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Delayed Placement of Zeramex XT Implants

Last Updated: Apr 15, 2019

Case submitted by: Dr. Gary Adams

This case documents a delayed placement of 2 Zeramex XT 5.5x10mm implants followed by immediate fixture level impressions and placement of healing caps. The patient traveled 2.5 hours to my office 4 weeks prior for removal of #19 and #30 with diagnosis of non-restorable and failed root canals. The teeth were extracted and grafted with platelet rich fibrin.

Patient arrived the day of implant surgery and modified osteotomies were performed in the delayed sites with no elevation of flaps. The implants were placed with ease achieving primary stability of 45Ncm. Fixture level impressions were taken the day of surgery and healing caps placed. The patient returned in 3.5 months for delivery of final crowns.

The interesting part of this case is the newly FDA approved Zeramex XT implant (the XT implant is the same implant as the Nobel Pearl, but the XT simply costs less). The Zeramex XT implant is made of zirconium dioxide and has the following characteristics:

2 piece implant system
Screw retained components
Bone level implant
Internal connection
Tapering form with aggressive threads for good primary stability and immediate placement
Platform switch options available because the 4.2mm and the 5.5mm wide implants share the same size connection.

Basically, long story short, the XT Implant is a ceramic implant that places like titanium, and has all the conveniences of titanium. I guess that is why Nobel has finally jumped on the bandwagon. I use these implants in the smile zone, patients with suspected metal allergies, and all thin and translucent tissue types. It works great for singles and 3-5 unit bridges. I do not recommend these for full mouth cases, because custom abutments cannot be made a this time and there are not uni-abutments or any angle correcting components for ‘All-on-4’ case type corrections. I recommend everyone take a look at these because there is a place for these in every practice. They also give you an opportunity for you to differentiate your practice from others, who are not offering this type of implant, i.e. “tooth colored”, “cosmetic”, and “metal free”.

12 Comments on Delayed Placement of Zeramex XT Implants

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Dr. Moe

4/15/2019

Hi, Nice case!!! I am excited about these implants because they will be perfect for aesthetic cases in anterior maxilla, however, when I inquired from Nobel about them, they are wide implants. I think I was told that they come in 5mm and 5.5 mm diameter only, nothing smaller, Yet. So, I guess with issues with bone in the anterior Maxilla, there are only limited cases where they can be done for now. As far as I am concerened, 5.0 is a wide implant for anterior maxilla. Just my $0.02

Gary

4/15/2019

use Mike Foley @ www.emerginnova.com to get the Zeramex implants.

Gary

4/15/2019

Maybe Nobel only sells the 5.5mm wide, but these implants definitely come in 5.5mm and 4.2mm. I have placed like 25 of these in the last 3 mos. and they places super easy like titanium. Talk to Mike Foley at zermexusa.com I am placing titanium for most of my full mouth cases, bruxers, small spaces and these for anything with thin gum tissue, translucent gum tissue, smile zone or some of the patients just would rather not have "metal." I charge $400 more for zirconia surgery vs titanium, but other than that I run these cases just all the other titanium cases. Zermex implants cost less than Nobel FYI and it is the same implant, surgical kit and everything. The manufacturing company is Dental Point who sells to distributors (Nobel and Zeramex in the USA)

Dr. Moe

4/15/2019

Thanks for the info. Appreciate it!! Keep up the good work.

Ed Dergosits DDS

4/16/2019

Why charge more for placing an implant with this system if it does not cost more?

Sean Rayment

4/16/2019

Gary, I'm sure there is an area of need for these types of implants, if for nothing else but the patient who says they don't want a "metal" implant in their head (yes, a lot of them out there). My question is why did you have this patient back at 4 weeks for the implant placement and why did you elect to do the final impression on the day of surgery? How comfortable are you that you know where the ridge crest will be at 4 weeks? Thx

LSDDDS

4/16/2019

Not so crazy. Less than one percent cause Osteosarcoma. Disclosure not mandatory

Gary

4/20/2019

Good questions. Patients always want their teeth back yesterday and why make them wait when you do not need to. This patient has a wide ridge and thick tissue type. Based on the shape of the extraction site, I knew I could get good primary stability without waiting 3-4 months for total ridge healing. Also, I have found that while gingival height is absolutely predictable with complete healing, loss of gingival height and contour can be seen. It these cases you get a taller crown and less gingival in the gingival embrasures, resulting in a decreased esthetic result and more food trapping. I believe placing an implant into healing bone is better than placing an implant into already healed bone or needing to drill a hole in bone once it has already healed. That is I think placing an implant ASAP 1) immediately or 2) delayed is best. That is just my camp. Faster for patients too. I used PRF on the day of extraction in both sites btw. The patient wanted a non-metal implant and traveled 2.5 hours to see me. I took the impression because success is highly likely, there was tons of stability and I will hope to deliver her crown in 2 visits to save driving time. Most of the time I impress after verifying integration at 3 months postop. Hopefully this helps even if you disagree. I think placement technique and grafting technique is part of what determines where the gingival levels end up too.

Gary

4/20/2019

Please tell us what you are talking about.

Greg Kammeyer, DDS, MS, D

4/16/2019

Seeing the contour of your soft tissue reminds me of why I mix an allograft with L-PRF, & why I wait 3+ months before placing the implant minimum. I've placed one Pearly implant and am not fond of the implant driver. Do you have any comments about that?? What other problems have you encountered?

Gary

4/20/2019

About the implant driver. I really have not had a problem with the driver. It is a funky shape, but It has a good but not too good of a fit into the fixture (does not drop off during placement and does not have me jerking hard to remove after placement). I also place Hiossen, Astra and I like the Astra driver better. I am not a huge fan of the cover screw and that hand driver. It looks like a flat phillips head. Is that the one you are talking about? See my comment above about placement time. I love adding graft material to PRF. I do it almost every time.

DrK

4/24/2019

The flexural compressive and tensile strength difference of a ceramic fixture and that of a titanium fixture is so wide that other than "patient asks for non metal implant" does not justify its usage. Even in aesthetic zones with a thin tissue biotype a right sized titanium implant, a zirconia abutment and a well matched crown are all that's needed to take care of the aesthetics.

demineralized bone allografts cortical cancellous fully bio resorbable delayed paresthesia thoughts