Failures with Z System’s Zirconium Oxide Implants: Explanations?

Dr. E, You do not clarify the placement protocols on these ceramic implants. What were the sites like pre-op? Were they completely submerged? 3 mm under surface or near surface? Prep protocols? Long axis and cross sectional shapes? Back in the 70's and 80's a number of synthetic implants were tried after the qualified success of the sub-periosteal and titanium blade implants. As in any bone prep, a hand prep or under 50 rpm prep can be less traumatic (esp. heat-wise) than a higher speed rotational prep, even with sailine cooling. Even an ultrasonic prep can over heat the remaining bone in some situations. So one big question in the failure of some and not others would consider the pre-op and prep conditions. We had some successes with the early synthetic implants back in the 80's, but most eventually became invaded with epithelium. Many patients resisted our removing them even in that "squishy" state, so, if there was no inflammation, we'd leave them in place with a close watch. If the top surface of the implant was close to the level of the periosteum, it would eventually invade the implant/bone interface over time. Of course, the vitreous carbon had a tapering, square or rectangular cross section which was quite an adventure to prep. Let us know what you find out ! John

Also, some site preservation graft materials can actually interfere with the osseointegration, esp. since most are not gone within the 2 month timeline you mention. As for me, in those closely timed procedures, I'd rather skip the graft at extraction, have virgin bone in which to place the implant a month or so later, and place any graft material at the time of implant placement. I don't think you'll be losing a lot more bone in a month or two delay and you'd be gaining a great deal more circulation and new bone cell surface. John

As far as my experience with zirc implants (Whitesky from germany) they dont have better o worse percentages than titanium implants and yes in my opinion they are more sensitive to movement or load,in the early stages of osseointegration.

The question is way too vaque! Let us see the case . With success rates in the high 90% brackets(99%), why would you use anything other than commercially pure titanium? Bv

John, why are you extracting and waiting? Why not place the implants immediately and graft with autogenous, or just place a good membrane . My tone is inquisitive, by the way. If you are leveling the bony arch and placing slightly bigger implants(than original tooth), the pdl. will be drilled out. Since most roots are slightly curved, I am placing these implants in virgin bone, most of the time, anyway. There is typically enough bone on your osteotomy drills, thus obviating the need of going to a donor sight. Bv

If I understand correctly, you are asking "why not all of them succeed". I do not think that it is reasonable to expect 100% success from any one implant system, whether the material it is made of is zirconia or titanium.

If I am not mistaken, all Zirconia implants are "one piece" implants. Therefore, they are placed, and they have an abutment which is subject to load. The chance of non-integration in a pt who is not 100% compliant is amplified.

In the last year and a half or so I have been placing Zirconia implants, 80% of implants placed in my practice are Zirconia implants. Yes, like any other implantable device there are failures.But I like to point out that 2-3 months implantation after bone grafting/soket preservation is not enough time to have adequate and complete bone formation and maturation.Futhermore the type of bone you use can be a major factor in the success (amount of new viable bone versus residual graft material) of your graft. When you adopt new technology and modalities you probably want to start with very simple cases just as you did with titanium.One thing remember also that the surfaces of Zr implants on the market today do not have coatings and bioactive surfaces. Their surfaces are modified (laser etched), therefore there is a delay in the actual bone integration. The initial stability you get is mechanical but the time between the mechanical primary stability and the actual bone integration and stabilityis longer for Zir implants compared to coated Ti implants. Finally since Zr are one piece they are vulnerable to initial macro or micro movements.

Since you mention the brand of the implant on the title, "Z-systems" the surface of this implant is clearly less rough than premium titanium implant systems. If you are looking to work with a rough surface that is to the same level as TOP 5 titanium implant brands, then I recommend that you try the CeraRoot. I have tried several ceramic implant brands. CeraRoot I believe has less than 3% failures, and it really doesn't matter the type of bone. It's all about how the patient avoids chewing on the implant or "playing" with the tongue during the first 1-2 months. I do not recommend the use of two-piece ceramic implants because the mechanical properties are not the same as titanium implants. Ceramics are not flexible, so they don't behave the same way titanium implants do. I know doctors that have had several cemented abutments (from two-piece implants) fracture and having to trephine them out. One-piece implants there might be a fracture every 2.000 implants....

I am looking if there are any dentists in the Pittsburgh, Pa. area that use your system? The dentists I spoke to only uses Titanium and I have an autoimmune disease and am having concerns not only of rejection but other issues down the road due to the autoimmune disease. Any info would be appreciated.

Which brans of zirconia implant do you like best for an upper#7 tooth?