Zirconium Implants

posted in Dental Implant Systems, Dental Implant Safety

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Dr. Johnson asks:
Can you please give your opinion on the newer zirconium dental implants that
are being developed for use in the US? I believe Nobel Biocare is
currently testing one called ZiUnite [Zi short for zirconium].

I think that
zirconium dental implants are already being used in Europe but not yet in the
US.

Do you think the zirconium implants will osseointegrate as well as
titanium implants?

Do you think they will fracture more than titanium?

Some people do not want to put metal [titanium] into their bones and
therefore welcome the zirconium implants. And I have read that titanium
dental implants are more prone to inflammation than zirconium implants, and
that inflammation is now being linked to heart disease and cancer so
maybe zirconium dental implants might be safer from an "immune perspective."

All thoughts on this topic will be greatly appreciated.

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21 Responses to “ Zirconium Implants ”

  • Larry S. August 1st, 2006

    Kyocera made a BIOCERAM dental implant in the early 1980’s that was zyrconia. It osseointegrated fine, it was not prosthetically versitile because it was a “one piece” type implant. Because of this it fell out of favor. Now that thye have refined machining of zyrconia, I feel it offers some potential especially in thin tissue biotypes (think, “show thru” of titianium) and the esthetic zone. I look foward to seeing them.

  • Alejandro Berg August 1st, 2006

    We allready know that zirconia oxide ceramic implants are even more likely to integrate than titanium implants.(So are rubidium ones)
    They are not yet at comercial use level …. alumina oxide ceramic were used in germany for many many years with great success in the anterior area, but those tended to fracture under more stress or load, something that has not happened with Zi implants (as per partial reports) which means that Zi implants are probably the next thing in dental implants.
    The tendency in europe today is to avoid metals in the body… due to a few scattered studys/reports that show an increment in the titanium oxide deposits and circulating levels in the body in implant patients, europeans are trying ceramics that dont have that problem.
    In relation to the inflamation- auto inmune thing, you should remember that TiO is a natural antinflamatory so…
    Yes there is a clear link between chronic inflamation and Heart disease but in implant dentistry we try to achieve no chronic inflamation, we want stability… and there are no studys that link implants and heart problems as it has been clearly shown with perio patients. Evenmore many studys show that implant patients have better health than partial prosthesis wearers. Finally I dont think we will remove ti implants in favour of Zi ones, as we will not remove all teeth to prevent heart disease in perio patients(not all at once,at least we will give the fight for them).

  • Mike H. August 3rd, 2006

    I have read that zirconia may be radioactive. I don’t know how radioactive it might be —lots of things are radioactive but don’t seem to harm us if the degree of radioactivity is miniscule.

    Does anyone know if the implant zirconia manufacturers have solved the radioactive issues at this time?

    Here is some research I saw on this radiation effect of zirconia on a different site:

    “Radioactive burden resulting from zirconia implants”

    [Article in German]

    Fischer-Brandies E, Pratzel H, Wendt T.

    Klinik und Poliklinik fur Kieferchirurgie der Universitat Munchen.

    Due to its mechanical properties circonia is an interesting implantation material. However, it may contain a certain amount of radioactive isotopes. The measurement of alpha-emission reveals varying amounts of radiation. As a result, a declaration of radioactivity should be required for circonia implants and only circonia with low emission levels should be used for implantation purposes.

    PMID: 1817864 [PubMed]

    “Zirconia Ceramics as Biomaterials – Radioactivity Issues”

    Background

    Zirconium compounds are refined from naturally occurring ores, notably zircon, and usually contain trace amounts of other elements depending upon the source of the original ore.

    In particular, zirconia typically contains trace amounts of radionuclides of the actinide series such as 226Ra and 228Th.

    As a consequence there have been some concerns about the use of zirconia ceramics as implant materials.

    The Radioactivity of Zirconia Biomaterials

    However, the radioactivity of zirconia is negligible.

    For example, the radiation emitted by a 3 mol% Y2O3-ZrO2 powder was the same order of magnitude as alumina powder, both of which were several orders of magnitude less than that typically measured for water, milk, vegetables and meat (in Europe).

    The radioactivity of Y-TZP zirconia femoral heads were shown to be similar to that of alumina and cobalt-chrome alloy femoral heads accepted for human implantation.

    The radiation dose of each material was well below European radiation limits specified for general external exposure of the human body and also for local internal exposure of organs and tissue, and was no more than the ambient radiation of the surroundings.

    The Radioactivity of Commercially Available Zirconia Powders
    Similarly, the radiation levels of several commercially-available zirconia powders (Nilcra Ceramics, Melbourne, Australia) measured by the Australian Radiation Laboratory were found to be minimal and well below acceptable limits.

    The Radiation Health Committee of the National Health and Medical Research Council of Australia consider that magnesia partially stabilised zirconia femoral heads made from these powders would pose very little hazard to surrounding tissue.

    Radiation Absorption

    In a dense ceramic, almost all the radiation will be absorbed within the bulk of the material. Any external radiation could come only from radionuclides at the surface in the case of a-emission, or from radionuclides in the first few millimetres in the case of b-emission.

    Furthermore, in the case of artificial hip joints, any radiation from the femoral head will be absorbed mostly by the ultra high molecular weight polyethylene acetabular cup or the metal femoral stem.

    The radiation risk of zirconia ceramics is negligible and certainly no more than that of alumina.

    Primary author: Dr. Owen Standard.
    Source: Abstracted from Ph.D Thesis “Application of Transformation-Toughened Zirconia Ceramics as Bioceramics”, University of New South Wales, Australia, 1995.

  • mac August 5th, 2006

    A pioneer in Z.implants is Prof. Dr. Ami Sandhaus , Lausanne, CH. He has started studies regarding Z-implants for more than 30 years.
    I visited a manufacturer of Z-implants in Switzerland. The ney tehnology makes it possible to produce almost any design of implant including also two parts implants.
    Prof. Ami Sandhaus presented at the intl. Congress of Oral Implantology from Bucharest6 Romania a verry vell documanteted material regarding metalosis caused by dental alloys , including Ti.
    I thonk the future of dentalmaterials belogs to nonmetallic solutions.

  • Anonymous August 5th, 2006

    Are Zirconium implants “safer” than titanium implants? Do they have any health consequences? What health benefits do they have over titanium implants? Can eaith type of implant cause disease?

    And please let us know is medical grade zirconium radioactive? What health effects will or could that have?

  • Dr. Tataru August 10th, 2006

    Zirconium implants have a very high modulus of elasticity compared to bone and therefore induce very high stress forces in the jaw bone. And this is exactly what we should try not to do.

  • Anonymous August 10th, 2006

    Dr. Tataru, so you feel that titanium implants are better for the bone? And if you had to choose between the zirconium or titanium dental implants you would choose the titanium?

  • Anonymous August 10th, 2006

    Is it tougher or more complicated to install a zirconium implant?

    If so, why?

    In other words, are different procedures involved with installing a zirconium implant [that aren’t involved when a titanium implant is installed]? If yes, why are the different procedures needed in the zirconium implant case?

  • Dany February 14th, 2007

    We have been involved with Y-TZP Zr02 (according to ISO 13356) Implants for about 2 years in Europe and so far we achieved highly positive feedbacks from clinicians and patients. There is no doubt that this material requires ample clinical documentation. However, this generation of material can not be compared to what has been in use in the 60’s and 70’s, reference is made to most recent works by Sennerby et al (2005), Piatelli et al (2006) and others. We recognize a trend towards metall-free implant-borne restorations. However, ZrO2 requires a completely different approach in designing and working with such a sophisticated material - it can not be compared at all to Titanium and its alloys. Machining requires perfectly defined parameters and ample quality control (100%!). Although the professional use of this material in dentistry is at its beginning only and a lot of misinformation is circling around. The material and its use will be evolving and will offer great alternatives to titanium implants.

  • Robert February 17th, 2007

    One definite advantage of titanium as the foundation/ root of the implant prosthetic is the fact that it (depending on the implant brand/grade of titanium- something that should be considered far more than it is these days with mountless delivery systems) carries a degree of malleability along with its rigidity.

    With zirconium abutments there is still a challenge that the zirconium does not “give” and will have a higher tendency to crack and break- especially in placements where ideal occlusion was not possible.

    A criticism of the implants of today in general is the lack of a PDL. Wouldnt a zirconium implant just present another weakness in this area?

    Finally, with success rates of 98.6% using titanium the way they are being done today, is the ability to load an implant a week or two earlier or have a little more bone to implant contact such a truly critical factor?

    I see the next generation being more based in genetic tooth regeneration using as opposed to artificial materials.

    Just my two cents…

  • Q April 21st, 2007

    I just found this discussion- I am not subscribed to this, but I will try to leave a comment. I may need implants at some point soon- I have ALWAYS known that I do not want metal in my body. I am really happy to learn of zirconium implants- Does anyone think they will come to the US within 5 years or so?

  • Jem October 3rd, 2007

    I have a titanium implant in the very front of my mouth. I am extremely bioincompatible with titanium, a different issue from inflammation.

    I think this bioincompatibility may be why gum transplants, to build up the gum around the implant, have failed, though creatively contrived.

    I am anxiously awaiting approval of zirconium implants. I understand that posts are approved already, crowns, etc., and that implants were to have been approved in fall of 2006 but were not.

    Any updates on this?
    Thanks.

  • Victoria November 7th, 2007

    In regard to Zirconium Implants:

    What is Polycrystalline?
    What are the ingredients of the coloring agent used?
    **Still waiting for someone with MCS to try the implant and report in on the results or any side affects.

  • Villie November 10th, 2007

    I would like to know if titanium implants cause any health risk. My implants were placed in place of #30 and #31. Can the titanium cause any problems with bones or muscles in other parts of the body other than the oral cavity?

  • Dr. JB November 21st, 2007

    Titanium is not a health risk…even if you have a metallic allergy…the percentages of someone having an allergic reaction to titanium is very very low (like .5% or something like that)…no need to worry unless you are the .5%….even then there are preventive measures you can take.

    Also I read a comment about there are no articles on linking implants to the heart…I think you should so some more research. There are articles coming out every month these days on this. USE GOOGLE - Periodontal pathogens and dental implants….I am not going to get into what they are saying because we all need to do our own research and look at all the evidence from different sources.

    Zirconia has come a long way, however I science doesn’t change….actually I should say the Periodic table hasn’t updated the “Zr” and science can’t change its strength….they are a great idea that came out in the 80’s…as already noted advances have came since then but I still say these are very suseptible to fractures….don’t read the company literature….wait for an independent that isn’t tied to the company in any way shape or form to doa complete analysis on these. Nobel is known for pushing products through their pipeline to get them to the public to be sold. As a doctor, I ask all patients to not be the guinea pig.

  • Piatelly January 5th, 2008

    Regarding zirconia implants, there is an interesting paper “ONE YEAR FOLLOWUP OF FIRST 100 ZIRCONIA DENTAL IMPLANTS IN HUMANS” published in JOMI (2007;22:430-435.
    The success rate at 1 year is 98%.
    I think we should be alert to future investigations about zirconia implants.

  • Bogdan Vladila January 6th, 2008

    Dear Dr Piatelly,

    I published in France in november 2007 my article about using angulated 15 degrees monobloc Zirconium Oxide Implants on humans.
    I placed in last 2 years more then 200 Zirconia monobloc 15 degrees angulated and I am very happy.

    If you want to read my article please write me and I will send you the article translated into english, of course.

    Sincerely,

    Dr. Bogdan Vladila

  • Guy Levi January 8th, 2008

    High success rate of zirconium dental implants is not surprising : in the whole , the main surgical principles of root form implant placement are similar with a little differences between cylindrical and spiral implants , and the regeneration of bone near the zirconium surface supposed to be similar to that of titanium surface.

  • Elaine January 21st, 2008

    On 11-1-01-07, I had a titanium dental implant and returned to the surgeon today. He indicated the x-ray looks great and the tissue/mouth area is pink and looks fine. However, I have occasional throbbing on that side of my jaw. Also, recently my blood test indicated some problems involving elevated Alk Phos, segs,uric acid, Glu, T Prot, Sed rate, and ANA. Could this have anything to do w. a reaction to titanium?? I have never had blood test results w. these problems. I have annual blood tests for thyroid which was removed about 5 years ago.

  • MJM February 2nd, 2008

    Elaine:

    I would be very interested to know the outcome of your situation, as I also require a restorative plan that may include implants, but I have some serious reservations about Titanium, as I have done some research and found information that shows titanuim is not as inert as once thought and corrosion problems are of serious concern.

    The material I read indicated that the titanuim does in fact adversley affect the lymphatic and nervous systems, t-cell issues as well as other problems. I spoke to my periodontist about this information, and he just dismissed my thoughts and became irritated that I am questioning his assurances that Ti is completely safe.

    Here is my email (mjmz2001@gmail.com), please let me know what you find out.

  • Zoe February 2nd, 2008

    I am booked into having titanium implants next week.Is titanium safe in the body? I get contradictory information.If you have had an implant write to me to let me know how its gone for you.

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