1
|
Ciszyński M, Chwaliszewski B, Simka W, Dominiak M, Gedrange T, Hadzik J. Zirconia Dental Implant Designs and Surface Modifications: A Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:4202. [PMID: 39274592 PMCID: PMC11396535 DOI: 10.3390/ma17174202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/14/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024]
Abstract
Titanium currently has a well-established position as the gold standard for manufacturing dental implants; however, it is not free of flaws. Mentions of possible soft-tissue discoloration, corrosion, and possible allergic reactions have led to the development of zirconia dental implants. Various techniques for the surface modification of titanium have been applied to increase titanium implants' ability to osseointegrate. Similarly, to achieve the best possible results, zirconia dental implants have also had their surface modified to promote proper healing and satisfactory long-term results. Despite zirconium oxide being a ceramic material, not simply a metal, there have been mentions of it being susceptible to corrosion too. In this article, we aim to review the literature available on zirconia implants, the available techniques for the surface modification of zirconia, and the effects of these techniques on zirconia's biological properties. Zirconia's biocompatibility and ability to osseointegrate appears unquestionably good. Despite some of its mechanical properties being, factually, inferior to those of titanium, the benefits seem to outweigh the drawbacks. Zirconia implants show very good success rates in clinical research. This is partially due to available methods of surface treatment, including nanotopography alterations, which allow for improved wettability, bone-to-implant contact, and osteointegration in general.
Collapse
Affiliation(s)
- Michał Ciszyński
- Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroclaw, 50-425 Wroclaw, Poland
| | - Bartosz Chwaliszewski
- Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroclaw, 50-425 Wroclaw, Poland
| | - Wojciech Simka
- Faculty of Chemistry, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Marzena Dominiak
- Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroclaw, 50-425 Wroclaw, Poland
| | - Tomasz Gedrange
- Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroclaw, 50-425 Wroclaw, Poland
- Department of Orthodontics, Technische Universität Dresden, 01069 Dresden, Germany
| | - Jakub Hadzik
- Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroclaw, 50-425 Wroclaw, Poland
| |
Collapse
|
2
|
Schnurr E, Sperlich M, Sones A, Romanos GE, Rutkowski JL, Duddeck DU, Neugebauer J, Att W, Sperlich M, Volz KU, Ghanaati S. Ceramic Implant Rehabilitation: Consensus Statements from Joint Congress for Ceramic Implantology: Consensus Statements on Ceramic Implant. J ORAL IMPLANTOL 2024; 50:435-445. [PMID: 38867376 DOI: 10.1563/aaid-joi-d-23-00083] [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] [Indexed: 06/14/2024]
Abstract
The objectives of the study group focused on the following main topics related to the performance of 1- and 2-piece ceramic implants: defining bone-implant-contact percentages and its measurement methods, evaluating the pink esthetic score as an esthetic outcome parameter after immediate implantation, recognizing the different results of ceramic implant designs as redefined by the German Association of Oral Implantology, incorporating the patient report outcome measure to include satisfaction and improvement in oral health-related quality of life, and conducting preclinical studies to address existing gaps in ceramic implants. During the Joint Congress for Ceramic Implantology (2022), the study group evaluated 17 clinical trials published between 2015 and 2021. After extensive discussions and multiple closed sessions, consensus statements and recommendations were developed, incorporating all approved modifications. A 1-piece implant design features a coronal part that is fused to the implant body or interfaces with the postabutment restoration platform, undergoing transmucosal healing. Long-term evaluations of this implant design are supported by established favorable clinical evidence. Inaccuracies in the pink esthetic score and bone-implant-contact percentages were managed by establishing control groups for preclinical studies and randomizing clinical trials. The patient-reported outcome measures were adjusted to include an individual visual analog scale, collected from each clinical study, that quantified improved oral health and quality of life. Preclinical investigations should focus on examining the spread of ceramic debris and the impact of heat generation on tissue and cellular levels during drilling. Further technical advancements should prioritize wound management and developing safe drilling protocols.
Collapse
Affiliation(s)
- Etyene Schnurr
- Ceramic and Biological Dentistry Foundation, Kreuzlingen, Switzerland
- Basic Science Department, Health Institute of Nova Friburgo, Federal Fluminense University, Brazil
| | | | - Amerian Sones
- Board of Directors of the Academy of Osseointegration
| | - George E Romanos
- Department of Periodontology and Endodontics, School of Dental Medicine, Stony Brook University, Stony Brook, New York
| | - J L Rutkowski
- Restorative Dentistry, School of Dental Medicine, State University of New York, Buffalo, New York
| | | | - Jörg Neugebauer
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Köln, Germany
| | - Wael Att
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts
| | | | | | - Shahram Ghanaati
- Frankfurt Oral Regenerative Medicine, Clinic for Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt Am Main, Germany
| |
Collapse
|
3
|
Basak SS, Guler Ayyıldız B, Eken S, Karakıs Akcan S. Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study. J Dent 2024; 144:104935. [PMID: 38499282 DOI: 10.1016/j.jdent.2024.104935] [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: 12/13/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES The recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri‑implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis. METHODS This retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation. RESULTS The incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively. CONCLUSION This study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease. CLINICAL SIGNIFICANCE This study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.
Collapse
Affiliation(s)
- Suna Selver Basak
- Kutahya Health Sciences University, Faculty of Dentistry, Department of Prosthodontics, Kutahya, Turkey.
| | - Berceste Guler Ayyıldız
- Kutahya Health Sciences University, Faculty of Dentistry, Department of Periodontology, Kutahya, Turkey.
| | - Seyma Eken
- Kutahya Health Sciences University, Faculty of Dentistry, Department of Periodontology, Kutahya, Turkey; Kutahya Health Sciences University, Tavsanlı Vocational School of Health Services, Oral Health Department, Kutahya, Turkey.
| | - Serap Karakıs Akcan
- Istanbul Gelısım University, Faculty of Dentistry, Department of Periodontology, Istanbul, Turkey.
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Laleman I, Lambert F, Gahlert M, Bacevic M, Woelfler H, Roehling S. The effect of different abutment materials on peri-implant tissues-A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:125-142. [PMID: 37750527 DOI: 10.1111/clr.14159] [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: 04/12/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES In patients with dental implants, what is the effect of transmucosal components made of materials other than titanium (alloys) compared to titanium (alloys) on the surrounding peri-implant tissues after at least 1 year? MATERIALS AND METHODS This systematic review included eligible randomized controlled trials identified through an electronic search (Medline, Embase and Web of Science) comparing alternative abutment materials versus titanium (alloy) abutments with a minimum follow-up of 1 year and including at least 10 patients/group. Primary outcomes were peri-implant marginal bone level (MBL) and probing depth (PD), these were evaluated based on meta-analyses. Abutment survival, biological and technical complications and aesthetic outcomes were the secondary outcomes. The risk of bias was assessed with the RoB2-tool. This review is registered in PROSPERO with the number (CRD42022376487). RESULTS From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 12 articles could be included. Concerning the primary outcomes (MBL and PD), no differences could be seen between titanium abutment and zirconia or alumina abutments, not after 1 year (MBL: zirconia: MD = -0.24, 95% CI: -0.65 to 0.16, alumina: MD = -0.06, 95% CI: -0.29 to 0.17) (PD: zirconia: MD = -0.06, 95% CI: -0.41 to 0.30, alumina: MD = -0.29, 95% CI: -0.96 to 0.38), nor after 5 years. Additionally, no differences were found concerning the biological complications and aesthetic outcomes. The most important technical finding was abutment fracture in the ceramic group and chipping of the veneering material. CONCLUSIONS Biologically, titanium and zirconia abutments seem to function equally up to 5 years after placement.
Collapse
Affiliation(s)
- 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
| | - F Lambert
- 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
| | - M Gahlert
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- Sigmund Freud Private University, Vienna, Austria
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - M Bacevic
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - H Woelfler
- Professor for Demography, University of Bamberg, Bamberg, Germany
| | - S Roehling
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- 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
| |
Collapse
|