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da Silva AMP, Horta Dos Santos FA, Mota RF, Teixeira MKS, Telles DM, Lourenço EJV. Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial. Clin Oral Investig 2024; 28:380. [PMID: 38886209 DOI: 10.1007/s00784-024-05783-3] [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: 12/28/2023] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. MATERIALS AND METHODS Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. RESULTS The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). CONCLUSION The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. CLINICAL RELEVANCE These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.
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Affiliation(s)
- Alexandre Marques Paes da Silva
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | | | - Rodrigo Franco Mota
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Mayla Kezy Silva Teixeira
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
| | - Daniel Moraes Telles
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Eduardo José Veras Lourenço
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
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Gul A, Papia E, Naimi-Akbar A, Ruud A, Vult von Steyern P. Zirconia dental implants; the relationship between design and clinical outcome: A systematic review. J Dent 2024; 143:104903. [PMID: 38437977 DOI: 10.1016/j.jdent.2024.104903] [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: 11/17/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To evaluate the clinical outcome of different designs of zirconia dental implants. DATA This systematic review adhered to the PRISMA checklist and followed the PICO framework. The protocol is registered in PROSPERO (CRD42022337228). SOURCES The search was conducted in March 2023 through four databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) along with a search of references in the related reviews. Three authors reviewed on title, and abstract level and analysed the risk of bias, and all authors reviewed on a full-text level. STUDY SELECTION Clinical studies excluding case reports for patients treated with different designs of zirconia dental implants were included. From a total of 2728 titles, 71 full-text studies were screened, and 27 studies were included to assess the risk of bias (ROBINS-I tool) and data extraction. After quality assessment, four studies were included, and the remaining 23 excluded studies were narratively described. RESULT The included prospective studies with moderate risk of bias reported success and survival rates of one-piece implants that ranged between 95 and 98.4 % with no difference between different lengths and diameters. The acid-etched roughened surface showed higher clinical outcomes compared to other surface roughness designs. CONCLUSION Promising 5-year clinical outcomes were found for one-piece zirconia implants with no difference between different diameters and lengths. Concerning surface roughness, better outcomes were found when using the acid-etched implant surface. However, due to the limited available studies, further high-quality clinical studies comparing zirconia one-piece and two-piece implants with different diameters, lengths, and surface roughness are needed. CLINICAL SIGNIFICANCE Based on this systematic review, under suitable clinical situations, the one-piece zirconia implants with diameters of 4.0 mm, 4.5 mm, or 5.5 mm and lengths of 8 mm, 10 mm, 12 mm, or 14 mm have similar promising clinical outcomes. Additionally, the acid-etched roughened implant surface may be preferable.
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Affiliation(s)
- Abdulaziz Gul
- Department of Materials Science and Technology, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Evaggelia Papia
- Department of Materials Science and Technology, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Aron Naimi-Akbar
- Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Oral and Maxillofacial Surgery and Oral Medicine, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Amund Ruud
- Nordic Institute of Dental Materials, NIOM, Oslo, Norway
| | - Per Vult von Steyern
- Department of Materials Science and Technology, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden; Nordic Institute of Dental Materials, NIOM, Oslo, Norway
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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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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: 2] [Impact Index Per Article: 2.0] [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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Chopra D, Jayasree A, Guo T, Gulati K, Ivanovski S. Advancing dental implants: Bioactive and therapeutic modifications of zirconia. Bioact Mater 2022; 13:161-178. [PMID: 35224299 PMCID: PMC8843948 DOI: 10.1016/j.bioactmat.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/22/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022] Open
Abstract
Zirconium-based implants have gained popularity in the dental implant field owing to their corrosion resistance and biocompatibility, attributed to the formation of a native zirconia (ZrO2) film. However, enhanced bioactivity and local therapy from such implants are desirable to enable the earlier establishment and improved long-term maintenance of implant integration, especially in compromised patient conditions. As a result, surface modification of zirconium-based implants have been performed using various physical, chemical and biological techniques at the macro-, micro-, and nano-scales. In this extensive review, we discuss and detail the development of Zr implants covering the spectrum from past and present advancements to future perspectives, arriving at the next generation of highly bioactive and therapeutic nano-engineered Zr-based implants. The review provides in-depth knowledge of the bioactive/therapeutic value of surface modification of Zr implants in dental implant applications focusing on clinical translation.
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Affiliation(s)
| | | | | | - Karan Gulati
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
| | - Sašo Ivanovski
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
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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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de Matos JDM, Lopes GDRS, Nakano LJN, Ramos NDC, Vasconcelos JELD, Bottino MA, Tribst JPM. Biomechanical evaluation of 3-unit fixed partial dentures on monotype and two-piece zirconia dental implants. Comput Methods Biomech Biomed Engin 2021; 25:239-246. [PMID: 34559574 DOI: 10.1080/10255842.2021.1946798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study aimed to evaluate the biomechanical behavior, stress distributions and bone microstrain of fixed partial dentures (FPD) with ceramic abutments supported on monotype zirconia implants, titanium implants and two-piece zirconia implants, using finite element analysis. A three-dimensional model of the jaw was simulated containing 1.0 mm thick cortical bone and cancellous bone tissue. A FPD and implant models (4.1 x 10 mm) were modeled containing a cement-retained implant abutment. These models were replicated in three groups with similar geometries: Titanium Implant and Zirconia Abutment (Ti-Zr); Zirconia Implant and Zirconia Abutment (Zr-Zr) and Monotype Zirconia Implant (Zr-S). An axial load of 300 N was applied to the center of the first premolar. The microstrain (με) and the Von-Mises stress (MPa) were assumed as failures criteria. For the three groups, a higher stress concentration was observed in the region of FPD connectors. The Ti-Zr group showed a higher stress concentration in the prosthesis and implant when compared to the other groups. However, the smaller elastic modulus of the titanium implant, in relation to the zirconia, provided a lower stress in the abutment and in the prosthetic screw. The monotype implant system allowed a more homogeneous stress distribution and its strain were predominantly located in the cervical region of the peri-implant bone tissue. Monotype or two-piece zirconia implants can be used for rehabilitation with FPD. However, the absence of separation between implant and abutment in the monotype system avoids the stress concentration in the prosthetic screw and reduced the peri-implant bone strain.
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Affiliation(s)
- Jefferson David Melo de Matos
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Sao Paulo, Brazil
| | - Guilherme da Rocha Scalzer Lopes
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Sao Paulo, Brazil
| | - Leonardo Jiro Nomura Nakano
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Sao Paulo, Brazil
| | - Nathália de Carvalho Ramos
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Sao Paulo, Brazil.,Department of Dentistry, Universidade São Francisco (USF), Bragança Paulista, Brazil
| | | | - Marco Antonio Bottino
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Sao Paulo, Brazil
| | - João Paulo Mendes Tribst
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Sao Paulo, Brazil.,Department of Dentistry, University of Taubaté (UNITAU), Taubaté, Brazil
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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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Microwave assisted sol-gel synthesis of bioactive zirconia nanoparticles – Correlation of strength and structure. J Mech Behav Biomed Mater 2020; 112:104012. [DOI: 10.1016/j.jmbbm.2020.104012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/21/2022]
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Galárraga-Vinueza ME, Tangl S, Bianchini M, Magini R, Obreja K, Gruber R, Schwarz F. Histological characteristics of advanced peri-implantitis bone defects in humans. Int J Implant Dent 2020; 6:12. [PMID: 32211972 PMCID: PMC7093613 DOI: 10.1186/s40729-020-00208-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Inflammatory osteolysis is the clinical hallmark of peri-implantitis. The morphology of the remaining peri-implant bone and the level of osseointegration, however, remain unknown. Our aim was to characterize advanced peri-implantitis bone defects in humans. METHODS Four patients (3 female and 1 male) were diagnosed with peri-implantitis. A total of 5 implants with machined surfaces and a mean loading time of 12 ± 6 years were removed due to advanced bone loss. The defect extension, the peri-implant bone density (bone area per tissue area in percentage), bone-to-implant contact (%), and the number of filled and empty osteocyte lacunae were calculated based on undecalcified histological specimens. RESULTS The defect extension was on average 4.2 mm (95% CI 0.8-3.4). Remaining peri-implant bone showed a high density of 85.5% (95% CI 79.1-91.3) and covered in total 74% (95% CI 70.5-77.5) of the implant surface. Filled and empty osteocyte lacunae density was on average 191 and 165/mm2 (95% CI 132-251; 103-225), respectively. Histology further revealed signs of ongoing bone formation and resorption. CONCLUSION There are signs that suggest that once the original cortical bone is lost due to peri-implantitis, the remaining apical trabecular bone is reinforced and transformed into cortical bone that might take over the functional load.
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Affiliation(s)
- Maria Elisa Galárraga-Vinueza
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Stefan Tangl
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Marco Bianchini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Ricardo Magini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, Austria.
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
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Schünemann FH, Galárraga-Vinueza ME, Magini R, Fredel M, Silva F, Souza JCM, Zhang Y, Henriques B. Zirconia surface modifications for implant dentistry. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 98:1294-1305. [PMID: 30813009 DOI: 10.1016/j.msec.2019.01.062] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Zirconia has emerged as a versatile dental material due to its excellent aesthetic outcomes such as color and opacity, unique mechanical properties that can mimic the appearance of natural teeth and decrease peri-implant inflammatory reactions. OBJECTIVE The aim of this review was to critically explore the state of art of zirconia surface treatment to enhance the biological and osseointegration behavior of zirconia in implant dentistry. MATERIALS AND METHODS An electronic search in PubMed database was carried out until May 2018 using the following combination of key words and MeSH terms without time periods: "zirconia surface treatment" or "zirconia surface modification" or "zirconia coating" and "osseointegration" or "biological properties" or "bioactivity" or "functionally graded properties". RESULTS Previous studies have reported the influence of zirconia-based implant surface on the adhesion, proliferation, and differentiation of osteoblast and fibroblasts at the implant to bone interface during the osseointegration process. A large number of physicochemical methods have been used to change the implant surfaces and therefore to improve the early and late bone-to-implant integration, namely: acid etching, gritblasting, laser treatment, UV light, CVD, and PVD. The development of coatings composed of silica, magnesium, graphene, dopamine, and bioactive molecules has been assessed although the development of a functionally graded material for implants has shown encouraging mechanical and biological behavior. CONCLUSION Modified zirconia surfaces clearly demonstrate faster osseointegration than that on untreated surfaces. However, there is no consensus regarding the surface treatment and consequent morphological aspects of the surfaces to enhance osseointegration.
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Affiliation(s)
- Fernanda H Schünemann
- School of Dentistry (DODT), Post-Graduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900 Florianópolis, SC, Brazil
| | - María E Galárraga-Vinueza
- School of Dentistry (DODT), Post-Graduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900 Florianópolis, SC, Brazil
| | - Ricardo Magini
- School of Dentistry (DODT), Post-Graduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900 Florianópolis, SC, Brazil
| | - Márcio Fredel
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Filipe Silva
- CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
| | - Júlio C M Souza
- CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal; Department of Dental Sciences, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal
| | - Yu Zhang
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, NYU, New York, NY 10010, USA
| | - Bruno Henriques
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900, Florianópolis, SC, Brazil; CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal.
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ArRejaie AS, Al-Hamdan RS, Basunbul GI, Abduljabbar T, Al-Aali KA, Labban N. Clinical performance of one-piece zirconia dental implants: A systematic review. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2018; 10:e12384. [PMID: 30588750 DOI: 10.1111/jicd.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/28/2018] [Indexed: 01/11/2023]
Abstract
The aim of the present review was to evaluate the clinical and radiographic performance of one-piece zirconia implants (O-PZI). This review followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines that addressed the following focused question: What is the overall clinical and radiographic performance of O-PZI? The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases were searched. Six clinical studies were included. For studies evaluating O-PZI compared with one-piece titanium implants, zirconia implants showed higher crestal bone loss (CBL) in both the studies. However, one study demonstrated a high failure rate compared to titanium dental implants, while one study demonstrated comparable survival rates between zirconia and titanium dental implants. For studies evaluating O-PZI for the restoration of single crown and fixed dental prostheses, O-PZI showed comparable bone loss and survival rates for single crowns and fixed dental prostheses. Two studies were included that compared O-PZI with two-piece zirconia (T-PZI). One study showed a higher CBL and low survival rate for O-PZI compared to T-PZI, whereas the other study demonstrated comparable CBL and survival rates between O-PZI and T-PZI. It is still debatable whether O-PZI demonstrate better clinical performance when compared with titanium implants or two-piece design.
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Affiliation(s)
- Aws S ArRejaie
- Department of Prosthetic Dental Science, King Saud University, Riyadh, Saudi Arabia
| | - Rana S Al-Hamdan
- Department of Restorative Dental Science, King Saud University, Riyadh, Saudi Arabia
| | - Ghadeer I Basunbul
- Department of Oral and Maxillofacial Rehabilitation, Faculty of Dentistry, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Science, King Saud University, Riyadh, Saudi Arabia
| | - Khulud A Al-Aali
- Department of Prosthodontics, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nawaf Labban
- Department of Prosthetic Dental Science, King Saud University, Riyadh, Saudi Arabia
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Roehling S, Schlegel KA, Woelfler H, Gahlert M. Performance and outcome of zirconia dental implants in clinical studies: A meta‐analysis. Clin Oral Implants Res 2018; 29 Suppl 16:135-153. [DOI: 10.1111/clr.13352] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/28/2018] [Accepted: 07/04/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Stefan Roehling
- Clinic for Oral and Cranio‐Maxillofacial SurgeryHightech Research CenterUniversity Hospital BaselUniversity of Basel Basel Switzerland
- Clinic for Oral and Cranio‐Maxillofacial SurgeryKantonsspital Aarau Aarau Switzerland
- Unit for Oral & Maxillofacial SurgeryMedical Healthcare Center Lörrach Lörrach Germany
| | - Karl A. Schlegel
- Private Clinic for Oral and Maxillofacial Surgery Prof. Schlegel Munich Germany
- Maxillofacial Surgery DepartmentUniversity Hospital ErlangenUniversity of Erlangen Erlangen Germany
| | | | - Michael Gahlert
- Clinic for Oral and Cranio‐Maxillofacial SurgeryHightech Research CenterUniversity Hospital BaselUniversity of Basel Basel Switzerland
- Private Dental Clinic PD Dr. Gahlert Munich Germany
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Haro Adánez M, Nishihara H, Att W. A systematic review and meta-analysis on the clinical outcome of zirconia implant–restoration complex. J Prosthodont Res 2018; 62:397-406. [DOI: 10.1016/j.jpor.2018.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 11/26/2022]
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Kohal RJ, Spies BC, Bauer A, Butz F. One-piece zirconia oral implants for single-tooth replacement: Three-year results from a long-term prospective cohort study. J Clin Periodontol 2017; 45:114-124. [DOI: 10.1111/jcpe.12815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry; Center for Dental Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Benedikt C. Spies
- Department of Prosthetic Dentistry; Center for Dental Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Annalena Bauer
- Department of Prosthetic Dentistry; Center for Dental Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Frank Butz
- Department of Prosthetic Dentistry; Center for Dental Medicine; Medical Center - University of Freiburg; Faculty of Medicine; University of Freiburg; Freiburg Germany
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Pol CWP, Raghoebar GM, Kerdijk W, Boven GC, Cune MS, Meijer HJA. A systematic review and meta-analysis of 3-unit fixed dental prostheses: Are the results of 2 abutment implants comparable to the results of 2 abutment teeth? J Oral Rehabil 2017; 45:147-160. [PMID: 28940725 DOI: 10.1111/joor.12575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/28/2022]
Abstract
The purpose of the systematic review and meta-analysis was to compare the performance of 3-unit bridges on teeth with 3-unit bridges on implants, evaluating survival of the bridges, survival of the teeth or implants, condition of the hard and soft tissues surrounding the supports, complications and patient-reported outcome measures (PROM) after a mean observation period of at least 1 year. A literature search was conducted using a combination of the search terms: fixed partial denture and fixed dental prostheses (FDPs). An electronic search for data published until January 2017 was undertaken using the MEDLINE, EMBASE and Cochrane Library databases. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational, which evaluated the results of 3-unit FDPs on either 2 implants or 2 abutment teeth. The search identified 1686 unique references. After applying eligibility criteria, 66 articles were included in the analysis. A total of 1973 3-unit FDPs were supported by teeth, and 765 were implant-supported. No significant differences were found either in the survival of the supporting abutments (P = .52; 99% vs 98.7% survival per year) or in the survival of the prostheses (P = .34; 96.4% vs 97.4% survival per year). Both treatments show an almost equally low complication rate, but there is a low level of reporting of hard and soft tissue conditions and PROM. It is concluded that implant-supported 3-unit FDPs seem to be a reliable treatment with survival rates not significantly different from the results of teeth-supported 3-unit FDPs.
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Affiliation(s)
- C W P Pol
- Dental School, Department of Implant Dentistry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W Kerdijk
- Dental School, Department of Public and Individual Oral Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G C Boven
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M S Cune
- Dental School, Department of Implant Dentistry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H J A Meijer
- Dental School, Department of Implant Dentistry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sivaraman K, Chopra A, Narayan AI, Balakrishnan D. Is zirconia a viable alternative to titanium for oral implant? A critical review. J Prosthodont Res 2017; 62:121-133. [PMID: 28827030 DOI: 10.1016/j.jpor.2017.07.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/22/2017] [Accepted: 07/11/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Titanium based implant systems, though considered as the gold standard for rehabilitation of edentulous spaces, have been criticized for many inherent flaws. The onset of hypersensitivity reactions, biocompatibility issues, and an unaesthetic gray hue have raised demands for more aesthetic and tissue compatible material for implant fabrication. Zirconia is emerging as a promising alternative to conventional Titanium based implant systems for oral rehabilitation with superior biological, aesthetics, mechanical and optical properties. This review aims to critically analyze and review the credibility of Zirconia implants as an alternative to Titanium for prosthetic rehabilitation. STUDY SELECTION The literature search for articles written in the English language in PubMed and Cochrane Library database from 1990 till December 2016. The following search terms were utilized for data search: "zirconia implants" NOT "abutment", "zirconia implants" AND "titanium implants" AND "osseointegration", "zirconia implants" AND compatibility. RESULTS The number of potential relevant articles selected were 47. All the human in vivo clinical, in vitro, animals' studies were included and discussed under the following subheadings: Chemical composition, structure and phases; Physical and mechanical properties; Aesthetic and optical properties; Osseointegration and biocompatibility; Surface modifications; Peri-implant tissue compatibility, inflammation and soft tissue healing, and long-term prognosis. CONCLUSIONS Zirconia implants are a promising alternative to titanium with a superior soft-tissue response, biocompatibility, and aesthetics with comparable osseointegration. However, further long-term longitudinal and comparative clinical trials are required to validate zirconia as a viable alternative to the titanium implant.
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Affiliation(s)
- Karthik Sivaraman
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, 576104, India.
| | - Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, India
| | - Aparna I Narayan
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, 576104, India
| | - Dhanasekar Balakrishnan
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, 576104, India
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Benic GI, Thoma DS, Sanz-Martin I, Munoz F, Hämmerle CH, Cantalapiedra A, Fischer J, Jung RE. Guided bone regeneration at zirconia and titanium dental implants: a pilot histological investigation. Clin Oral Implants Res 2017; 28:1592-1599. [DOI: 10.1111/clr.13030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Fernando Munoz
- Faculty of Veterinary; University of Santiago de Compostela; Santiago Spain
| | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Jens Fischer
- Division of Dental Materials and Engineering; University of Basel; Basel Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Abstract
PURPOSE About 10 years ago, one-piece zirconia implants were introduced to dentistry. The aim of the study was to evaluate the clinical success of two-piece zirconia implants regarding osseointegration using the manufacturers' warranty data. MATERIALS AND METHODS Over a period of 4 years (2010-2014), the data of warranty replacements of 15,255 sold Zeramex implants were evaluated retrospectively and blinded. RESULTS Three hundred forty-seven (2.2%) nonosseointegrated implants were sent back. Zeramex T showed an average success rate of 96.7%, whereas Zeralock implants exhibited an average success rate of 98.5%. Furthermore, Zeramex Plus implants exhibit an average success rate of 99.4% within the investigated period. Assuming, that 2% of the failed implants were unreturned, the above-mentioned values show no changes. Assuming 5% (10%) of unreturned nonosseointegrated implants, the average success rate of Zeramex T decreases from 96.7% to 96.6% (96.4%) and of Zeralock from 98.5% to 98.4% (98.4%), respectively. The success rate of Zeramex Plus implants remains unchanged at 99.4%. CONCLUSION The results of this study imply that two-piece zirconia implants show competitive success rates, improved from >96.7% to >98.5% over three product generations.
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Kim HK, Woo KM, Shon WJ, Ahn JS, Cha S, Park YS. Comparison of peri-implant bone formation around injection-molded and machined surface zirconia implants in rabbit tibiae. Dent Mater J 2017; 34:508-15. [PMID: 26235717 DOI: 10.4012/dmj.2015-024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this study was to compare osseointegration and surface characteristics of zirconia implants made by the powder injection molding (PIM) technique against those made by the conventional milling procedure in rabbit tibiae. Surface characteristics of 2 types of implants were evaluated. Sixteen rabbits received 2 types of external hex implants with similar geometry, either machined zirconia implants or PIM zirconia implants, in the tibiae. Removal torque tests and histomorphometric analyses were performed. The roughness of the PIM zirconia implants was higher than that of machined zirconia implants. The PIM zirconia implants exhibited significantly higher bone-implant contact and removal torque values than the machined zirconia implants (p<0.001). The osseointegration of the PIM zirconia implant is promising, and PIM, using the roughened mold etching technique, can produce substantially rougher surfaces on zirconia implants.
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Affiliation(s)
- Hong-Kyun Kim
- Department of Oral Anatomy, Dental Research Institute and School of Dentistry, Seoul National University
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Cionca N, Hashim D, Mombelli A. Zirconia dental implants: where are we now, and where are we heading? Periodontol 2000 2016; 73:241-258. [DOI: 10.1111/prd.12180] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Pieralli S, Kohal R, Jung R, Vach K, Spies B. Clinical Outcomes of Zirconia Dental Implants: A Systematic Review. J Dent Res 2016; 96:38-46. [DOI: 10.1177/0022034516664043] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Pieralli
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - R.J. Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - R.E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - K. Vach
- Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, Medical Center–University of Freiburg, Freiburg, Germany
| | - B.C. Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center–University of Freiburg, Freiburg, Germany
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Abstract
INTRODUCTION The use of zirconia in medicine and dentistry has rapidly expanded over the past decade, driven by its advantageous physical, biological, esthetic, and corrosion properties. Zirconia orthopedic hip replacements have shown superior wear-resistance over other systems; however, risk of catastrophic fracture remains a concern. In dentistry, zirconia has been widely adopted for endosseous implants, implant abutments, and all-ceramic crowns. Because of an increasing demand for esthetically pleasing dental restorations, zirconia-based ceramic restorations have become one of the dominant restorative choices. Areas covered: This review provides an updated overview of the applications of zirconia in medicine and dentistry with a focus on dental applications. The MEDLINE electronic database (via PubMed) was searched, and relevant original and review articles from 2010 to 2016 were included. Expert commentary: Recent data suggest that zirconia performs favorably in both orthopedic and dental applications, but quality long-term clinical data remain scarce. Concerns about the effects of wear, crystalline degradation, crack propagation, and catastrophic fracture are still debated. The future of zirconia in biomedical applications will depend on the generation of these data to resolve concerns.
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Affiliation(s)
- Yen-Wei Chen
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
| | - Joelle Moussi
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
| | - Jeanie L Drury
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
| | - John C Wataha
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
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Kammermeier A, Rosentritt M, Behr M, Schneider-Feyrer S, Preis V. In vitro performance of one- and two-piece zirconia implant systems for anterior application. J Dent 2016; 53:94-101. [PMID: 27528418 DOI: 10.1016/j.jdent.2016.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the long-term in vitro performance and fracture resistance of one-piece and bonded two-piece zirconia implant systems for anterior application. METHODS Two groups of bonded two-piece zirconia (ZZB), four groups of one-piece zirconia (Z), and two groups of two-piece titanium (TTS, reference) implant systems were restored with identical monolithic zirconia crowns (n=10/group). Eight specimens per group were mounted at an angle of 135° in the chewing simulator and subjected to thermal cycling (TC:18,000 cycles; 5°/55°) and mechanical loading (ML:3.6×10(6) cycles; 100N) simulating an anterior situation. Fracture resistance and maximum bending stress were determined for specimens that survived aging and for two references per group after 24h water storage. SEM pictures were used for failure analysis. Data were statistically analysed (one-way-ANOVA, post-hoc Bonferroni, Kaplan-Meier-Log-Rank, α=0.05). RESULTS A one-piece zirconia and a two-piece titanium implant system survived TCML without failures. Both bonded two-piece zirconia implant systems and a one-piece zirconia implant system totally failed (fractures of abutment or implant). Failure numbers of the other systems varied between 1× (1 group) and 5× (2 groups). Significantly different survival rates were found (Log-Rank-test: p=0.000). Maximum fracture forces/bending stresses varied significantly ( ANOVA p=0.000) between 188.00±44.80N/381.02±80.15N/mm(2) and 508.67±107.00N/751.45±36.73N/mm(2). Mean fracture values after 24h water storage and TCML were not significantly different. CONCLUSION Zirconia implant systems partly showed material defects or connection insufficiencies. Bonded two-piece systems had higher failure rates and lower fracture resistance than one-piece implants. CLINICAL SIGNIFICANCE Individual zirconia implant systems may be applied in anterior regions with limitations.
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Affiliation(s)
- Armin Kammermeier
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Michael Behr
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Sibylle Schneider-Feyrer
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Verena Preis
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany.
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Al-Ahmad A, Karygianni L, Schulze Wartenhorst M, Bächle M, Hellwig E, Follo M, Vach K, Han JS. Bacterial adhesion and biofilm formation on yttria-stabilized, tetragonal zirconia and titanium oral implant materials with low surface roughness - an in situ study. J Med Microbiol 2016; 65:596-604. [DOI: 10.1099/jmm.0.000267] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, University Hospital Freiburg, School of Dentistry, Freiburg, Germany
| | - Lamprini Karygianni
- Department of Operative Dentistry and Periodontology, University Hospital Freiburg, School of Dentistry, Freiburg, Germany
| | - Max Schulze Wartenhorst
- Department of Operative Dentistry and Periodontology, University Hospital Freiburg, School of Dentistry, Freiburg, Germany
| | - Maria Bächle
- Department of Prosthodontics, University Hospital Freiburg, School of Dentistry, Freiburg, Germany
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, University Hospital Freiburg, School of Dentistry, Freiburg, Germany
| | - Marie Follo
- Department of Hematology and Oncology, Core Facility, Albert Ludwigs University, Freiburg, Germany
| | - Kirstin Vach
- Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jung-Suk Han
- Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, South Korea
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Hashim D, Cionca N, Courvoisier DS, Mombelli A. A systematic review of the clinical survival of zirconia implants. Clin Oral Investig 2016; 20:1403-17. [PMID: 27217032 PMCID: PMC4992030 DOI: 10.1007/s00784-016-1853-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/06/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this review was to evaluate the clinical success and survival rates of zirconia ceramic implants after at least 1 year of function and to assess if there is sufficient evidence to justify using them as alternatives to titanium implants. MATERIALS AND METHODS An electronic search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Clinical Trials (CENTRAL) databases was performed in April 2015 by two independent examiners to retrieve clinical studies focusing on the survival rate of zirconia implants after at least 1 year of function. Implant survival was estimated using the overall proportion reported in the studies with a Clopper-Pearson 95 % confidence interval (random effect model with a Der-Simonian Laird estimate). RESULTS Fourteen articles were selected out of the 1519 titles initially screened. The overall survival rate of zirconia one- and two-piece implants was calculated at 92 % (95 % CI 87-95) after 1 year of function. The survival of implants at 1 year for the selected studies revealed considerable heterogeneity. CONCLUSIONS In spite of the unavailability of sufficient long-term evidence to justify using zirconia oral implants, zirconia ceramics could potentially be the alternative to titanium for a non-metallic implant solution. However, further clinical studies are required to establish long-term results, and to determine the risk of technical and biological complications. Additional randomized controlled clinical trials examining two-piece zirconia implant systems are also required to assess their survival and success rates in comparison with titanium as well as one-piece zirconia implants. CLINICAL RELEVANCE Zirconia implants provide a potential alternative to titanium ones. However, clinicians must be aware of the lack of knowledge regarding long-term outcomes and specific reasons for failure.
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Affiliation(s)
- Dena Hashim
- School of Dental Medicine, Division of Periodontology, University of Geneva, Rue Barthelemy-Menn 19, CH-1205, Geneva, Switzerland.
| | - Norbert Cionca
- School of Dental Medicine, Division of Periodontology, University of Geneva, Rue Barthelemy-Menn 19, CH-1205, Geneva, Switzerland
| | - Delphine S Courvoisier
- University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Genève, Switzerland
| | - Andrea Mombelli
- School of Dental Medicine, Division of Periodontology, University of Geneva, Rue Barthelemy-Menn 19, CH-1205, Geneva, Switzerland
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Preis V, Kammermeier A, Handel G, Rosentritt M. In vitro performance of two-piece zirconia implant systems for anterior application. Dent Mater 2016; 32:765-74. [PMID: 27068740 DOI: 10.1016/j.dental.2016.03.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/03/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the influence of the implant-abutment connection on the long-term in vitro performance and fracture resistance of two-piece zirconia implant systems for anterior application. METHODS Six groups of two-piece zirconia implant systems (n=10/group) with screw-retained (5×) or bonded (1×) connections were restored with full-contour zirconia crowns. A two-piece screw-retained titanium system served as reference. For simulating anterior loading the specimens (n=8/group) were mounted at an angle of 135° in the chewing simulator, and subjected to thermal cycling (TC: 2×9000×5°/55°C) and mechanical loading (ML: 3.6×10(6)×100N). Failed restorations were examined (scanning electron microscopy). Fracture resistance and maximum bending stress of surviving restorations were determined. 2 specimens per group were loaded to fracture after 24h water storage without TCML. Data were statistically analyzed (ANOVA; Bonferroni; Kaplan-Meier-Log-Rank; α=0.05). RESULTS The bonded zirconia system and the titanium reference survived TCML without any failures. Screw-retained zirconia systems showed fractures of abutments and/or implants, partly combined with screw fracture/loosening. Failure frequency (F) varied between the groups (F=8×: 3 groups, F=3×: 1 group, F=1×: 1 group). The Log-Rank-test showed significant (p=0.000) differences. Fracture forces and maximum bending stresses (mean±standard deviation) differed significantly ( ANOVA p=0.000) between 233.4±31.4N/317.1±42.6N/mm(2) and 404.3±15.1N/549.2±20.5N/mm(2). Fracture forces after TCML were similar to 24h fracture forces. SIGNIFICANCE Screw-retained two-piece zirconia implant systems showed higher failure rates and lower fracture resistance than a screw-retained titanium system, and may be appropriate for clinical anterior requirements with limitations. Failures involved the abutment/implant region around the screw, indicating that the connecting design is crucial for clinical success.
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Affiliation(s)
- Verena Preis
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany.
| | - Armin Kammermeier
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany
| | - Gerhard Handel
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany
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Evaluation of alumina toughened zirconia implants with a sintered, moderately rough surface: An experiment in the rat. Dent Mater 2016; 32:65-72. [DOI: 10.1016/j.dental.2015.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/13/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022]
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31
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Schienle S, Al-Ahmad A, Kohal RJ, Bernsmann F, Adolfsson E, Montanaro L, Palmero P, Fürderer T, Chevalier J, Hellwig E, Karygianni L. Microbial adhesion on novel yttria-stabilized tetragonal zirconia (Y-TZP) implant surfaces with nitrogen-doped hydrogenated amorphous carbon (a-C:H:N) coatings. Clin Oral Investig 2015; 20:1719-32. [DOI: 10.1007/s00784-015-1655-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/09/2015] [Indexed: 12/14/2022]
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Implant Supported Fixed Dental Prostheses Using a New Monotype Zirconia Implant-A Case Report. Dent J (Basel) 2015; 3:79-92. [PMID: 29567928 PMCID: PMC5851168 DOI: 10.3390/dj3030079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/04/2015] [Accepted: 09/10/2015] [Indexed: 11/24/2022] Open
Abstract
Currently, titanium or specific titanium alloys are the most often used materials for the fabrication of dental implants. Many studies have confirmed the osseointegrative capacity and clinical long-term performance of moderately rough titanium implants. However, disadvantages have also been reported with regard to peri-implant infections and the titanium metal properties. Tooth colored ceramic implants have attracted the interest of clinicians since the end of the 1960s. Initially, alumina was used for the fabrication of ceramic implants; however, due to the poor biomechanical properties, alumina implants are not commercially available any more. Since end of the 1990s, zirconia has been established in dentistry due to its superior biomechanical properties compared to other oxide ceramics such as alumina. Currently, zirconia is the material of choice for the fabrication of ceramic implants. Zirconia implants show superior biocompatibility compared to titanium and other metals. Additionally, it has been reported that zirconia implants with a micro-rough surface topography show at least a comparable osseointegrative capacity and similar clinical survival rates to moderately rough titanium implants. The present case reports a fixed implant-supported reconstruction of a large edentulous space with compromised local bone conditions using new monotype zirconia dental implants with a micro-rough surface topography.
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Kohal RJ, Schwindling FS, Bächle M, Spies BC. Peri-implant bone response to retrieved human zirconia oral implants after a 4-year loading period: A histologic and histomorphometric evaluation of 22 cases. J Biomed Mater Res B Appl Biomater 2015; 104:1622-1631. [DOI: 10.1002/jbm.b.33512] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry; Center for Dental Medicine, Medical Center-University of Freiburg; Freiburg Germany
| | | | - Maria Bächle
- Department of Prosthetic Dentistry; Center for Dental Medicine, Medical Center-University of Freiburg; Freiburg Germany
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry; Center for Dental Medicine, Medical Center-University of Freiburg; Freiburg Germany
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Spies B, Balmer M, Patzelt S, Vach K, Kohal R. Clinical and Patient-reported Outcomes of a Zirconia Oral Implant. J Dent Res 2015; 94:1385-91. [DOI: 10.1177/0022034515598962] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to determine the clinical, radiographic, and patient-reported outcomes of a 1-piece alumina-toughened zirconia implant restored with single crowns (SCs) or 3-unit fixed dental prostheses (FDPs) after 3 y of observation. Forty patients received 53 implants, placed in a 1-stage operation with immediate temporization. Finally, 50 implants were restored with 24 SCs and 13 FDPs. To evaluate peri-implant bone loss, standardized radiographs were taken at implant insertion, at final restoration delivery, and after 1 and 3 y. Additionally, several soft tissue parameters and patient-reported outcome measures were evaluated. Linear mixed models with random intercept for each patient and patients as clusters were used to compare subgroups. Three patients did not receive a SC due to early implant loss, and 1 patient died. As a result, 36 patients with 49 implants were followed-up for 3 y, giving a cumulative survival rate of 94.2%. The average marginal bone loss amounted to 0.79 mm (SCs, 0.47 mm; FDPs, 1.07 mm; P < 0.001). After the delivery of the final prosthetic restoration, further bone loss was not statistically significant (0.09 mm; P = 0.700). Probing depth, clinical attachment level, and modified bleeding index increased significantly at the implant sites, whereas gingival recession decreased significantly. Compared with the pretreatment questionnaires, the patient-reported outcome measures showed a permanently improved perception of function, aesthetics, sense, speech and self-esteem. The survival rate of the investigated ceramic implant system seems to be comparable to reported survival rates of titanium implants when immediately restored. The recorded parameters suggest its potential for clinical utilization.
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Affiliation(s)
- B.C. Spies
- Medical Center–University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Freiburg, Germany
| | - M. Balmer
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - S.B.M. Patzelt
- Medical Center–University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Freiburg, Germany
| | - K. Vach
- Medical Center–University of Freiburg, Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, Freiburg, Germany
| | - R.J. Kohal
- Medical Center–University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Freiburg, Germany
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Jung RE, Grohmann P, Sailer I, Steinhart YN, Fehér A, Hämmerle C, Strub JR, Kohal R. Evaluation of a one-piece ceramic implant used for single-tooth replacement and three-unit fixed partial dentures: a prospective cohort clinical trial. Clin Oral Implants Res 2015. [DOI: 10.1111/clr.12670] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Philipp Grohmann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Irena Sailer
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
- Division of Fixed Prosthodontics and Biomaterials; Clinic of Dental Medicine; University of Geneva; Geneva Switzerland
| | - Yann-Niclas Steinhart
- Department of Prosthetic Dentistry; Center for Dental Medicine; University Medical Center Freiburg; Freiburg Germany
| | | | - Christoph Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Jörg Rudolf Strub
- Department of Prosthetic Dentistry; Center for Dental Medicine; University Medical Center Freiburg; Freiburg Germany
| | - Ralf Kohal
- Department of Prosthetic Dentistry; Center for Dental Medicine; University Medical Center Freiburg; Freiburg Germany
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Crestal bone loss and periimplant inflammatory parameters around zirconia implants: A systematic review. J Prosthet Dent 2015; 114:351-7. [PMID: 26047803 DOI: 10.1016/j.prosdent.2015.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 01/28/2023]
Abstract
STATEMENT OF PROBLEM Zirconia implants have been used for oral rehabilitation; however, evidence of their ability to maintain crestal bone and periimplant soft tissue health is not clear. PURPOSE The purpose of this systematic review was to evaluate crestal bone loss (CBL) around zirconia dental implants and clinical periimplant inflammatory parameters. MATERIAL AND METHODS The focus question addressed was, "Do zirconia implants maintain crestal bone levels and periimplant soft tissue health?" Databases were searched for articles from 1977 through September 2014 with different combinations of the following MeSH terms: "dental implants," "zirconium," "alveolar bone loss," "periodontal attachment loss," "periodontal pocket," "periodontal index." Letters to the editor, case reports, commentaries, review articles, and articles published in languages other than English were excluded. RESULTS Thirteen clinical studies were included. In 8 of the studies, the CBL around zirconia implants was comparable between baseline and follow-up. In the other 5 studies, the CBL around zirconia implants was significantly higher at follow-up. Among the studies that used titanium implants as controls, 2 studies showed significantly higher CBL around zirconia implants, and in 1 study, the CBL around zirconia and titanium implants was comparable. The reported implant survival rates for zirconia implants ranged between 67.6% and 100%. Eleven studies selectively reported the periimplant inflammatory parameters. CONCLUSIONS Because of the variations in study design and methodology, it was difficult to reach a consensus regarding the efficacy of zirconia implants in maintaining crestal bone levels and periimplant soft tissue health.
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Thoma DS, Benic GI, Muñoz F, Kohal R, Sanz Martin I, Cantalapiedra AG, Hämmerle CHF, Jung RE. Marginal bone-level alterations of loaded zirconia and titanium dental implants: an experimental study in the dog mandible. Clin Oral Implants Res 2015; 27:412-20. [DOI: 10.1111/clr.12595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel S. Thoma
- Clinic for Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Goran I. Benic
- Clinic for Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Fernando Muñoz
- Department of Veterinary Clinical Sciences; University of Santiago de Compostela; Lugo Spain
| | - Ralf Kohal
- Department of Prosthodontics; Albert-Ludwigs-University; Freiburg Germany
| | | | | | - Christoph H. F. Hämmerle
- Clinic for Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Ronald E. Jung
- Clinic for Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
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An alumina toughened zirconia composite for dental implant application: in vivo animal results. BIOMED RESEARCH INTERNATIONAL 2015; 2015:157360. [PMID: 25945324 PMCID: PMC4402487 DOI: 10.1155/2015/157360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/29/2014] [Accepted: 10/15/2014] [Indexed: 02/04/2023]
Abstract
Ceramic materials are widely used for biomedical applications because of their remarkable biological and mechanical properties. Composites made of alumina and zirconia are particularly interesting owing to their higher toughness with respect to the monolithic materials. On this basis, the present study is focused on the in vivo behavior of alumina toughened zirconia (ATZ) dental implants treated with a hydrothermal process. A minipig model was implemented to assess the bone healing through histology and mRNA expression at different time points (8, 14, 28, and 56 days). The novel ATZ implant was compared to a titanium clinical standard. The implants were analyzed in terms of microstructure and surface roughness before in vivo tests. The most interesting result deals with a statistically significant higher digital histology index for ATZ implants with respect to titanium standard at 56 days, which is an unprecedented finding, to the authors' knowledge. Even if further investigations are needed before proposing the clinical use in humans, the tested material proved to be a promising candidate among the possible ceramic dental implants.
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Gahlert M, Kniha H, Weingart D, Schild S, Gellrich NC, Bormann KH. A prospective clinical study to evaluate the performance of zirconium dioxide dental implants in single-tooth gaps. Clin Oral Implants Res 2015; 27:e176-e184. [DOI: 10.1111/clr.12598] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Sabine Schild
- Klinikum Stuttgart; Katharinenhospital; Stuttgart Germany
| | | | - Kai-Hendrik Bormann
- Hannover Medical School; Hannover Germany
- Dental Clinic Bormann; Oralchirurgie am Hafen; Hamburg Germany
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40
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Roehling S, Woelfler H, Hicklin S, Kniha H, Gahlert M. A Retrospective Clinical Study with Regard to Survival and Success Rates of Zirconia Implants up to and after 7 Years of Loading. Clin Implant Dent Relat Res 2015; 18:545-58. [PMID: 25801578 DOI: 10.1111/cid.12323] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The study aims to retrospectively investigate the clinical performance of first-generation zirconia implants with a sandblasted surface up to and after 7 years of loading. MATERIALS AND METHODS Clinical records of patients treated with zirconia implants between 2004 and 2009 were screened. Consequently, adequate patients were invited to a clinical and radiographic investigation to classify each implant according to strict success criteria. RESULTS Seventy-one patients receiving 161 implants were available for the evaluation. Overall, 36 implants (22.4%) were lost due to early (n = 14) and late failures (n = 4) or fractures (n = 18). All surviving 125 implants fulfilled the success criteria. None of the investigated implants had a history of peri-implant infections. Mean values with regard to gingival index, plaque index, modified sulcus bleeding index, and probing depth were 0.03, 0.23, 0.59, and 2.80 mm, respectively. The radiographically evaluated mean crestal bone loss was 0.97 ± 0.07 mm. Diameter-reduced implants (3.25 mm) showed lower survival (58.5%) compared with implants with a diameter of 4.0 mm (88.9%) and 5.0 mm (78.6%). The overall longitudinal survival rate was 77.3%. CONCLUSIONS First-generation zirconia implants showed low overall survival and success rates. The evaluated clinical and radiographic parameters were consistent with healthy peri-implant tissues. Additionally, nonfractured failures were not associated with peri-implant infections.
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Affiliation(s)
- Stefan Roehling
- Department of Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Periodontics, Health and Science Center at San Antonio, University of Texas, San Antonio, TX, USA
| | | | - Stefan Hicklin
- Department for Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Heinz Kniha
- Private Dental Clinic Dres. Kniha and Gahlert, Munich, Germany
| | - Michael Gahlert
- Department of Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland.,Private Dental Clinic Dres. Kniha and Gahlert, Munich, Germany
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Osman RB, Swain MV. A Critical Review of Dental Implant Materials with an Emphasis on Titanium versus Zirconia. MATERIALS 2015; 8:932-958. [PMID: 28787980 PMCID: PMC5455450 DOI: 10.3390/ma8030932] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/20/2015] [Accepted: 02/12/2015] [Indexed: 01/21/2023]
Abstract
The goal of the current publication is to provide a comprehensive literature review on the topic of dental implant materials. The following paper focuses on conventional titanium implants and more recently introduced and increasingly popular zirconia implants. Major subtopics include the material science and the clinical considerations involving both implant materials and the influence of their physical properties on the treatment outcome. Titanium remains the gold standard for the fabrication of oral implants, even though sensitivity does occur, though its clinical relevance is not yet clear. Zirconia implants may prove to be promising in the future; however, further in vitro and well-designed in vivo clinical studies are needed before such a recommendation can be made. Special considerations and technical experience are needed when dealing with zirconia implants to minimize the incidence of mechanical failure.
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Affiliation(s)
- Reham B Osman
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centrum of Dentistry Amsterdam (ACTA), 1081 LA Amsterdam, The Netherlands.
- Department of Removable Prosthodontics, Cairo University, Giza 11553, Egypt.
| | - Michael V Swain
- Biomaterials Laboratory, Sydney Dental Hospital, the University of Sydney, Surry Hills, NSW 2010, Australia.
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Spies BC, Sauter C, Wolkewitz M, Kohal RJ. Alumina reinforced zirconia implants: Effects of cyclic loading and abutment modification on fracture resistance. Dent Mater 2015; 31:262-72. [DOI: 10.1016/j.dental.2014.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/12/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
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Spies BC, Sperlich M, Fleiner J, Stampf S, Kohal RJ. Alumina reinforced zirconia implants: 1-year results from a prospective cohort investigation. Clin Oral Implants Res 2015; 27:481-90. [DOI: 10.1111/clr.12560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Benedikt Christopher Spies
- Center for Dental Medicine; Department of Prosthetic Dentistry; Albert-Ludwigs-University; Freiburg Germany
| | | | | | - Susanne Stampf
- Institute for Medical Biometry and Statistics; Department for Medical Biometry and Medical Informatics; Albert-Ludwigs-University; Freiburg Germany
| | - Ralf-Joachim Kohal
- Center for Dental Medicine; Department of Prosthetic Dentistry; Albert-Ludwigs-University; Freiburg Germany
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Noro A, Kameyama A, Haruyama A, Takahashi T. Influence of Hydrophilic Pre-treatment on Resin Bonding to Zirconia Ceramics. THE BULLETIN OF TOKYO DENTAL COLLEGE 2015; 56:33-9. [DOI: 10.2209/tdcpublication.56.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Akio Noro
- Division of General Dentistry, Tokyo Dental College Chiba Hospital
| | - Atsushi Kameyama
- Division of General Dentistry, Department of Clinical Oral Health Science, Tokyo Dental College
- Division of General Dentistry, Tokyo Dental College Chiba Hospital
| | - Akiko Haruyama
- Division of General Dentistry, Department of Clinical Oral Health Science, Tokyo Dental College
- Division of General Dentistry, Tokyo Dental College Chiba Hospital
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Rosentritt M, Hagemann A, Hahnel S, Behr M, Preis V. In vitro performance of zirconia and titanium implant/abutment systems for anterior application. J Dent 2014; 42:1019-26. [PMID: 24699071 DOI: 10.1016/j.jdent.2014.03.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/05/2014] [Accepted: 03/23/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the type of failure and fracture resistance behaviour of different zirconia and titanium implant/abutment systems for anterior application. METHODS Eight groups of implant-abutment combinations (n=8/system) were restored with identical full-contour zirconia crowns. The systems represented one-piece and multi-piece zirconia (Z) or titanium (T) implants/abutments with different types of connection (screwed=S, bonded=B). The following combinations (implant-abutment-connection) were investigated: ZZS, ZZB, ZZZB (three-piece), ZTS, TTS, TTS reference, and Z (one-piece, 2×). To simulate clinical anterior loading situations the specimens were mounted into the chewing simulator at an angle of 135° and subjected to thermal cycling (2×3000×5°/55°C) and mechanical loading (1.2×10(6)×50N; 1.6Hz). Fracture resistance and maximum bending stress were determined for all specimens that survived ageing. Data were statistically analyzed with the Kolmogorov-Smirnov-test and one-way ANOVA (α=0.05). Survival performance was calculated with the Kaplan-Meier Log-Rank test. RESULTS Independent of the material combinations screwed systems showed partly failures of the screws during simulation (ZZS: 3×, ZTS: 8×, TTS: 3×). Screw failures were combined with implant/abutment fractures of zirconia systems. Zirconia one-piece implants and the reference system did not show any failures, and only one specimen of the systems with a bonded connection (ZZZB) fractured. Mean (±standard deviation) fracture forces and maximum bending stresses differed significantly (p=0.000) between 187.4±42.0N/250.0±56.0N/mm(2) (ZZZB) and 524.3±43.1N/753.0±61.0N/mm(2) (Z). CONCLUSIONS Both material (zirconia or titanium) and the type of connection influenced failure resistance during fatigue testing, fracture force, and maximum bending stress. CLINICAL SIGNIFICANCE Different material combinations for implants and abutments as well as different types of connection achieved acceptable or even good failure and fracture resistance that may be satisfactory for anterior clinical application.
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Affiliation(s)
- Martin Rosentritt
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Anna Hagemann
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Sebastian Hahnel
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Michael Behr
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Verena Preis
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany.
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Nakamura T, Sugano T, Usami H, Wakabayashi K, Ohnishi H, Sekino T, Yatani H. Shear bond strength of veneering porcelain to porous zirconia. Dent Mater J 2014; 33:220-5. [PMID: 24615000 DOI: 10.4012/dmj.2013-191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this study, two types of porous zirconia and dense zirconia were used. The flexural strength of non-layered zirconia specimens and those of the layered zirconia specimens with veneering porcelain were examined. Furthermore, the shear bond strength of veneering porcelain to zirconia was examined. The flexural strength of the non-layered specimens was 1,220 MPa for dense zirconia and 220 to 306 MPa for porous zirconia. The flexural strength of the layered specimens was 360 MPa for dense zirconia and 132 to 156 MPa for porous zirconia, when a load was applied to the porcelain side. The shear bond strength of porcelain veneered to dense zirconia was 27.4 MPa and that of porcelain veneered to porous zirconia was 33.6 to 35.1 MPa. This suggests that the veneering porcelain bonded strongly to porous zirconia although porous zirconia has a lower flexural strength than dense zirconia.
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Affiliation(s)
- Takashi Nakamura
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
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Spies BC, Stampf S, Kohal RJ. Evaluation of Zirconia-Based All-Ceramic Single Crowns and Fixed Dental Prosthesis on Zirconia Implants: 5-Year Results of a Prospective Cohort Study. Clin Implant Dent Relat Res 2014; 17:1014-28. [DOI: 10.1111/cid.12203] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Susanne Stampf
- Center for Medical Biometry and Medical Informatics; Medical Center - University of Freiburg; Freiburg Germany
| | - Ralf-Joachim Kohal
- Clinic of Prosthodontics, School of Dentistry; Albert-Ludwigs-University; Freiburg Germany
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Payer M, Heschl A, Koller M, Arnetzl G, Lorenzoni M, Jakse N. All-ceramic restoration of zirconia two-piece implants - a randomized controlled clinical trial. Clin Oral Implants Res 2014; 26:371-376. [DOI: 10.1111/clr.12342] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Payer
- Department of Oral Surgery and Radiology; School of Dentistry; Medical University of Graz; Graz Austria
| | - Alexander Heschl
- Department of Prosthodontics; School of Dentistry; Medical University of Graz; Graz Austria
| | - Martin Koller
- Department of Prosthodontics; School of Dentistry; Medical University of Graz; Graz Austria
| | - Gerwin Arnetzl
- Department of Prosthodontics; School of Dentistry; Medical University of Graz; Graz Austria
| | - Martin Lorenzoni
- Department of Prosthodontics; School of Dentistry; Medical University of Graz; Graz Austria
| | - Norbert Jakse
- Department of Oral Surgery and Radiology; School of Dentistry; Medical University of Graz; Graz Austria
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