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Ask UsAll Zirconium Dental Implants: Opinions?
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Rob, a dentist asks,
I’ve heard that Nobel BioCare’s new all zirconium one piece dental implant, is supposed to come to the U.S. market sometime in 2007. There are also other zirconium implants from other companies on the market.
What do the dentists here think of these new all zirconium implants? Do you think they will osseointegrate as well as titanium, and perform as well as the titanium dental implants? Do you think they will be more prone to fracture? What might some of the benefits of an all zirconium implant be [i can see a one-piece all zirconium implant maybe doing away with the microgap bacterial issue seen with some titanium implants]? Thanks for your thoughts.
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47 Responses to “ All Zirconium Dental Implants: Opinions? ”
Zr provides lower levels of phosphates- this will compromise new bone formation relative to oxidized Ti. It is also very difficult to prep- and in the end, you don’t really know how strong the remaining material is because there is no way to detect the presence of microfractures. I don’t really see an upside to this product, with the possible exception of very thin mucosa in the anterior. If this product appears stark white like the other Procera products, as opposed to shaded, then even in those instances it will be easily detected and of little or no benefit. Strength should not be a concern, other than in the case of microfracture caused in the prepping of the material.
why is the zirconium implant harder to prep?
i guess the bone formation issue could be handled by adding some bone when the implant is placed.
i think i also read where the zirconium will not corrode over time [like some of the literature says the titanium does].
any one have more thoughts on all this?
The formation of titanium oxide is probably the reason the titanium integrates to the bone. Nobel Biocare has gone to great efforts to make the titanium oxide thicker for better initial integration. However If the oxide surface is too rough it may also alow the oral bacteria to colonize the surface and result in peri-implantitis. No one knows how long the Zirconium will be stable as it absorbs H2o over time??
Dear all,
regarding the ZrO2 implants there are still to many wrong rumors and thoughts about it.
The material which is used today is not radioactive!
Zirconia is aging, but stable enough to survive a long time. The only problem you get if you prep the implant post after surgery. Because of the aging and the mini cracks the implant will probably breake.
The white ZrO2 implants having of course some advantages and some disadvantages.
The most critical points are:
1.A right design, a ceramic like design is requand ired! (the Nobel Direct implants does not have it, a titanium screw design is wrong)
2.The prosthodontic post of the implant should be standardized, to avoid the material damage preparing.
3. Osseointegration is an issue - as Zirconia is the only bioinert material which our body is tolerating. In the orthopaedic field it is since years well known that Zirconia can not osseointegrate as titanium. The bone to implant contact of normal Zirconia implants is about 30-40%. A rough surface is good, an osseoconductive surface is better. A German compnay called Ziterion launched at the IDS in Cologne such a surface. They have also done a dog study.
The advantages of Zirconia implants:
A single stage implant is perfect to avoid bone loss (no micro gap, no movement …)
The soft tissue likes the ZrO2 ceramic, the tissue is even grwoing along the implant head
The aesthetic is perfect in the anterior region.
Ceramic implants will become the future, of course there are still studies and scientific data missing. I can not believe that Nobel will have some real scienticic data available yet. We will see…so far good luck if somebody is starting!
Hi everybody !
I placed the first zirconia implants 4 months before. I am facing the problems spcific of onepiece implants. You can hardly use zirconia implants in the upper front area because of the angulation of the bone ! So i don’t see any advantage . The implants have a too smooth surface and the stability suffers a lot. We still don1t know which design is the best for Ti implants. How can we say which design is the best for zirconia implants. We should start placing implants and soon we will finde out where the triks are hiding.
Good luck !!
the Z-System all zirconium implant has been on the market in Europe for many years now I believe.
Have any of the dentists here placed them?
If so, what have you noticed regarding osteointegration, fracture rates, complication rates, aesthetics, etc etc?
It seems like we should already have *some* of the answers regarding zirconium implants given the extensive use of them in Europe.
Steven, you are right….In my practice I would use it for esthetic reasons, and if I can not get the propper angulation?….
I definitevly would change metal for other bio-inert materials….but many of us will not see it…
metal is metal …even if Ti works propperly….
Yesterday I removed the first Zi implants. No integration ocuured. Meanwhile I found in the litriture that the osseointegfration of Zi is less than that of Ti !! I lies little above 50% !! Can this damage the image of my practice ?
I visited the Z-System in Konstanz. Verry nice people. The problem of the implants is that they has to be prepared with a bur for angulation that causes a lot of cracks ! Meanwhile the firm was taken over by I firm from Switzerland.
I visited another producer from Switzerland but they didn’t show me any clinical studies.
I was very enthusiastic and wanted to establish an organisation for metalfree dentistry. But I heard a lot of problems regarding Zi so can give me somebady a psychological support to continue ?
Thanks
Steven,
so are you going to try to reinsert the zirconium implant with some added bone to see if it takes the 2nd time around?
this being your first and only case with the zirconium, maybe this case had issues such as bad or infected bone that compromised the implant.
if you said you placed 50 zirconium implants and 30 or 35 of them failed, then that would be a better indication of things. but placing just 1 and seeing 1 fail is hardly a barometer to measure things by.
by the way, does anyone know if nobel biocare officially announced that they are selling their zirconium implant in the USA? i had heard via a colleague that they were suppose to do so this month [may 07].
well talkin about such implants, who do think are the market leaders in Zi implants and Ti implants?
how can the implant market be quantitatively segmented?on the basis of Endosseous,subperiosteal and transmandibular as in theory or on the basis of implants such as Ti and Zi?
Dr Daniel–
so Dr Daniels, who are the market leaders in the zirconium and titanium implants?
and what is your opinion on the all zirconium implant?
Dear Collegues
I have just published the latest data on osseointegration and soft tissue response to Zirconium dental implants in “Norwegian endocrinology letter”.
The osseontegration rate was comporable to publications concerning titanium (98%), the soft tissue response however far superior..
doppler x-ray as well as clnical explorative surgeries have furthermore established that the osseointegrative quality was superior to titanium as well. However the osseintegration process is different to Titanium, which has an effect on teh clinical procedure.
With regarsd to breakage of the implants we had 8 fractures in 10k implants.
There are currently 3 companies producing such implants,
namly Z-systems, Ziterion and bredent. Metoxit and NOB are working on one.
Currenlty the only implant with clinical data published in peer reviewed journals is teh Z-systems implant.
Bredent implants are placed, however i am not sure how many are out there.
Ziterion - I still have to see any clinical data. I persoally know of now reputative suergeon using these implants.
It all comes back to patient selection, i do personally place aprox 150 titanium and aprox 100 zieconium implants per year.
I must agree with Chris - I have placed 200 custom made zirconia implants using various designs of ‘’root'’ shapes .These have all fulfilled the criteria used for successful integration in titanium implants - some have been in place for 3-4 yrs - excellent soft tissue response and stable bone levels exceeding results obtained with titanium implants - huge advantage in the aesthetic zone.
Undoubtedly great potential as further scientific evidence becomes available.
Could Chris provide a citation for the article referenced in the “Norwegian endocrinology letter”. I would like to read the entire article.
So has Nobel Biocare put the all zirconium implant on the U.S. market officially now, or are they still waiting to introduce it?
Honestly, why do you think NOBEL is coming out with this implant….to gain more market share!!! Be careful on using a product that doesn’t have extensive research….NOBEL is known for throwing things into the market place and then saying, “Oops! We didn’t see that coming…” They are a large company with their best interest in making more MONEY….they always want to be the first in every new technology no matter what the consequences may be, because they can always resort back and say they were the first to try it and when the technology becomes more suseptible for actual implantation….they can then come back and say who came out with it first and has the most experience in that specific area….THEY ARE KNOWN FOR THIS!!!
We need to open our eyes as DRs and really look into what is good for the patients long term health!!! YES long term health….why change something that is working well….all they want to do is try to shorten the life cycles and sell it to us that we can make more money faster so they can make more money faster….I suggest you don’t be the TEST facilty for potential failure! STICK WITH WHAT WORKS and has worked for the past 25+ years! Let the company do the right thing by doing more long term studies and producing all of the evidence and instead of PARTIAL….which is another problem we have with the big companies!
To my knowledge most implants are placed subgingival,with the abutment and crown being responsible for aesthetic outcome.My question,how is zirconia implant superior to titanium one?
Dr. Lapa–
I have read where the zirconium implant is metal free; some patients prefer not to put any metals, like titanium, into their bodies.
I have also read where titanium particles have been found to *leach off* of the titanium implants, and these particles have been found in the nearby tissues; no one really knows if that has an adverse effect on one’s health over a long period of time.
Titanium might osteo-intergrate better, but the zirconium folks say the zirconium implants are pretty close to having the same integration rate as the titanium.
Dr JB, You are 100% correct, thank you for being so honest. The reason NB is coming out with something new all the time is they have a lot of bacterial problems about their implants (the microgap). They need a one piece implant to prevent these problems. Ti implants work very well, if the bone and soft tissue problems are corrected first the implant will be a success for the patient(function, esthetics, longevity, and gingival health)
The University of Mainz in Germany, Prof. Wagner (Dept. of Maxillo Facial Surgery) just finished to evaluate a dog study (standard model) to compare two types of ziterion zirconia implants from Germany with a titanium implant in the same design and the same rough structure. One zirconia had a normal rough structure, the other the same plus an osseoconductive surface coating. The outcomes are very promising and a bit surprising. Both zirconia groups did osseointegrate after 14 weeks in situ in the same level, the titanium implant as control even a bit less. The evaluation was done by REM to measure the bone to implant contact which has been in the avverage abozt 63% for the zirconia implants. This study has shown that even zirconia implants with a defined rough structure osseointegrate as well as titanium implants. Of course it also depends on the design of the implant. The study will be published as soon as possible in one of the international journals.
There is no more questionmark about oseointegration of zirconia implants. The most critical issue is the material itself. The wrong implant design, the wrong manufacturing process as well as the wrong treatment in the dentist hand (like preparing) will influence a lot the long term survival. If everything is done right, you can believe me that a zirconia implant will be break-proof.
Hello,
I’m missing tooth #19, and I am seeking information about Zirconia root implants here in the U.S. or in West Coast Canada, but I would go further to see a reputable implantologist. I have a history of osteonecrosis (presumably from taking fosamax), and I have other chronic health issues that cause me to be fearful of titanium implants. Any dentists out there who can provide me with information and/or resources?
Thanks.
Dear Coleagues,
I have been following your dispute for a long time. You are all right, there is not today an implant perfect for everybody.
I used many Ti implants with very good results but in the last year I inserted more then 100 Zirconia Implants with CE accreditation which are excellent and I had no fracture problems.
The Zirconia implants integration is excellent and I can send you an article published about my cases.
However Zirconia implants seems to be as safe as Ti implants but they have the huge advantage of being white.
It is worth to cooperate together for developing Zirconia Implant in near future. I am sure that all big dental companies will introduce the Zirconia alternative in their catalogues.
Waiting for your reply,
Sincerely,
Dr. Bogdan Vladila
Hi
How well-suited are zirconia post/crown combos (i.e. like Ceraroot) for a #8 replacement of a metal post/PFM crown?
This is not implants per say but rather a post/crown job-how well does the ceramic post integrate into the bone?
Anybody know the duration of such a product?
Also don’t zirconia crowns rub against the other teeth causing wear down?
Thanks
Zirconia crowns, like all OTHER ceramic/porcelain crowns, have the potential to accelerate toothwear of opposing dentition. Should it be then, that we always tell our patients to get a splint/nightguard to prevent accelerated wear due to bruxism, as part of the terms before you can promise any warranty to your treatment?
I do believe that Zirconia has a great potential of becoming an alternative implant fixture material as opposed to a Ti one. However so far the debate has only been based on limited studies, which is a bit of a pity. It almost seemed like the amalgam/composite resin debate…?
so to repeat my question above, has Nobel Biocare put the all zirconium implant on the U.S. market now, or are they still waiting to introduce it?
anyone know about this?
if it’s not yet on the market, any reason why [eg., technical issues with it]???
Do you know if anyone with MCS (multiple Chemical Sensitivity) thas has had a Zirconium Implant Bridge and if so what, have they had any symptoms from it? Thank you so much.
Have been placing zirconium implants for 3 years now.Had some good integration and some failures . Most of the failures I think was caused by micromovement–tongue thrust etc.All of the implants that failed hd excellent soft tissue integration .What I mean is that there was no infection or inflammation , and the gum seemed “happy” around the implant.
I use both the bredent whitesky and z-system implants. The whitesky has a roughened surface and wide thick thread which I think is beter as laminer bone formion is better than next to a very fine thread. I have replaced some failed zirconium implants with wider ones ( 4.5 - mm) and had success the second time round.
I have also placed zirconium in to some areas of exceptionally weak bone where I could only have wished for bone formation with great success.
The success of zirconium in my practice has been comparable to titanium , providing I kept the implant abutment part well protected out of the bite and the tongues harmfull ways.
I have heard so many controversial things about the zirconium implant. When you visit the sites, they never give you enough information re the studies they do. Or the case studies that are done. The lenght of follow up. How can you start with the use of a product that cannot give you the proper background and honest feedback on 3 years and more. What happens on the implant/bone interface? Can you advise me which website to visit to find this information. Many thanks.
Dear all (especially TP):
Quote: “I have also read where titanium particles have been found to *leach off* of the titanium implants, and these particles have been found in the nearby tissues; no one really knows if that has an adverse effect on one’s health over a long period of time.”
My mother is considering a dental implant with titanium. Her doctor says it’s the best solution, mine says it is possible that it will be proven dangerous and even carcinogenic in the future. They are both University professors with published work and partners at the private practice we go to. What’s your advise?
THANK YOU SO MUCH!!!!!!
DearAll: If anyone knows of A doctor with good experience with zichronia implants in the new york area i would greatly appreciate it.Thank You
Hello,
I am a young woman possibly needing a few implants in the future. I do not wish to have metal put into my body and am interested in researching zirconium implants.
Are they available in the US anywhere? Or Canada?
Zirconia implants have not shown to be advantageous in any peer reviewed article. First, you have to determine what the benefits to an all zirconia implant would be. Integration of titanium to bone has been proven in hundreds of articles to be safe and predictable in the short and Long term. The first wave of zirconia implants did not show the success rates of titanium. Really, it comes down to the perception that a white implant is more aesthetic. Superior aesthetics of zirconia implant is only considered when the implant is placed in a poor position. Proper placement of a titanium implant yields the same aesthetics.
As for tissue “happiness” around zirconia implants, this is anecdotal and not science. Many implant companies that sell titanium implants claim better tissue response compared to other titanium implants based on design. The truth of the matter is that some patients have a “biotype” that is more resistant to inflammation and produces a healthier appearance than other patients. All things being equal, zirconia and titanium have similar tissue responses.
With regards to the Zirconium implant and responded primarily for Dr. JB. I believe the direction of zirconium implants is of a monetary nature, obviously implant companies are out to make money, but I believe it’s a multilevel process at this time, not necessarily to just trade titanium for zirconium on the implant itself. Companies like IMZ from way back have experimented with zirconium for a very long time given it’s aesthetic value with tissue. But the zirconium implants that you see today from major companies like Nobel aren’t there just to make money because of it being different. I believe they learned their lesson with things like the “perfect” implant. What they are needing to do at this time is gain acceptance that zirconium can and will integrate and be accepted as a “surface.” With the emergence of companies such as Keystone and soon Thollmen and Nobel which have high end scanning and 3D mapping technology they will be able to manufacture customized “one-piece” implants from zirconium. This would be too cost prohibitive with Titanium but very attainable with zirconium. The eventual endstate would be a scan and a custom, one-piece implant that will eventually not need to be prepped. This can potentially eliminate any micro-gap, custom angulations that aren’t strength compromised and a material which is much more friendly to the soft tissue. **And then yes, more money for the implant companies. But hopefully in the long-term at the benefit of the patients. With how effective titanium implants have become these days there doesn’t seem to be any great advantage in moving to zirconium on the implant portion itself but gaining acceptance that the material is no worse with regards to integration will open up a whole new world of quiality implant restorations in the future.
A few issues here ,the lack of semi-conductive nature (to encourage cell growth) of titanium and the problems associated with zirconia in hip replacement and flexible nature of titaium.Interest waning in Europe….
Nobel CEO said on 2/11/2008 on stock analyst conference call that the Zirconia implant launch has been delayed at least until 2010. Nobel does have a proprietary surface they are calling ZiUnite. Even so they have pretty much concluded that this implant needs further study and development.
Peter F.; you wrote: “A few issues here, the lack of semi-conductive nature (to encourage cell growth) of titanium….”
Peter: could you please explain what you mean when you speak about titanium and “encouraging cell growth?”
Are you saying that titanium has been scientifically proven NOT to be a carcinogenic material?
I think several posters here are concerned about titanium and whether it may have any link at all to cancer.
Thanks in advance for your clarification.
Thanks, RobMee, for recent posting re: Nobel’s stock analyst conference call concerning zirconium oxide implants.
What about Z-systems, aren’t they a competitor with a solid product? If you know, can you take a moment and explain what it is that would make Nobel’s now-delayed launch implant so proprietary/advanced? I ask because I am awaiting enough studies, info, re zirc oxide implants, before I decide to have them placed.
Also, do you know which zirc oxide implant is most likely to get FDA approval in the near future?
Thanks again,
GS
Research at german bio-medcine institute in Munich , titanium is the best tolerated bio material , zirconia is a big step back in that issue but read online ,only possible benefit is aesthetics which is not important if placement is goood and bone is stable.
One of our employee’s brother is hyper allergic to many materials including ti but is interested in an implant to replace a missing bi. Are there any implant solutions for someone like him? We suggested forgetting the implant and just doing a 3 unit YZ bridge.
We are talking about metal free, but if we look to the periodic system Zi which is a part of zrkonium comes from the same group as Ti. So what I have learned from my high school years is that the elements of the same group have properties like eachother. So I think the difference betweem Titaniumoxide ( also a sort of mineral) will not differ to much from Zirkoniumoxide. The colour is different and because of the crystal structure being a hexagone it is more difficult to prevent progression of fractures as with the real metals. Most times when we drill the temperature arises and this will change the crystal structure making it more prone for fractures. That is probably the same reason when we find titaniumoxide particles sheared of from the implants. These structures have other properties then metals and are stringer but more prone for fracturing like your porcelain. We are talking about biomechanics and there isn’t any material that will offer everything we want in this way. If we want that we must go to the field of tissue-engenering, but then we have again the troubles of tooth-decay. So there are always advantages and disadvantages and personally I think the zirkoniumimplants have a niche functio in replacing single teeth, but I am waiting to see what will happen if we try to use them in large brigde constructions, because we need some elastic features for this kind of structure. I think we can learn a lot of bridge builders—> they calculate which materials they have to use by their properties and not to put them in place and see if the survival rate is as great as we want it to be. In y opinion is that the sortcomming I have that don’t have the background to judge these materials like the engeneers. I do have leared some things about materials and their properties but think it is not enough and that is why we let us sell everything some sponsored collegeus say that it works. We see this even in the discussion above by some collegues mentioning brands. They just say those thinks because of clinical date which are important, but we can’t predict as a dentist the features in front
I’m a patient…I have three extractions, failed root canals (I have autoimmune disorders) - done two months ago - I hear time is fleeing and I have two dentists with opposed opinions, one thinking NO implant is good, and the other doing zirconium. What do patients do? I am so afraid of being toothless!!
I currently need implants to raplace teeth # 12,13,14,15,2,3 & 19. I lack accurate knowledge of current research, but feel that a non-metal implant is a better option for me. I live in South Orange County, CA and would like to know if there are dentists in my area that are successfuly using zirconium implants. Thanks a lot.
Can anyone please say who the top surgeons or implantologists are in europe for zirconium that have the best track record because i am thinking about traveling from the usa to europe for an implant with zirconium. Or where I can find this information out. Thank you!!!
Dear nirmada, you may seach for a company called Dental-Offer. They do metal free implants and have the according experience. I have just been at their clinic in Bratislava for several cerec crowns and I was impressed by their service and medical standards. Good luck!
I need to get rid of a root canal tooth soon (have had inflammation since the tooth was done, perhaps because of possible leaking)and want to opt for Zirconium as a metal free option. Anyone know of experts in their field who can do this in South Africa or Cape Town?
Thankyou
Dear Nirmada
Wait until it is available in your own country if possible.Zirconium implant are a one piece structure and you will need to see your dentist quite a few times over a period of 4 - 6 months for monitoring of the healing.
because it is a one piece structure zirconium implants stick out of the gum and is more prone to tongue interference and bite interference during the healing period. I would advice you against travelling across the atlantic to have this done , unless you are a aircrew and Uk/Europe is almost your second home.
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