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Cao L, Lin H, Wang S, Zhan X, Xiang D, Peng L, Han J. Surface modification of dental zirconia implants with a low infiltration temperature glass. Dent Mater J 2024; 43:597-608. [PMID: 38960668 DOI: 10.4012/dmj.2024-034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
The glass infiltration technique was employed for surface modification of zirconia implants in this study. The prepared glass-infiltrated zirconia with low infiltrating temperature showed excellent mechanical properties and enough infiltrating layer. The zirconia substrate was pre-sintered at 1,200°C and the glass infiltration depth reached 400 μm after infiltrating at 1,200°C for 10 h. The infiltrating glass has good wetting ability, thermal expansion match and good chemical compatibility with the zirconia substrate. Indentation fracture toughness and flexural strength of the dense sintered glass-infiltrated zirconia composite are respectively 5.37±0.45 MPa•m1/2 and 841.03±89.31 MPa. Its elasticity modulus is 163.99±7.6 GPa and has about 500 μm infiltrating layer. The glass-infiltrated zirconia can be acid etched to a medium roughness (1.29±0.09 μm) with a flexural strength of 823.65±87.46 MPa, which promotes cell proliferation and has potential for dental implants.
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Affiliation(s)
- Lulu Cao
- Department of Dental Materials, Peking University School and Hospital of Stomatology & Dental Medical Devices Testing Center & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NMPA Key Laboratory for Dental Materials
| | - Hong Lin
- Department of Dental Materials, Peking University School and Hospital of Stomatology & Dental Medical Devices Testing Center & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NMPA Key Laboratory for Dental Materials
| | - Shuo Wang
- State Key Laboratory of Multiphase Complex Systems, Institute of Process Engineering, Chinese Academy of Sciences
| | - Xinxin Zhan
- Department of Dental Materials, Peking University School and Hospital of Stomatology & Dental Medical Devices Testing Center & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NMPA Key Laboratory for Dental Materials
| | - Dong Xiang
- Department of Dental Materials, Peking University School and Hospital of Stomatology & Dental Medical Devices Testing Center & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NMPA Key Laboratory for Dental Materials
| | - Lian Peng
- State Key Laboratory of Multiphase Complex Systems, Institute of Process Engineering, Chinese Academy of Sciences
| | - Jianmin Han
- Department of Dental Materials, Peking University School and Hospital of Stomatology & Dental Medical Devices Testing Center & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NMPA Key Laboratory for Dental Materials
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Cruz MB, Silva N, Marques JF, Mata A, Silva FS, Caramês J. Biomimetic Implant Surfaces and Their Role in Biological Integration-A Concise Review. Biomimetics (Basel) 2022; 7:74. [PMID: 35735590 PMCID: PMC9220941 DOI: 10.3390/biomimetics7020074] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The increased use of dental implants in oral rehabilitation has been followed by the development of new biomaterials as well as improvements in the performance of biomaterials already in use. This triggers the need for appropriate analytical approaches to assess the biological and, ultimately, clinical benefits of these approaches. AIMS To address the role of physical, chemical, mechanical, and biological characteristics in order to determine the critical parameters to improve biological responses and the long-term effectiveness of dental implant surfaces. DATA SOURCES AND METHODS Web of Science, MEDLINE and Lilacs databases were searched for the last 30 years in English, Spanish and Portuguese idioms. RESULTS Chemical composition, wettability, roughness, and topography of dental implant surfaces have all been linked to biological regulation in cell interactions, osseointegration, bone tissue and peri-implant mucosa preservation. CONCLUSION Techniques involving subtractive and additive methods, especially those involving laser treatment or embedding of bioactive nanoparticles, have demonstrated promising results. However, the literature is heterogeneous regarding study design and methodology, which limits comparisons between studies and the definition of the critical determinants of optimal cell response.
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Affiliation(s)
- Mariana Brito Cruz
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; (J.F.M.); (A.M.)
| | - Neusa Silva
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), LIBPhys-FTC UID/FIS/04559/2013, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal;
| | - Joana Faria Marques
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; (J.F.M.); (A.M.)
| | - António Mata
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; (J.F.M.); (A.M.)
- Cochrane Portugal, Instituto de Saúde Baseada na Evidência (ISBE), Faculdade de Medicina Dentária, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Felipe Samuel Silva
- Center for Microelectromechanical Systems (CMEMS), Department of Mechanical Engineering, University of Minho, 4800-058 Guimarães, Portugal;
| | - João Caramês
- Bone Physiology Research Group, Faculdade de Medicina Dentária, Universidade de Lisboa, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal;
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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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Thomé G, Uhlendorf J, Vianna CP, Caldas W, Bernardes SR, Trojan LC. Clinical and radiographic success of injection-molded 2-piece zirconia implants submitted to immediate loading: A 12-month report of two cases. Clin Case Rep 2021; 9:e05118. [PMID: 34917363 PMCID: PMC8643492 DOI: 10.1002/ccr3.5118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 11/07/2022] Open
Abstract
This case report describes the treatment of two patients who presented with single edentulous sites in the region of upper premolars and were rehabilitated through the placement of injection-molded 2-piece zirconia implants and immediate single crowns. Three months after surgery, definitive prostheses were confectioned through digital workflow. Both patients were followed for 12 months during which clinical and radiographic implant success were observed, concerning implant stability, absence of peri-implantitis signs, complete implant osseointegration, good marginal bone-level maintenance, and excellent soft tissue esthetics. No biological or mechanical complications were observed within this period.
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Affiliation(s)
- Geninho Thomé
- Department of ImplantologyLatin American Institute for Research and Dental Education (ILAPEO); Scientific President of NeodentCuritibaBrazil
| | | | | | | | - Sergio Rocha Bernardes
- Department of ImplantologyLatin American Institute for Research and Dental Education (ILAPEO); Head of Global Research & Education of NeodentCuritibaBrazil
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Han J, Zhang F, Van Meerbeek B, Vleugels J, Braem A, Castagne S. Laser surface texturing of zirconia-based ceramics for dental applications: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:112034. [PMID: 33812647 DOI: 10.1016/j.msec.2021.112034] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Laser surface texturing is widely explored for modifying the surface topography of various materials and thereby tuning their optical, tribological, biological, and other surface properties. In dentistry, improved osseointegration has been observed with laser textured titanium dental implants in clinical trials. Due to several limitations of titanium materials, dental implants made of zirconia-based ceramics are now considered as one of the best alternatives. Laser surface texturing of zirconia dental implants is therefore attracting increasing attention. However, due to the brittle nature of zirconia, as well as the metastable tetragonal ZrO2 phase, laser texturing in the case of zirconia is more challenging than in the case of titanium. Understanding these challenges requires different fields of expertise, including laser engineering, materials science, and dentistry. Even though much progress was made within each field of expertise, a comprehensive analysis of all the related factors is still missing. This review paper provides thus an overview of the common challenges and current status on the use of lasers for surface texturing of zirconia-based ceramics for dental applications, including texturing of zirconia implants for improving osseointegration, texturing of zirconia abutments for reducing peri-implant inflammation, and texturing of zirconia restorations for improving restoration retention by bonding.
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Affiliation(s)
- Jide Han
- KU Leuven, Department of Mechanical Engineering and Flanders Make@KU Leuven-MaPS, Celestijnenlaan 300, 3001 Leuven, Belgium
| | - Fei Zhang
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001 Leuven, Belgium; KU Leuven, Department of Oral Health Sciences, BIOMAT, Kapucijnenvoer 7 Block A, 3000 Leuven, Belgium
| | - Bart Van Meerbeek
- KU Leuven, Department of Oral Health Sciences, BIOMAT, Kapucijnenvoer 7 Block A, 3000 Leuven, Belgium
| | - Jozef Vleugels
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - Annabel Braem
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - Sylvie Castagne
- KU Leuven, Department of Mechanical Engineering and Flanders Make@KU Leuven-MaPS, Celestijnenlaan 300, 3001 Leuven, Belgium.
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Thomé G, Sandgren R, Bernardes S, Trojan L, Warfving N, Bellón B, Pippenger BE. Osseointegration of a novel injection molded 2-piece ceramic dental implant: a study in minipigs. Clin Oral Investig 2020; 25:603-615. [PMID: 32914271 DOI: 10.1007/s00784-020-03513-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study compared the osseointegrative potential of a novel injection molded zirconia dental implant (Neodent Zi ceramic implant, test) and a commercially available titanium implant (Neodent Alvim implant, control) in terms of histomorphometrically derived bone-to-implant contact (BIC), first bone-to-implant contact (fBIC), and the ratio of bone area to total area (BATA) around the implant. MATERIALS AND METHODS A total of 36 implants, 18 per individual test device, were implanted in a split-mouth arrangement in either side of the edentulous and fully healed mandible of 6 minipigs. Histomorphometric analysis of BIC, fBIC, and BATA were performed 8 weeks post implantation and subjected to statistical non-inferiority testing. Surface characteristics of both implant types were compared in terms of contact angle, surface topography, and elemental composition. RESULTS BIC, fBIC, and coronal BATA values of test and control implants were statistically comparable and non-inferior. BIC values of 77.8 ± 6.9% vs. 80.7 ± 6.9% (p = 0.095) were measured for the test and control groups. fBIC lingual values were - 238 ± 328 μm compared with - 414 ± 511 μm (p = 0.121) while buccal values were - 429 ± 648 μm and - 588 ± 550 μm (p = 0.230) for the test and control devices, respectively. BATA in the apical segment was significantly higher in the test group compared with the control group (67.2 ± 11.8% vs. 59.1 ± 11.4%) (p = 0.0103). Surface topographies of both implant types were comparable. Surface chemical analysis indicated the presence of carbonaceous adsorbates which correlated with a comparable and predominantly hydrophobic character of the implants. CONCLUSION The results demonstrate that the investigated zirconia implants, when compared with a commercially available titanium implant, show equivalent and non-inferior bone integration, bone formation, and alveolar bone level maintenance. This qualifies the investigated zirconia implant as a potential candidate for clinical development. CLINICAL RELEVANCE This study investigated the osseointegration of a novel zirconia 2-piece dental implant prototype intended for clinical development. With the aim of translating this prototype into clinical development preclinical models, procedures and materials within this study have been selected as close to clinical practice and human physiological conditions as possible.
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Affiliation(s)
| | - Rebecca Sandgren
- Biomedical Center, Faculty of Medicine, Lund University, Lund, Sweden
| | | | | | | | - Benjamin Bellón
- Department of Preclinical and Translational Research, Institut Straumann AG, Peter Merian-Weg 12, 4052, Basel, Switzerland.,Department of Periodontology, Faculty of Dentistry, University of Zurich, Zurich, Switzerland
| | - Benjamin E Pippenger
- Department of Preclinical and Translational Research, Institut Straumann AG, Peter Merian-Weg 12, 4052, Basel, Switzerland. .,Department of Periodontology, Faculty of Dentistry, University of Zurich, Zurich, Switzerland.
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Crystal structure of zirconia affects osteoblast behavior. Dent Mater 2020; 36:905-913. [DOI: 10.1016/j.dental.2020.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/27/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
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Fernandes BF, da Cruz MB, Marques JF, Madeira S, Carvalho Ó, Silva FS, da Mata ADSP, Caramês JMM. Laser Nd:YAG patterning enhance human osteoblast behavior on zirconia implants. Lasers Med Sci 2020; 35:2039-2048. [PMID: 32556830 DOI: 10.1007/s10103-020-03066-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Zirconia has been regarded as a promising material for dental implants, and Nd:YAG laser treatment has been proposed as a potential strategy to improve its bioactivity. The main aim of the present study was to evaluate the in vitro behavior of human fetal osteoblasts in contact with laser-textured zirconia implant surfaces assessing the effect of different texture patterns, spacing between laser passes and number of laser passes. Zirconia discs were produced and treated with Nd:YAG laser according to test group variables: texture (microgrooves and micropillar array), distance between surface features (25 μm, 30 μm and 35 μm), and laser passes [1, 2, 4, and 8]. Untextured sandblasted and acid-etched zirconia discs (SBAE) were used as controls. Human osteoblasts (hFOB 1.19) were cultured for 14 days on test and control samples. Morphology and cellular adhesion were observed using scanning electron microscopy (SEM). Cell viability and proliferation were evaluated at 1, 3, 7, and 14 days using a commercial resazurin-based method. Collagen type I was evaluated at 3 days using ELISA. Alkaline phosphatase (ALP) activity was evaluated at 7 days using a colorimetric enzymatic technique. Group comparisons were tested using ANOVA or Mann-Whitney test (Tukey's post hoc) using statistical software, and significance was set at p < 0.05. Cell viability and proliferation increased over time for all groups with statistically higher values for laser-textured groups when compared with control at 7 and 14 days in culture (p < 0.05). Collagen type I levels were higher for study groups (p < 0.05) when compared with control group. No statistically differences were detected for ALP activity levels between texture and control groups (p > 0.05). The results suggest that laser-machined zirconia implant surfaces may benefit biological osteoblast response. However, the type of texture, spacing at the range of 25-35 μm, and number of laser passes did not seem to be relevant variables.
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Affiliation(s)
- Beatriz Ferreira Fernandes
- Oral Biology and Biochemistry Research Group, LIBPhys, Faculty of Dental Medicine, Universidade de Lisboa, 1649-003, Lisboa, Portugal.
| | - Mariana Brito da Cruz
- Oral Biology and Biochemistry Research Group, LIBPhys, Faculty of Dental Medicine, Universidade de Lisboa, 1649-003, Lisboa, Portugal
| | - Joana Faria Marques
- Oral Biology and Biochemistry Research Group, LIBPhys, Faculty of Dental Medicine, Universidade de Lisboa, 1649-003, Lisboa, Portugal
| | - Sara Madeira
- Center for Microelectromechanical Systems (CMEMS), Dept. of Mechanical Engineering, University of Minho, 4800-058, Guimarães, Portugal
| | - Óscar Carvalho
- Center for Microelectromechanical Systems (CMEMS), Dept. of Mechanical Engineering, University of Minho, 4800-058, Guimarães, Portugal
| | - Filipe Samuel Silva
- Center for Microelectromechanical Systems (CMEMS), Dept. of Mechanical Engineering, University of Minho, 4800-058, Guimarães, Portugal
| | | | - João Manuel Mendez Caramês
- Bone Physiology Research Group, LIBPhys, Faculty of Dental Medicine, Universidade de Lisboa, 1649-003, Lisboa, Portugal
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Roehling S, Schlegel KA, Woelfler H, Gahlert M. Zirconia compared to titanium dental implants in preclinical studies—A systematic review and meta‐analysis. Clin Oral Implants Res 2019; 30:365-395. [DOI: 10.1111/clr.13425] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Stefan Roehling
- Clinic for Oral and Cranio‐Maxillofacial Surgery Hightech Research Center University Hospital Basel University of Basel Basel Switzerland
- Clinic for Oral and Cranio‐Maxillofacial Surgery Kantonsspital Aarau Aarau Switzerland
- Unit for Oral & Maxillofacial Surgery Medical Healthcare Center Lörrach Lörrach Germany
| | - Karl A. Schlegel
- Private Clinic for Oral and Maxillofacial Surgery Prof. Schlegel Munich Germany
- Maxillofacial Surgery Department University Hospital Erlangen University of Erlangen Erlangen Germany
| | | | - Michael Gahlert
- Clinic for Oral and Cranio‐Maxillofacial Surgery Hightech Research Center University Hospital Basel University of Basel Basel Switzerland
- Dental Clinic for Oral Surgery and Implant Dentistry Prof. Gahlert Munich Germany
- Department for Oral Surgery Faculty of Medicine Sigmund Freud University Vienna Vienna Austria
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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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11
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Current status of zirconia implants in dentistry: preclinical tests. J Prosthodont Res 2018; 63:1-14. [PMID: 30205949 DOI: 10.1016/j.jpor.2018.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE This systematic review aimed to provide an overview of zirconia implants as well as regarding the outcome of the implant-restorative complex in preclinical studies. STUDY SELECTION An electronic search of the literature prior to July 2017 was performed to identify all articles related to preclinical research on zirconia implants. The search was conducted using MEDLINE (National Library of Medicine) and PubMed without restrictions concerning the date of publication. The search terminology included: zirconia implant, osseointegration, bone-to-implant contact, soft tissue, histology, histomorphometry, surface modification, surface roughness, surface characteristics, and restoration (connecting multiple keywords with AND, OR). RESULTS Fifty-seven studies were finally selected from an initial yield of 654 titles, and the data were extracted. The identified preclinical studies focused on several aspects related to zirconia implants, namely biocompatibility, mechanical properties, implant design, osseointegration capacity, soft tissue response, and restorative options. Due to heterogeneity of the studies, a meta-analysis was not possible. The most frequently used zirconia material for the fabrication of implants is yttria-stabilized tetragonal zirconia polycrystal. The resistance-to-fracture for zirconia implants ranged between 516-2044N. The mostly investigated parameter was osseointegration, which is compared to that of titanium. A lack of evidence was found with other parameters. CONCLUSIONS Due to its good biocompatibility as well as favorable physical and mechanical properties, zirconia implants are a potential alternative to titanium implants. However, knowledge regarding the implant-restorative complex and related aspects is still immature to recommend its application for daily practice.
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12
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Pieralli S, Kohal RJ, Lopez Hernandez E, Doerken S, Spies BC. Osseointegration of zirconia dental implants in animal investigations: A systematic review and meta-analysis. Dent Mater 2017; 34:171-182. [PMID: 29122237 DOI: 10.1016/j.dental.2017.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the osseointegration rate of zirconium dioxide (ZrO2) dental implants in preclinical investigations. DATA Data on the osseointegration rate was extracted considering the bone to implant contact (BIC), removal torque analysis (RTQ) and push-in tests. Meta analyses were conducted using multilevel multivariable mixed-effects linear regression models. The Šidák method was used in case of multiple testing. SOURCES An electronic screening of the literature (MEDLINE/Pubmed, Cochrane Library and Embase) and a supplementary manual search were performed. Animal investigations with a minimum sample size of 3 units evaluating implants made of zirconia (ZrO2) or its composites (ZrO2>50vol.%) were included. STUDY SELECTION The search provided 4577 articles, and finally 54 investigations were included and analyzed. Fifty-two studies included implants made from zirconia, 4 zirconia composite implants and 37 titanium implants. In total, 3435 implants were installed in 954 animals. CONCLUSIONS No significant influence of the evaluated bulk materials on the outcomes of interest could be detected. When comparing different animal models, significant differences for the evaluated variables could be found. These results might be of interest for the design of further animal investigations.
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Affiliation(s)
- Stefano Pieralli
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), CC 3 Dental and Craniofacial Sciences, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Straße 4-6, 14197 Berlin, Germany.
| | - Ralf-Joachim Kohal
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Emilia Lopez Hernandez
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Sam Doerken
- Medical Center - University of Freiburg, Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, Faculty of Medicine - University of Freiburg, Hebelstr. 11, 79104 Freiburg, Germany
| | - Benedikt Christopher Spies
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), CC 3 Dental and Craniofacial Sciences, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
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Martins R, Cestari TM, Arantes RVN, Santos PS, Taga R, Carbonari MJ, Oliveira RC. Osseointegration of zirconia and titanium implants in a rabbit tibiae model evaluated by microtomography, histomorphometry and fluorochrome labeling analyses. J Periodontal Res 2017; 53:210-221. [PMID: 29044523 DOI: 10.1111/jre.12508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study compares the osseointegration of machined-zirconia implants containing yttria (M-Y-TZP) with machined (M-Ti) and resorbable blast media (RBM-Ti) titanium implants. MATERIAL AND METHODS M-Y-TZP, M-Ti and RBM-Ti implants were randomly placed in rabbit tibiae. Fluorochrome bone labels (tetracycline, alizarin and calcein) were administered at different time periods. After 8 weeks, osseointegration was evaluated in terms of bone-to-implant contact (BIC), new bone area (nBA), remaining cortical bone area (rBA) and temporal quantification of fluorochromes, using micro-CT and histomorphometric analyses. RESULTS RBM-Ti implants showed higher resorption of the remaining cortical bone and bone formation (rBA = 36.9% and nBA = 38.8%) than M-Y-TZP implants (rBA = 48% and nBA = 26.5%). The BIC values showed no differences among the groups in the cortical region (mean = 52.2%) but in the medullary region, they were 0.45-fold higher in the RBM-Ti group (51.2%) than in the M-Y-TZP group (35.2%). In all groups, high incorporation of tetracycline was observed (2nd to 4th weeks), followed by alizarin (4th to 6th weeks) and calcein (6th to 8th weeks). In the cortical region, incorporation of tetracycline was similar between RBM-Ti (49.8%) and M-Y-TZP (35.9%) implants, but higher than M-Ti (28.2%) implants. Subsequently, alizarin and calcein were 1.1-fold higher in RBM-Ti implants than in the other implants. In the medullary region, no significant differences were observed for all fluorochromes. CONCLUSION All implants favored bone formation and consequently promoted primary stability. Bone formation around the threads was faster in RBM-Ti and M-Y-TZP implants than in M-Ti implants, but limited bone remodeling with M-Y-TZP implants over time can have significant effects on secondary stability, suggesting caution for its use as an alternative substitute for titanium implants.
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Affiliation(s)
- R Martins
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - T M Cestari
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - R V N Arantes
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - P S Santos
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - R Taga
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - M J Carbonari
- Insper - Instituto de Ensino e Pesquisa, São Paulo, SP, Brazil
| | - R C Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Effect of Zirconia Dental Implant Surfaces on Bone Integration: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9246721. [PMID: 28299337 PMCID: PMC5337335 DOI: 10.1155/2017/9246721] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022]
Abstract
Background. The information available about osseointegration and the bone to implant interaction of zirconia implants with various surface modifications is still far from sufficient. Objective. The purpose of this systematic review and meta-analysis was to evaluate and compare zirconia dental implants with different surface topographies, with a focus on bone to implant contact and removal torque. Methods. The systematic review of the extracted publications was performed to compare the bone to implant contact (BIC) with removal torque (RT) values of titanium dental implants and machined and surfaced modified zirconia implants. Results. A total of fifteen articles on BIC and RT values were included in the quantitative analysis. No significant difference in the BIC values was observed between titanium and machined zirconia implants (p = 0.373; 95% CI: −0.166 to 0.443). However, a significantly better BIC values were observed for acid etched zirconia implants compared with those of titanium implants (p = 0.032; 95% CI: 0.068 to 1.461). Unmodified zirconia implants showed favorable BIC values compared to modified-surface zirconia implants (p = 0.021; 95% CI: −0.973 to −0.080). Conclusion. Acid etched zirconia implants may serve as a possible substitute for successful osseointegration.
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