Roxolid: A Better Material for Dental Implants?

I`m looking forward to testing it

My thoughts on this are pretty skeptical....#1 reason: We all know (or should know) that zirconia cracks under lower stress elements than does titanium....with that being said...this article is proving one thing and one thing only....it osseointegrates much faster...which is GREAT, however I don't care how well it is osseointegrated, because my thought is once it is restored to function then the stress levels of occlusion, sheer, and tension (and any other elements of stress) could put microscopic cracks in the zirconia which would then lower the strength of the implant...hence eventually opening the doorways up for failure. I think the concept is great however it needs a lot and I mean a lot of testing and LONG term results...short term might prove to be the best thing since sliced bread, however if you know anything about science and how zirconia and titanium work together then this should answer this question...."MAY MAKE DENTAL IMPLANTS SMALLER AND STRONGER" - What is the biggest word in this statement....would you build a golf club driver head with titanium and zirconia...the stress of impact would crack the zirconia and distort the titanium...2 different metals that react 2 different ways under stress... I know that is a high stress scenario, however it proves my point on how different they are under stress levels. Again I am excited to see more literature, however I don't want to read only on how it osseointegrates faster and better than any other implant...I want studies to show the full spectrum... These companies how us so fixated on focusing on one thing, that we tend to forget about the full picture....great for osseointegration but not great for long term function.

Did not know Zirconia would improve osseointegration as unlike Titanuium it is not a semi-conductor.This although interesting may be not that valuble in real practice when improved grafting techniques would offer better long term benefits. SLA can have another meaning..

At the EAO I talked to a Straumann sales rep who admitted that the increase in strength is comparable with TiAl6V4. Titanium Alloy is safely used since the eighties in implant dentistry and many big manufacturors started to use it more and more, for example even 3i uses it today. Why present a solution which isn't science based yet, as a big innovation... The risks JRB describes have to be taken in consideration and these will probably not be revealed in the first years of function. So long term research should be conducted first.

Amazing that research found that bone will integrate with PEEK plastic better than Zr. Unfortunately, it won't hold up to dental stress either, but hopefully the research and innovation will continue, and who knows but that an out-of-the-box approach will positively transform some aspect of craniofacial implantolgy. Even though it is complicated by choices and an overwhelming info base, this is an amazing age to be living in.

I was at the EAO and saw a demonstration at Straumann's booth of bending of a bar of the Roxolid material compared to pure titanium. They even let me test it by pulling on what looked like a fish scale to see how much force it took to bend two bars, one of pure titanium and the other of the Titanium Zirconium alloy. Yes it was a little stiffer. I was later told that when someone else did this test, the bar of Roxolid snapped and the technician conducting the marketing demonstration quickly put the pieces out of site. Adding an element to titanium to provide greater stiffness with less modulous of elasticity could result in fractures over time of small diameter implants. Many companies sell small diameter implants (3.0mm-3.5mm) and only the NobelReplace 3.5 has a well known history of fractures... but that is because the size of the tri-lobe results in walls that are only 0.009" thick. When you use an internal hex, it is closer to being round and therefore the walls can be kept thicker even with small diameter implants. Straumann has become the new Nobel with products and research developed for marketing to justify "premium" pricing. As for faster osseointegration, let them compare it to HA coated implants and see what is faster. What does it matter if an osteoblast attaches to the metal in 3 weeks or 4 weeks when you can immediate load the implant relying only on the initial stability for success? More important is to use a tapered implant inserted into an undersized socket to increase stability in soft bone so that you can immediate load more often. Another important issue that Straumann overlooks is the surface area of thread engagement. Their implant uses shallow threads, widely spaced, minimizing load carrying capabilities. Straumann has introduced Roxolid to solve a problem that was already solved by switching from pure titanium to titanium 6Al/4V medical grade titanium alloy 27 years ago with the first Core-Vent Implant. The Micro-Vent 3.3mmD implant was launched in 1987 and 3i has been selling a 3.2mmD implant for about 17 years without fracture being a problem because they were both alloy. Straumann made such a big story about their using only pure titanium that when they now need something stronger, they had to switch to a new material rather than be seen as copying what has been around for 20 years.

Let us learn to appreciate the newer modifications which are comingup in implants, rather then just giving negative comments . even i was at EAO, and at the symposium of strauuman, speaker jan presented the student on roxolid , and the results where satisfactory.let me tell you iam not a strauuman user . and if it has any long term effects it will defnatly be creticized by publications to come ,

Many "newer modifications" in surfaces, threads, materials etc are made by manufacturers to differentiate their products from the competitors, and justify premium prices. Roxolid may be one of those so ask yourself what problem it solves that are not already solved by using Ti6Al4V implants with a 30 year history of strength and success. There are two alloys using Titanium and Zirconium, both with about the same stength as Ti6Al4V. Both have molybdenum as an additive so until once analyses the Straumann alloy, and sees the long-term results it is hard to know if this has any advantge over their Grade 4 CP Ti - breakage has not been a significant problem for Straumann even with their 3.3mmD implant. I have seen the clinical reports on the use of their SLA surface and they are no worse that their more expensive SLActive surface. Nobel launched NobelActive for $33 more than its Replace implant, and the first year results are less successful in both osseointegration and bone loss (posted on Nobel's web site.) I appreciate newer modifications if they solve some problem, not if they potentially create a new one.

Perhaps we should turn our attention more to bone science than implant materials when considering accelerated healing and osseointegration. A study ("Melatonin Stimulates Osteointegration of Dental Implants") reported by Cutando, et al. in the Journal of Pineal Research (2008 45:174-179) that use of topically administered, melatonin (a potent anti-inflammatory and antioxidant hormone) in osseotomy sites significantly shortened the osseointegration period of dental implant in dogs. Moreover, a study by Kücükakin B, et al. reported in the May 2008 issue of Journal of Pineal Research (2008 44(4): 426-431) demonstrated that treatment of human patients undergoing major aortic surgery with intravenously administered melatonin of up to 60 mg was safe. Regarding the strength of the implant, more attention should be focused on the design of the abutment-fixture interface than the materials. With appropriately designed occlusion and loading parameters, existing materials have been shown to be satisfactory.

Mechanical properties of the implant is not an issue, its been proved, but how's the force distribution to the bone with smaller impant? I think larger implant surface has better force distribution to the bone and less harmfull.

I agree with Dr. Niznick that Ti6Al4V ELI alloy has an excellent track record. However, the design of an implant also makes a difference. One-piece implants have a much higher strength than a conventional two-piece implants. The drawback – less restorative flexibility. I developed a new implant system – KAT (Key Assisted Transfer)Implants that allows the use of a single platform and a screwless locking taper connection in implants ranging in diameter from 2.5 to 5.0mm with 6.0 and 7.0mm implants coming later this year. Fatigue strength of a 3.5mm KAT implant is 425 N – far greater than conventional two-piece systems. Nobel reports 355 N for a NobelActive 4.3 implant and only 222 N for a 3.5 implant. We place implants in patients who are only 17 years old, average life expectancy in US is 78, it is reasonable to conclude that implants may have to serve up to 80 years. Even with an excellent 30 year record of Ti6Al4V alloy we still have to strive for a better design that would provide greater fatigue strength for implants.

Leonard: You are most correct.