Differentiated Osseointegration with Zirconia Implants : Any Comments?

Dr. M asks:

Can anyone comment knowledgeably about the work of the Vienna team Kocher & Pirker, who are working with zirconium oxide to create individualized models (“bioimplants”) of extracted roots, a process they call differentiated osseointegration?

Editor’s Note: According to Kocher and Pirker:
“None of the prefabricated and axially symmetric Titanium/Zirconia dental implants currently on the market fits perfectly in the individual tooth socket when immediate implantation is performed. The gaps between implant and bone must be filled with bone or bone substitutes and in addition stabilized and covered with barrier membranes for esthetic and functional reasons.

In contrast to these complex and costly procedures, an exact fit and perfect esthetic outcome is simply and safely achieved, by taking advantage of the up to date principles of differentiated osseointegration, the use of Zirconia, a highly biocompatible implant material, combined with the application of the latest CAD/CAM technology.

Wolfgang Pirker: “Respecting the anatomy of the soft and hard tissue by using individual anatomically formed Zirconia implants for immediate root replacement renders drilling, risk bearing augmentations and barrier membranes absolutely unnecessary. This minimal invasive method enhances patient acceptance and maximizes esthetic outcome.”

14 Comments on Differentiated Osseointegration with Zirconia Implants : Any Comments?

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"The gaps between implant and bone must be filled with bone or bone substitutes and in addition stabilized and covered with barrier membranes for esthetic and functional reasons." It's not true. Some of the implants are favorable of distance osteogenesis.
Alejandro Berg
"The gaps between implant and bone must be filled with bone or bone substitutes and in addition stabilized and covered with barrier membranes for esthetic and functional reasons." This is not only false but also in general slows the new bone formation "The influence of Bio-Oss collagen on healing of an extraction socket - An experimental study in the dog Authors and reference: Araújo M. Linder E. Wennström J. Lindhe J. April 2008 Int. J. of Periodontics and Restorative Dentistry Vol. 28 No. 2 pp 123-135 Grafting of tooth extraction sockets with inorganic bovine bone or bioactive glass particles - Comparative histometric study in rats Authors and reference: Calixto R. Teófilo J. Brentegani L. Lamano-Carvalho T. September 2007 Implant Dentistry Vol. 16 No. 3 pp 260-269 Dental implants placed in extraction sites implanted with bioactive glass - Human histology and clinical outcome Volume 11, Number 1, May 2002 Norton M.R., Wilson J.; Int. Journal of Oral and Maxillofacial Implants; Vol. 17 No. 2 pp 249-257; April/2002 Also the use of such implants is not for most cases, since this need to fit into a fresh socket and in many cases we do or need to do delayed implant placement or there is no ral socket and you need to put an implant get stability and maybe graft... too much research would have to be done and yet for a small percentage of cases. I guess this pressure fit system since is not standard would need lots of work(machined zirconia is not sterile) so more time during surgery (and we all know how patients love that). Dont see the upside since I do inmediate loading inmost of my inmediate placing with very nice results.
Dr. Morales Schwarz
Interesting... I think we all must keep an eye on that. A few doubts: How will a thin buccal alveolar wall respond to those devices? Will the alveolar resorption be stopped or not? If the answer is no, there is still a lot of research and work to do.
Peter Fairbairn
Main issue with Zirconia is that it is not a semi-condutor whereas Titanium is ,thus osseointegration will not be comparable ( Problems with zirconia Hips).As to grafting the peri implant socket , material choice is critical.We need a material that is fully resorbed at 4 to 6 months , so as not to affect the implant bone interface (HA??).Sure 1mm even more of a gap the bone will grow (botticelli)but the quality of bone will be better with resorbable graft material present especially at the vital crestal area.
Dr. Vilches
In addition, the surface that is obtained to mechanize the zirconium is little rough, what it is translated in a slower osteointegración and of worse quality. And, which are the mechanical properties? No better than the titanium, sure.
Dr HArold Bergman
I assume by bone substitutes you mean bone grafting materials. Whatever happened to the "pre-implant era" good old blood clot filling in the tooth extraction socket after a routine extraction and eventually becoming bone. Blood can be a "bone substitute" and a good one and very inexpensive. Dr Bergman
sonia bessa
Regarding the comment of Dr. Bergman where he says that Blood can be a "bone substitute", what happens to a root which had an abcess next to it and during the cleaning procedure (removal of a small amalgam filling from old surgery where 10% of tip of root was cut out)the periodontist used saline thoroughout. He didn't do another filling and said that bone would grow around it. When the small surgery was done and stithes done the gum was already looking almost healed (pale). During recovery there was no swalowing or bleeding. could the fact that he used saline and the non bleeding situation slow down the process of growth of the bone?
dr david harpaz
Interesting idea, we must keep on eye on it. We are not there yet. dr david harpaz
R. Hughes, DDS
The clot forming in an ares where you have had recent trauma is part of the angiogenic process alomg with the RAP, which facilitates bone regeneration. However a 5 wall defect (natural or man made) is essential. Saline has nothing to do with this.
mike stanley, asst.
I read that Press Release a while back. First, it sounds like a lot of work to replace existing prefabricated systems that work pretty well. It seems to me, (non doctor that I am) that an atraumatic removal would leave a very different environment for osseointegration. Wouldn't there be periodontal ligament tissues left behind? Thin layer of socket bone (name escapes me, sorry) nearby. Not a nice 'fresh' osteotomy with bone and blood. How would that affect integration, healing, infection, etc? It's very interesting technology though.... taking 'Root-Form' implants to the next level.
hyesuk kang
is anyone in uas doing this? if so, how can i get in thouch with. Thank you for the good info hyesuk
DR. Larsen
Dr. Pirker's novel implant system is revolutionary for those interested in providing safe minimally invasive implantology. His system is ideal for those who have good bone surrounding a tooth that needs to be removed (not good for periodontally involved teeth). I am currently doing a clinical trial on the system here in the USA.
Any update? Is this available in the U.S.?
Craig Ellis
This method is very interesting, and makes a lot of sense. My question is in regards to the extraction process. My understanding is that the extraction must be done carefully so as not to disturb the periodontal membrane, or ligament. In a biological tooth extraction, however, my understanding is that the ligament is completely removed down to solid bone, so as to avoid future cavitations. Is it true that the ligament is preserved in this Bioimplant method, and what happens to it as the socket heals?

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