loss. Soft-tissue parameters were also assessed. Linear mixed regression models as well as Wilcoxon Signed Rank tests were used for analyzing differences between groups and time points (p < 0.05). At the three-year evaluation, one implant was lost, resulting in a cumulative survival rate of 98.1%. The mean marginal bone loss amounted to 2.16 mm. An implant success grade I of 52% (bone loss of ≤2 mm) and success grade II of 61% (bone loss of ≤3 mm) were achieved. None of the evaluated baseline parameters affected bone loss. The survival rate of the zirconia implants was comparable to market-available titanium implants. However, an increased marginal bone loss was observed with a high peri-implantitis incidence and a resulting low implant success rate.
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Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Correspondence:
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Zinkmattenstr. 6a, 79108 Freiburg, Germany
| | - Frank Butz
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Belchenstr. 6a, 79189 Bad Krozingen, Germany
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Sebastian Berthold Maximilian Patzelt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Am Dorfplatz 3, 78658 Zimmern ob Rottweil, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Duan C, Ye L, Zhang M, Yang L, Li C, Pan J, Wu Y, Cao Y. Clinical performance of zirconium implants compared to titanium implants: a systematic review and meta-analysis of randomized controlled trials. PeerJ 2023; 11:e15010. [PMID: 36949758 PMCID: PMC10026713 DOI: 10.7717/peerj.15010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/16/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose To quantitatively assess and compare the clinical outcomes, including survival rate, success rate, and peri-implant indices of titanium and zirconium implants in randomized controlled trials. Methods The electronic databases searched included the Cochrane Central Register of Controlled Trials (CENTRAL), Medline via Ovid, EMBASE, and Web of Science. Randomized controlled trials (RCTs) that reported the effects of zirconium implants on primary outcomes, such as survival rate, success rate, marginal bone loss (MBL), and probing pocket depth (PPD), compared to titanium implants were included in this review. Two reviewers independently screened and selected the records, assessed their quality, and extracted the data from the included studies. Results A total of four studies from six publications reviewed were included. Two of the comparative studies were assessed at minimal risk of bias. Zirconium implants may have a lower survival rate (risk ratio (RR) = 0.91, CI [0.82-1.02], P = 0.100, I 2 = 0%) and a significantly lower success rate than titanium implants (RR = 0.87, CI [0.78-0.98], P = 0.030, I 2 = 0%). In addition, there was no difference between the titanium and zirconium implants in terms of MBL, PPD, bleeding on probing (BOP), plaque index (PI), and pink esthetic score (PES) (for MBL, MD = 0.25, CI [0.02-0.49], P = 0.033, I 2 = 0%; for PPD, MD = -0.07, CI [-0.19-0.05], P = 0.250, I 2 = 31%). Conclusion Zirconium implants may have higher failure rates due to their mechanical weakness. Zirconium implants should be strictly assessed before they enter the market. Further studies are required to confirm these findings.
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Affiliation(s)
- Chengchen Duan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Li Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mengyun Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Lei Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jian Pan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingying Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Lemos CAA, Verri FR, de Luna Gomes JM, Santiago Junior JF, Miyashita E, Mendonça G, Pellizzer EP. Survival and prosthetic complications of monolithic ceramic implant-supported single crowns and fixed partial dentures: A systematic review with meta-analysis. J Prosthet Dent 2022:S0022-3913(22)00736-3. [PMID: 36564291 DOI: 10.1016/j.prosdent.2022.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
STATEMENT OF PROBLEM Monolithic ceramic implant-supported restorations have been used to rehabilitate partially edentulous patients. However, knowledge of the survival and prosthetic complications of single crowns (SCs) and fixed partial dentures (FPDs) is limited. PURPOSE The purpose of this systematic review with meta-analysis was to evaluate the clinical performance of monolithic ceramic implant-supported SCs and FPDs in terms of survival and prosthetic complication rates. MATERIAL AND METHODS The systematic review was registered on the prospective register of systematic reviews (PROSPERO) (CRD42017078568). Five electronic databases were independently searched by 2 authors for articles published until May 2022. In addition, a hand search was performed in the nonpeer-reviewed literature, specific journals, and reference lists of included articles. A single-arm meta-analysis was performed by using the R program. The risk of bias and quality were assessed using the Cochrane risk of bias tools and the Newcastle-Ottawa scale. RESULTS Twenty-eight studies were included in the quantitative synthesis. A total of 1298 monolithic ceramic implant-supported restorations (1116 SCs and 182 FPDs) were evaluated in 1193 participants, with a median observation time of 24 months (range: 12 to 72 months). Meta-analysis indicated the proportion of failures and prosthetic complication rates of 2% (95% confidence interval [CI]: 1% to 4%) for SCs. No difference was observed for monolithic zirconia and lithium disilicate SCs. In the FPDs, only monolithic zirconia was considered, with 1 failure reported totaling the proportion of failures of 0% (0% to 1%) and complication rates of 4% (0% to 12%). The most complications reported for both types of restorations were screw loosening, debonding, and minor chipping and were considered repairable. The included studies showed a low risk of bias and good quality. CONCLUSIONS The use of monolithic ceramic implant-supported SCs, independent of ceramic material, and monolithic zirconia implant-supported FPDs should be considered an effective and safe treatment option because of favorable short-term survival and low prosthetic complications. However, additional well-conducted studies with a longer-term follow-up and direct comparison between veneered restorations are recommended to reassess clinical performance.
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Affiliation(s)
- Cleidiel Aparecido Araujo Lemos
- Adjunct Professor, Department of Dentistry, Federal University of Juiz de Fora - Campus Governador Valadares (UFJF/GV), Governador Valadares, Minas Gerais, Brazil.
| | - Fellippo Ramos Verri
- Adjunct Professor, Departament of Dental Materials and Prosthodontics, São Paulo State Univeristy (UNESP), Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | | | - Joel Ferreira Santiago Junior
- Professor, Departament of Health Sciences, School of Dentistry, Centro Universitário Sagrado Coração-UNISAGRADO, Bauru, São Paulo, Brazil
| | - Eduardo Miyashita
- Titular Professor, Department of Dentistry, UNIP - Universidade Paulista, São Paulo, Brazil
| | - Gustavo Mendonça
- Clinical Associate Professor, Department of Biological and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Eduardo Piza Pellizzer
- Titular Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
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15
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Brunello G, Rauch N, Becker K, Hakimi AR, Schwarz F, Becker J. Two-piece zirconia implants in the posterior mandible and maxilla: A cohort study with a follow-up period of 9 years. Clin Oral Implants Res 2022; 33:1233-1244. [PMID: 36184914 DOI: 10.1111/clr.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 08/12/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Long-term follow-up observations of zirconia implants are rare. This study aimed at evaluating the clinical performance of two-piece zirconia implants in the posterior jaws over 9 years. MATERIALS AND METHODS Sixty partially edentulous patients were treated with two-piece zirconia implants. In eight no primary stability could be achieved. Fifty-two patients received the final restoration (i.e., cemented fibreglass abutments and all-ceramic crowns). After 2 years, 2 implants failed and 4 dropouts were recorded. The remaining 46 patients with one target implant each were recalled at 9 years. Besides implant survival, clinical parameters at the implant level (plaque index-PI, bleeding on probing-BOP, probing depth-PD, mucosal recession-MR) were recorded and compared with previously collected data. Mechanical and technical complications were assessed. RESULTS Thirty patients responded. The mean observation period was of 111.1 ± 2.2 months. One implant was lost. Data recorded from the remaining 29 implants were analysed. PI values increased overtime. Mean BOP and PD remained unchanged during follow-up. No additional cases of peri-implantitis were recorded over the 10 diagnosed during the first 2 years of follow-up. No significant changes in mean MR values were detected over time, with 65% of the all included implants exhibiting no recession at 9 years and all the others, but one, a maximum MR of 1 mm. Three technical and 6 mechanical complications occurred in 7 patients between 2- and 9-years (6.9% and 20.7%, respectively, at patient level). CONCLUSION Within the limitations of the present study, a high survival rate was registered. Albeit frequent mechanical and technical complications, two-piece zirconia implants could represent a valid solution for the replacement of single teeth in the posterior jaws.
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Affiliation(s)
- Giulia Brunello
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy
| | - Nicole Rauch
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ahmad R Hakimi
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Private Practice, Berlin, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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16
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Thiem DGE, Stephan D, Kniha K, Kohal RJ, Röhling S, Spies BC, Stimmelmayr M, Grötz KA. German S3 guideline on the use of dental ceramic implants. Int J Implant Dent 2022; 8:43. [PMID: 36190587 PMCID: PMC9530079 DOI: 10.1186/s40729-022-00445-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/27/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Based on the excellent long-term data, dental implants made of titanium are considered the international implantological standard for replacing missing teeth. However, ceramic implants made of zirconia (ZrO2) have experienced a renaissance in the last 15 years due to constant innovations in materials and products, with material properties and soft tissue- and osseointegration behavior comparable to those of titanium. However, one limitation concerning ceramic implants is the lack of reliable long-term data, especially in the case of two-piece implant systems. As there is an increasing demand for ceramic implants from practitioners and patients, the German Society for Implantology (DGI) has decided to develop a guideline on the use of dental ceramic implants at the highest available evidence level with the involvement of experts in this field. METHODS Statements and recommendations were prepared after conducting a systematic literature search and an independent assessment process involving the relevant clinical literature from 2008 to 2021. The adopted recommendations and statements are summarized in this guideline. RESULTS AND CONCLUSIONS It confirms the feasible use of one-piece zirconia implants as an addendum/alternative to titanium implants. No final conclusion regarding the application of two-piece ceramic implant systems could be drawn on the basis of the existing data, thus its use can only be recommended after the patient has been informed in detail about the lack of long-term clinical data.
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Affiliation(s)
- D. G. E. Thiem
- grid.410607.4Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - D. Stephan
- grid.410607.4Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - K. Kniha
- Private Practice for Oral Surgery and Implantology, Rosental 6, 80331 Munich, Germany
| | - R. J. Kohal
- grid.7708.80000 0000 9428 7911Department of Prosthetic Dentistry, University Medical Centre Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - S. Röhling
- Private Praxis for Oral Surgery, Oralchirurgie T1, im Schäfflerhaus Theaterstr. 1, 80333 Munich, Germany
| | - B. C. Spies
- grid.7708.80000 0000 9428 7911Department of Prosthetic Dentistry, University Medical Centre Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - M. Stimmelmayr
- Private Practice for Oral Surgery, Josef-Heilingbrunner-Straße 2, 93413 Cham, Germany
| | - K. A. Grötz
- grid.491861.3Helios Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
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17
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Finite Element Analysis of Zirconia Dental Implant. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4030040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Titanium dental implants have had new competitors in recent years, such as fixtures made of zirconia, which promise better aesthetics. The purpose of this study is to evaluate their mechanical performance in silico (Finite Element Analysis). The investigation was performed on a single tooth Patent™ Dental Implant (Zircon Medical®, Altendorf, Switzerland) in two configurations: without offset (Test I) and with offset (Test II, 1.5 mm within the cortical bone). The Patent Implant system consists of two components: the implant with integrated abutment and the fibreglass post. The components of the dental implants were tested using a compression load of 400 N along the implant axis. The results showed that the chewing load generates stress distribution on the bone, therefore, the offset configuration should be avoided.
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Zirconia versus Titanium Implants: 8-Year Follow-Up in a Patient Cohort Contrasted with Histological Evidence from a Preclinical Animal Model. MATERIALS 2022; 15:ma15155322. [PMID: 35955254 PMCID: PMC9369473 DOI: 10.3390/ma15155322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Zirconia ceramic (ZC) implants are becoming more common, but comparisons between preclinical histology and long-term clinical trials are rare. This investigation comprised (1) 8-year clinical follow-up of one-piece ZC or titanium (Ti) implants supporting full overdentures and (2) histomorphometric analysis of the same implants in an animal model, comparing implants with various surface treatments. Methods: (1) Clinical trial: 24 completely edentulous participants (2 groups of N = 12) received 7 implants (one-piece ball-abutment ZC or Ti; maxilla N = 4, mandible N = 3) restored with implant overdentures. Outcomes after 8-years included survival, peri-implant bone levels, soft-tissue responses, and prosthodontic issues. (2) Preclinical trial: 10 New Zealand sheep received 4 implants bilaterally in the femoral condyle: Southern Implants ZC or Ti one-piece implants, identical to the clinical trial, and controls: Southern ITC® two-piece implants with the same surface or Nobel (NBC) anodised (TiUnite™) surface. %Bone-implant contact (%BIC) was measured after 12 weeks of unloaded healing. Results: 8 of 24 participants (33%) of an average age of 75 ± 8 years were recalled; 21% of original participants had died, and 46% could not be contacted. 80.4% of implants survived; excluding palatal sites, 87.5% of Ti and 79% of ZC implants survived. All failed implants were in the maxilla. Three ZC implants had fractured. Bone loss was similar for Ti vs. ZC; pocket depths (p = 0.04) and attachment levels (p = 0.02) were greater for Ti than ZC implants. (1.7 ± 1.6 mm vs. 1.6 ± 1.3 mm). All implants in sheep femurs survived. %BIC was not statistically different for one-piece blasted surface Ti (80 ± 19%) versus ZC (76 ± 20%) or ITC® (75 ± 16 mm); NBC had significantly higher %BIC than ITC (84 ± 17%, p = 0.4). Conclusion: Short-term preclinical results for ZC and Ti one-piece implants showed excellent bone-implant contact in unloaded femoral sites. This differed from the long-term clinical results in older-aged, edentulous participants. While ZC and Ti implants showed equivalent performance, the risks of peri-implantitis and implant loss in older, completely edentulous patients remain a significant factor.
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Young’s Modulus and Vickers Hardness of the Hydroxyapatite Bioceramics with a Small Amount of the Multi-Walled Carbon Nanotubes. MATERIALS 2022; 15:ma15155304. [PMID: 35955238 PMCID: PMC9369948 DOI: 10.3390/ma15155304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
The Vickers hardness and Young’s modulus of the hydroxyapatite (HA) bioceramics with a small amount of the multi-walled carbon nanotubes (MWCNTs) were studied by using ultramicrotester Shimadzu for dynamic tests DUH-211. Small concentrations of MWCNTs were from 0.05 to 0.5 wt.%. The argon inert atmosphere and vacuum condition were taken for the prevention of the MWCNTs oxidation. The Brunauer–Emmett–Teller (BET) surface area SBET of the HA-MWCNTs composites was determined by thermal adsorption-desorption of nitrogen. It was found that for HA-MWCNTs sintered in the Ar atmosphere, an increase in the concentration of nanotubes up to 0.5 wt.% leads to a decrease in porosity near 3 times in comparison to HA without MWCNTs additives. The small amount of additives of multi-walled carbon nanotubes leads to an increase in hardness of 1.3 times and compression strength of composite and compression strength of composite that is comparable in absolute values with the literature data of enamel hardness (3–5 GPa) and compression strength (95–370 MPa). The absolute values increase close to linearly with the increase of nanotube concentrations. The Young’s modulus of sintered composite slightly changes with the variation of concentrations of nanotubes and close to the enamel (75–100 GPa). The ratio of plastic work to total work and the ratio of elastic (reversible) work to the total work of deformation of composite HA/MWCNTs are practically constant at a studied range of MWCNTs concentration. The additives of the multi-walled carbon nanotubes lead to both an increase in the elasticity index of ~1.5 times and an increase in the resistance to plastic deformation of ~3 times, which improved the tribological performance of the surface. Plastic and elastic (reversible) work slightly changed.
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Surface Structure of Zirconia Implants: An Integrative Review Comparing Clinical Results with Preclinical and In Vitro Data. MATERIALS 2022; 15:ma15103664. [PMID: 35629692 PMCID: PMC9143528 DOI: 10.3390/ma15103664] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 01/27/2023]
Abstract
Background: The purpose of this review was to analyze and correlate the findings for zirconia implants in clinical, preclinical and in vitro cell studies in relation to surface structure. Methods: Electronic searches were conducted to identify clinical, preclinical and in vitro cell studies on zirconia implant surfaces. The primary outcomes were mean bone loss (MBL) for clinical studies, bone-to-implant contact (BIC) and removal torque (RT) for preclinical studies and cell spreading, cell proliferation and gene expression for cell studies. The secondary outcomes included comparisons of data found for those surfaces that were investigated in all three study types. Results: From 986 screened titles, 40 studies were included for data extraction. In clinical studies, only micro-structured surfaces were investigated. The lowest MBL was reported for sandblasted and subsequently etched surfaces, followed by a sinter and slurry treatment and sandblasted surfaces. For BIC, no clear preference of one surface structure was observable, while RT was slightly higher for micro-structured than smooth surfaces. All cell studies showed that cell spreading and cytoskeletal formation were enhanced on smooth compared with micro-structured surfaces. Conclusions: No correlation was observed for the effect of surface structure of zirconia implants within the results of clinical, preclinical and in vitro cell studies, underlining the need for standardized procedures for human, animal and in vitro studies.
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Clinical Performance Comparing Titanium and Titanium–Zirconium or Zirconia Dental Implants: A Systematic Review of Randomized Controlled Trials. Dent J (Basel) 2022; 10:dj10050083. [PMID: 35621536 PMCID: PMC9140125 DOI: 10.3390/dj10050083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 01/27/2023] Open
Abstract
Objectives: This study aimed to compare clinical results between titanium (Ti), zirconia (Zr), or titanium–zirconium (TZ) dental implants and to analyze survival rate (SR), bleeding on probing (BoP), marginal bone loss (MBL), and/or probing depth (PD). Data source: Manual and electronic searches were conducted (PubMed and Web of Science) to identify randomized controlled trials that compared the outcomes of at least two implant types (control and test group) within the same study. The focused question was determined according to the PICOT strategy. Seven studies were included out of 202 research studies initially found. The follow-up periods ranged from 12 to 80 months, and the mean age was from 43.3 to 65.8 years old. The SR for Ti, TZ, and Zr implants ranged from 92.6% to 100%, 95.8% to 100%, and 87.5% to 91.25%, respectively; MBL for Ti, TZ, and Zr implants varied from −1.17 mm to −0.125 mm for Ti, −0.6 mm to −0.32 mm for TZ, and −0.25 mm to −1.38 mm for Zr. Studies showed a low incidence of mucositis and peri-implantitis; however, BoP for Zr was 16.43%, Ti ranged between 10% and 20%, and TZ from 10% to 13.8%. PD for Ti ranged from 1.6 mm to 3.05 mm, TZ was 3.12 mm (only one study), and Zr ranged from 2.21 mm to 2.6 mm. Conclusion: All three types of implants showed similar tissue behavior. However, the TZ group had better results when compared with Ti and Zr for SR, MBL, and BoP, except for PD. Furthermore, the worst SR was found in the Zr implants group.
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22
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Endosseous Dental Implant Materials and Clinical Outcomes of Different Alloys: A Systematic Review. MATERIALS 2022; 15:ma15051979. [PMID: 35269211 PMCID: PMC8911578 DOI: 10.3390/ma15051979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/17/2022]
Abstract
In recent years, implantology has made significant progress, as it has now become a safe and predictable practice. The development of new geometries, primary and secondary, of new surfaces and alloys, has made this possible. The purpose of this review is to analyze the different alloys present on the market, such as that in zirconia, and evaluate their clinical differences with those most commonly used, such as those in grade IV titanium. The review, conducted on major scientific databases such as Scopus, PubMed, Web of Science and MDPI yielded a startling number of 305 results. After the application of the filters and the evaluation of the results in the review, only 10 Randomized Clinical Trials (RCTs) were included. Multiple outcomes were considered, such as Marginal Bone Level (MBL), Bleeding on Probing (BoP), Survival Rate, Success Rate and parameters related to aesthetic and prosthetic factors. There are currently no statistically significant differences between the use of zirconia implants and titanium implants, neither for fixed prosthetic restorations nor for overdenture restorations. Only the cases reported complain about the rigidity and, therefore, the possibility of fracture of the zirconium. Certainly the continuous improvement in these materials will ensure that they could be used safely while maintaining their high aesthetic performance.
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Jaeggi M, Gyr S, Astasov-Frauenhoffer M, Zitzmann NU, Fischer J, Rohr N. Influence of different zirconia surface treatments on biofilm formation in vitro and in situ. Clin Oral Implants Res 2022; 33:424-432. [PMID: 35137461 PMCID: PMC9304171 DOI: 10.1111/clr.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/10/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine if the surface treatment of zirconia affects biofilm formation in an in vitro three-species biofilm model and in situ. MATERIAL AND METHODS Zirconia surfaces considered for the transmucosal portion of a zirconia implant were compared with polished pure titanium grade 4 (Tp). Discs 13 mm in diameter of either polished (Zp), polished and heat-treated (Zpt), machined (Zm), machined and heat-treated (Zmt) and sandblasted, etched and heat-treated (Z14) zirconia were fabricated. Surface roughness and wettability of specimens was measured. Biofilm formation was evaluated by safranin staining and scanning electron microscopy (SEM) using a three-species model, and intraorally with 16 volunteers carrying oral splints in two independent experiments. Relative biofilm formation was compared with Kruskal-Wallis followed by Bonferroni post-hoc test (α=0.05). RESULTS In vitro biofilm formation with optical density values on Zp (0.14±0.01), Zpt (0.14±0.02), Zm (0.13±0.01) and Zmt (0.13±0.01) was significantly lower than on Tp (0.21±0.05) and Z14 (0.20±0.04) (p<0.05). In situ biofilm formation was significantly higher on Z14 (0.56±0.45) (p<0.05), while no significant differences in optical density were observed among Zp (0.25±0.20), Zm (0.36±0.34) and Tp (0.28±0.22). SEM analysis supported quantitative findings. CONCLUSIONS In the in vitro three-species biofilm model differences in material and surface roughness affected biofilm formation. In situ biofilm formation was mainly affected by the surface roughness of the specimens. Polishing of zirconia is recommended to reduce biofilm formation while heat-treatment has no significant effect.
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Affiliation(s)
- Marco Jaeggi
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Sharon Gyr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Monika Astasov-Frauenhoffer
- Department of Research, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Nicola U Zitzmann
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Jens Fischer
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Nadja Rohr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland.,Department of Research, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
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24
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Borgonovo AE, Ferrario S, Maiorana C, Vavassori V, Censi R, Re D. A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up. Int J Dent 2021; 2021:7534607. [PMID: 35003263 PMCID: PMC8739170 DOI: 10.1155/2021/7534607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/17/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes, of zirconia implants with 10-year follow-up. MATERIALS AND METHODS 10 patients were selected and 26 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge. After 10 years, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss. RESULTS The survival and success rates were 100%. The average marginal bone loss from baseline to 120 months after surgery was 0.92 ± 0.97 mm. CONCLUSION One-piece zirconia dental implants are characterised by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants.
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Affiliation(s)
- Andrea Enrico Borgonovo
- Department of Esthetic Dentistry, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Susanna Ferrario
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, University of Milan, Via Della Commenda 10, Milan 20122, Italy
| | - Carlo Maiorana
- Head Department of Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 10, Milan 20122, Italy
| | - Virna Vavassori
- Department of Esthetic Dentistry, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Rachele Censi
- Department of Esthetic Dentistry, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Dino Re
- Head Department of Esthetic Dentistry, Istituto Stomatologico Italiano, Milan 20122, Italy
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25
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Immediate Restoration of Single-Piece Zirconia Implants: A Prospective Case Series-Long-Term Results after 11 Years of Clinical Function. MATERIALS 2021; 14:ma14226738. [PMID: 34832139 PMCID: PMC8621133 DOI: 10.3390/ma14226738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this prospective case series was to evaluate single-piece zirconia implants restored with lithium disilicate CAD/CAM crowns through a long-term follow-up. METHODS In this trial, 20 one-piece zirconia implants were placed in 20 patients. Implants were restored (i) immediately with lithium disilicate CAD/CAM provisionals, and (ii) permanently four months after surgery. Patients were followed for 11 years. Clinical parameters and radiological measurements of the zirconia implants were assessed. For the statistical analysis, paired t-test was applied. RESULTS Four implants were counted as implant failure due to the loss of implant stability, resulting in a Kaplan-Meier survival rate of 80% up to 11 years. The mean bleeding on probing values were 19.1% (SD ± 13.1) and 18.2% (SD ± 17.6) 96 and 11 years after implant placement, respectively. The plaque index revealed a significant decrease over time (p < 0.001) with a value between 25.9% (SD ± 5.7) and 12.6% (SD ± 10.0) at baseline and 11-years follow-up respectively. The marginal bone level revealed a significant decrease 4, 8, and 11 years after implant insertion (p = 0.001, p = 0.019, and p = 0.027, respectively). CONCLUSIONS Immediately loaded zirconia single-piece implants showed a suitable success rate in clinical and radiographic outcomes.
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26
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Spitznagel FA, Balmer M, Wiedemeier DB, Jung RE, Gierthmuehlen PC. Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta-analyses. Clin Oral Implants Res 2021; 33:1-20. [PMID: 34665900 PMCID: PMC9297865 DOI: 10.1111/clr.13871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
Objective To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. Materials and Methods Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses. Results Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively. Conclusions Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
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Affiliation(s)
- Frank Akito Spitznagel
- Department of Prosthodontics, School of Dentistry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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27
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Stavropoulos A, Bertl K, Winning L, Polyzois I. What is the influence of implant surface characteristics and/or implant material on the incidence and progression of peri-implantitis? A systematic literature review. Clin Oral Implants Res 2021; 32 Suppl 21:203-229. [PMID: 34642989 DOI: 10.1111/clr.13859] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To answer the focused question, 'In animals or patients with dental implants, does implant surface characteristics and/or implant material have an effect on incidence and progression of peri-implantitis?' MATERIAL AND METHODS Pre-clinical in vivo experiments on experimental peri-implantitis and clinical trials with any aim and design, and ≥5 years follow-up, where the effect of ≥2 different type of implant material and/or surface characteristics on peri-implantitis incidence or severity, and/or progression, implant survival or losses due to peri-implantitis, and/or marginal bone levels/loss was assessed. RESULTS Meta-analyses based on data of pre-clinical experiments, using the ligature induced peri-implantitis model in the dog, indicated that after the spontaneous progression phase implants with a modified surface showed significantly greater radiographic bone loss (effect size 0.44 mm; 95%CI 0.10-0.79; p = .012; 8 publications) and area of infiltrated connective tissue (effect size 0.75 mm2 ; 95%CI 0.15-1.34; p = .014; 5 publications) compared to non-modified surfaces. However, in 9 out of the 18 included experiments, reported in 25 publications, no significant differences were shown among the different implant surface types assessed. Clinical and/or radiographic data from 7605 patients with 26,188 implants, reported in 31 publications (20 RCTs, 3 CTs, 4 prospective cohort, and 4 retrospective studies; 12 with follow-up ≥10 years), overall did not show significant differences in the incidence of peri-implantitis, when this was reported or could be inferred, among the various implant surfaces. In general, high survival rates (90-100%) up to 30 years and no clinically relevant differences in marginal bone loss/levels, merely compatible with crestal remodelling, were presented for the various implant types. CONCLUSION Pre-clinical in vivo experiments indicate that surface characteristics of modified implants may have a significant negative impact on peri-implantitis progression, while clinical studies do not support the notion that there is a difference in peri-implantitis incidence among the various types of implant surfaces. No assumptions can be made regarding the possible impact of implant material on incidence and/or peri-implantitis progression due to limited information.
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Affiliation(s)
- Andreas Stavropoulos
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.,Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Lewis Winning
- Department of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - Ioannis Polyzois
- Department of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
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28
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Pjetursson BE, Sailer I, Latyshev A, Rabel K, Kohal RJ, Karasan D. A systematic review and meta-analysis evaluating the survival, the failure, and the complication rates of veneered and monolithic all-ceramic implant-supported single crowns. Clin Oral Implants Res 2021; 32 Suppl 21:254-288. [PMID: 34642991 PMCID: PMC9293296 DOI: 10.1111/clr.13863] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
Objective To assess the survival, failure, and complication rates of veneered and monolithic all‐ceramic implant‐supported single crowns (SCs). Methods Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow‐up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all‐ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models. Results Forty‐nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta‐analysis of the included studies indicated an estimated 3‐year survival rate of veneered‐reinforced glass‐ceramic implant‐supported SCs of 97.6% (95% CI: 87.0%–99.6%). The estimated 3‐year survival rates were 97.0% (95% CI: 94.0%–98.5%) for monolithic‐reinforced glass‐ceramic implant SCs, 96.9% (95% CI: 93.4%–98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%–87.7%) for resin‐matrix‐ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates. Conclusions With the exception of RMC SCs, veneered and monolithic implant‐supported ceramic SCs showed favorable short‐term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.
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Affiliation(s)
- Bjarni Elvar Pjetursson
- Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland.,Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Andrey Latyshev
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Maxillofacial, Oral and Plastic Surgery, Faculty of Dentistry, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Kerstin Rabel
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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29
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Burkhardt F, Spies BC, Riemer L, Adolfsson E, Doerken S, Kohal RJ. Fracture resistance and crystal phase transformation of a one- and a two-piece zirconia implant with and without simultaneous loading and aging-An in vitro study. Clin Oral Implants Res 2021; 32:1288-1298. [PMID: 34352139 DOI: 10.1111/clr.13825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the influence of artificial aging on the transformation propagation and fracture resistance of zirconia implants. METHODS One-piece (with integrated implant abutment, 1P; regular diameter [4.1mm]; n = 16) and two-piece (with separate implant abutment, 2P; wide diameter [5 mm]; n = 16) zirconia implants were embedded according to ISO 14801. A two-piece titanium-zirconium implant (Ti-Zr; 4.1 mm diameter) served as a control (n = 16). One subgroup (n = 8) of each system was simultaneously dynamically loaded (107 cycles; 98N) and hydrothermally aged (85°C, 58 days), while the other subgroup (n = 8) remained untreated. Finally, specimens were statically loaded to fracture. Potential crystal phase transformation was examined at cross sections using scanning electron microscopy (SEM). A multivariate linear regression model was applied for statistical analyses. RESULTS The fracture resistance of 1P (1,117 [SD = 38] N; loaded/aged: 1,009 [60] N), 2P (850 [36] N; loaded/aged: 799 [84] N), and Ti-Zr implants (1,338 [205] N; loaded/aged: 1,319 [247] N) was not affected significantly by loading/aging (p = .171). However, when comparing the systems, they revealed significant differences independent of loading/aging (p ≤ .001). Regarding the crystal structure, a transformation zone was observed in SEM images of 1P only after aging, while 2P showed a transformation zone even before aging. After hydrothermal treatment, an increase of this monoclinic layer was observed in both systems. CONCLUSIONS The Ti-Zr control implant showed higher fracture resistance compared to both zirconia implants. Loading/aging had no significant impact on the fracture resistance of both zirconia implants. The wide-body 2P zirconia implant was weaker than the regular body 1P implant.
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Affiliation(s)
- Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | - Lennart Riemer
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | | | - Sam Doerken
- Medical Center - University of Freiburg, Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
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30
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Bittencourt TC, Souza Picorelli Assis NM, Ribeiro CG, Ferreira CF, Sotto-Maior BS. Evaluation of the peri-implant tissues in the esthetic zone with prefabricated titanium or zirconia abutments: A randomized controlled clinical trial with a minimum follow-up of 7 years. J Prosthet Dent 2021; 129:573-581. [PMID: 34334178 DOI: 10.1016/j.prosdent.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Long-term clinical studies are lacking on the influence of the type of abutment, titanium or zirconia, on peri-implant tissues. PURPOSE The purpose of this randomized clinical trial was to evaluate peri-implant tissues with titanium or zirconia abutments. MATERIAL AND METHODS A total of 26 single-tooth implant-supported prostheses in 14 participants were analyzed. They received either a titanium abutment with a metal-ceramic crown (TAG) or a zirconia abutment with a ceramic crown (ZAG). Data were collected immediately, at 5 months, and at a minimum of 7 years after crown delivery. The success rate, plaque and bleeding indexes, bleeding on probing, white and pink esthetic scores, and the relationships of the gingival phenotype with the pink esthetic score were analyzed. Statistical analyses were conducted with the t test for paired and independent data (α=.05). RESULTS The mean follow-up time was 95.2 ±2.6 months, showing an implant success rate of 96.7%. No statistically significant differences were found between TAG and ZAG among the time intervals evaluated for plaque or bleeding indexes (P>.05). A statistically significant difference was found for peri-implant probing depths in the mid-buccal sites between the groups at all the time intervals evaluated (TAG, P=.008; ZAG, P=.021): TAG showed an increase between 5 months (3.65 ±0.93 mm) and over 7 years (4.47 ±1.32 mm); and ZAG showed a reduction (5 months=5.22 ±1.71 mm; over 7 years=4.25 ±1.28 mm) in values. For the pink (PES) and white esthetic score (WES), ZAG (PES: immediately=6.33 ±1.41; 5 months=7.44 ±1.81; over 7 years=8.25 ±1.03; WES: immediately=7.67 ±1.50; over 7 years=8.38 ±0.74) showed higher mean values than TAG (PES: immediately=5.94 ±2.35; 5 months=6.53 ±2.15; over 7 years=7.44 ±1.81; WES: immediately=7.00 ±1.17; over 7 years=8.35 ±1.27) (P<.05). Statistically significant differences were found for gingival phenotype and for PES in TAG (P=.031), and the participants with thick phenotype showed higher PES in the 3 time intervals studied. CONCLUSIONS Zirconia abutments exhibited better results than titanium abutments in terms of the peri-implant tissues. Moreover, in those with a thin phenotype, zirconia provided improved gingival esthetics.
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Affiliation(s)
- Thais Camargo Bittencourt
- Master in Comprehensive Dentistry, Department of Prosthodontics, Federal University of Juiz de For a (UFJF) College of Dentistry, Juiz de Fora, Minas Gerais, Brazil.
| | - Neuza Maria Souza Picorelli Assis
- Associate Professor, the Department of Comprehensive Dentistry at the Federal University of Juiz de For a (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Cleide Gisele Ribeiro
- Professor, Maternidade Therezinha de Jesus (HMTJ/JF) and Faculdade de Ciências Médicas e da Saúde Juiz de For a (SUPREMA), Minas Gerais, Brazil
| | - Cimara Fortes Ferreira
- Associate Professor, Director of Implant Dentistry, Department of Periodontics, University of Tennessee (UT) College of Dentistry, Memphis, Tenn
| | - Bruno Salles Sotto-Maior
- Professor, Federal University of Juiz de Fora (UFJF), College of Dentistry, Departament of Restorative Dentistry, Juiz de Fora, Minas Gerais, Brazil
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31
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Ruiz Henao PA, Caneiro Queija L, Mareque S, Tasende Pereira A, Liñares González A, Blanco Carrión J. Titanium vs ceramic single dental implants in the anterior maxilla: A 12-month randomized clinical trial. Clin Oral Implants Res 2021; 32:951-961. [PMID: 34061402 DOI: 10.1111/clr.13788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/13/2021] [Accepted: 05/13/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this randomized clinical trial was to compare ceramic and titanium implants with respect to the esthetic and clinical parameters, and patient-reported outcome measures (PROMs). MATERIAL AND METHODS Thirty patients received thirty implants (8-12 mm in length, 3.3 mm diameter, and a tissue level design) to replace single teeth in the anterior maxilla. Patients were randomly allocated to receive a ceramic or a titanium implant. Esthetic, clinical parameters, and PROMs were evaluated 18 months after surgery. RESULTS At 12 months post-final loading, there were no significant differences between groups with respect to esthetics. Mean Index Crown Aesthetic score was 6.31 (95% C.I. 4.59-8.04) and 6.07 (95% C.I. 4.21-7.93) for ceramic and titanium implants, respectively. The pink esthetic score (PES) was 7.81 (95% C.I. 6.90-8.73) for ceramic implants and 7.86 (95% C.I. 7.11-8.60) for titanium implants, with no significant differences between groups. No statistically significant differences were found for any of the other clinical parameters and PROMs. CONCLUSIONS Monotype ceramic implants have proven to be a good treatment option in the upper anterior sector, showing favorable esthetic results, being comparable to titanium implants. This clinical trial has been registered in clinical trials with the identifier CI_RCT_US16 and registration number NCT04707677. A retrospective registration of the clinical trial was carried out since registration was not mandatory on the date the study began.
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Affiliation(s)
- Paula Andrea Ruiz Henao
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Leticia Caneiro Queija
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Santiago Mareque
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Almudena Tasende Pereira
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Liñares González
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.,Odontología Médico-Quirúrgica (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Blanco Carrión
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.,Odontología Médico-Quirúrgica (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Rohr N, Balmer M, Jung RE, Kohal RJ, Spies BC, Hämmerle CHF, Fischer J. Influence of zirconia implant surface topography on first bone implant contact within a prospective cohort study. Clin Implant Dent Relat Res 2021; 23:593-599. [PMID: 34047019 DOI: 10.1111/cid.13013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/12/2021] [Accepted: 04/29/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although 5-year clinical data exist for different zirconia implants, no analysis has yet been performed focusing on how the surface topography of the implant affects clinical parameters. PURPOSE To analyze the influence of zirconia implant topography on first bone implant contact (fBIC). MATERIALS AND METHODS In a prospective two-center cohort investigation 63 zirconia implants were evaluated at implant placement, prosthetic delivery, 1, 3, and 5 years. The distance (DIB) between implant shoulder and fBIC was measured at each time point in periapical radiographs at mesial and distal sites. Two-way ANOVA/Bonferroni was used to analyze the effects of time and center (α < 0.05). RESULTS Between the centers, the mean DIB varied significantly at implant placement (Freiburg [FR]: 1.4 ± 0.6 mm; Zurich [ZH]: 0.8 ± 0.5 mm). Thereafter, no statistically significant difference in DIB was observed, neither between centers nor between time points (prosthetic delivery: FR: 1.9 ± 0.6 mm, ZH: 1.7 ± 0.8 mm; 1 year: FR: 1.8 ± 0.6 mm, ZH: 1.6 ± 0.8 mm; 3 years: FR: 1.9 ± 0.8 mm, ZH: 1.7 ± 0.8 mm; 5 years: FR: 1.9 ± 0.8 mm, ZH 1.8 ± 0.6 mm). The overall mean DIB at prosthetic delivery to 5 years of both centers (1.8 ± 0.7 mm) is located within the transition zone between the smooth neck and the moderately rough intraosseous part (1.6-2.0 mm from the implant shoulder). However, individual DIB values are ranging from 0.1 to 4.2 mm overlapping the transition zone. CONCLUSIONS The standard deviation of the DIB indicates that the fBIC establishes on moderately rough and smooth surfaces. Consequently, soft tissue adapts to both topographies as well.
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Affiliation(s)
- Nadja Rohr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ralf J Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jens Fischer
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
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Kunrath MF, Gupta S, Lorusso F, Scarano A, Noumbissi S. Oral Tissue Interactions and Cellular Response to Zirconia Implant-Prosthetic Components: A Critical Review. MATERIALS 2021; 14:ma14112825. [PMID: 34070589 PMCID: PMC8198172 DOI: 10.3390/ma14112825] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
Background: Dental components manufactured with zirconia (ZrO2) represent a significant percentage of the implant prosthetic market in dentistry. However, during the last few years, we have observed robust clinical and pre-clinical scientific investigations on zirconia both as a prosthetic and an implantable material. At the same time, we have witnessed consistent technical and manufacturing updates with regards to the applications of zirconia which appear to gradually clarify points which until recently were not well understood. Methods: This critical review evaluated the “state of the art” in relation to applications of this biomaterial in dental components and its interactions with oral tissues. Results: The physico-chemical and structural properties as well as the current surface treatment methodologies for ZrO2 were explored. A critical investigation of the cellular response to this biomaterial was completed and the clinical implications discussed. Finally, surface treatments of ZrO2 demonstrate that excellent osseointegration is possible and provide encouraging prospects for rapid bone adhesion. Furthermore, sophisticated surface treatment techniques and technologies are providing impressive oral soft tissue cell responses thus leading to superior biological seal. Conclusions: Dental devices manufactured from ZrO2 are structurally and chemically stable with biocompatibility levels allowing for safe and long-term function in the oral environment.
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Affiliation(s)
- Marcel F. Kunrath
- Dentistry Department, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), P.O. Box 6681, Porto Alegre 90619-900, RS, Brazil;
- Materials and Nanoscience Laboratory, Pontifical Catholic University of Rio Grande do Sul (PUCRS), P.O. Box 6681, Porto Alegre 90619-900, RS, Brazil
| | - Saurabh Gupta
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20901, USA; (S.G.); (S.N.)
- Master Dental Science, Universitat Jaume I, 12071 Castellón de la Plana, Spain
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31-66100 Chieti, CH, Italy;
| | - Antonio Scarano
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20901, USA; (S.G.); (S.N.)
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31-66100 Chieti, CH, Italy;
- Correspondence: ; Tel.: +08713554084
| | - Sammy Noumbissi
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20901, USA; (S.G.); (S.N.)
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31-66100 Chieti, CH, Italy;
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Lorusso F, Noumbissi S, Francesco I, Rapone B, Khater AGA, Scarano A. Scientific Trends in Clinical Research on Zirconia Dental Implants: A Bibliometric Review. MATERIALS 2020; 13:ma13235534. [PMID: 33291827 PMCID: PMC7730252 DOI: 10.3390/ma13235534] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022]
Abstract
Background: The clinical use of zirconia implants has been shown to increase steadily due to their biological, aesthetic, and physical properties; therefore, this bibliometric study aimed to review the clinical research and co-authors in the field of zirconia dental implant rehabilitation. Methods: We searched Scopus and Web of Science databases using a comprehensive search strategy to 5 October 2020, and independently paired reviewers who screened studies, and collected data with inclusion criteria restricted to clinical research only (either prospective or retrospective). Data on article title, co-authors, number of citations received, journal details, publication year, country and institution involved, funding, study design, marginal bone loss, survival rate, failure, follow-up, and the author’s bibliometric data were collected and evaluated. Results: A total of 29 clinical studies were published between 2008 and 2020 as 41.4% were prospective cohort studies and 48.3% originated from Germany. Most of the included studies had been published in Clinical Oral Implant Research (n = 12), and the most productive institution was the Medical Center of University of Freiburg. The author with the largest number of clinical studies on zirconia implants was Kohal R.J. (n = 10), followed by Spies B.C. (n = 8). Conclusions: This study revealed that zirconia implants have been more prominent in the last ten years, which is a valuable option for oral rehabilitation with marginal bone loss and survival rate comparable to titanium dental implants.
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Affiliation(s)
- Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
| | - Sammy Noumbissi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
| | - Inchingolo Francesco
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Ahmad G. A. Khater
- Faculty of Oral and Dental Medicine, Ahram Canadian University, 6th of October City, 8655 Giza, Egypt;
| | - Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
- Correspondence: ; Tel.: +39-0871-355-4084; Fax: +39-0871-355-4099
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A Prospective Clinical Cohort Investigation on Zirconia Implants: 5-Year Results. J Clin Med 2020; 9:jcm9082585. [PMID: 32785031 PMCID: PMC7464596 DOI: 10.3390/jcm9082585] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Mid-term data on zirconia oral implants is very rare. Therefore, the aim of this prospective clinical investigation was to evaluate the survival rate and the marginal bone loss of a one-piece zirconia implant after five years. Patient-reported outcomes were also recorded. Zirconia implants to support single crowns (SC) or a 3-unit fixed dental prosthesis (FDP) were placed and subsequently restored. After the insertion of the implants, at prosthetic delivery, and after five years, standardized radiographs were taken to evaluate marginal bone loss (MBL). For bone tissue evaluation, linear mixed models with random intercepts were fitted. Twenty-seven patients received one implant for an SC and 13 patients received two implants for a 3-unit FDP. Three patients each lost one implant for an SC before prosthetic delivery. Thirty-five patients were seen after five years, and no further implant was lost. The cumulative five-year implant survival rate was 94.3%. The MBL from implant installation up to five years was 0.81 mm. The MBL from implant installation to prosthetic delivery was statistically significant (p < 0.001). Patients perceived a significant improvement in function, esthetics, sense, speech, and self-esteem from pretreatment up to the five-year follow-up. The present findings substantiate the clinical applicability of this implant system.
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