Zeramex Zirconia Impant Case on Tooth 13

Here is an interesting case using a Zeramex Zirconia Implant. Patient presented with pain on the tooth #13. All options were explained and the patient decided to replace the tooth with a dental implant. The case was evaluated by CBCT and Invivo software and proceeded under IV Sedation. The PDL and alveolar bone were decontaminated with diamond bur on surgical hand-piece with NS0.9%, copiously irrigation and Ozone Infusion. A Zeramex USA #13 (3.3 x 10 mm) was placed and torqued to 30 Ncm. Bone graft was done with Augma Bond Apatite Bone Cement, PRF and a Collagen Plug. (Case done by: Luis A Alicea DMD MSD)

40 thoughts on: Zeramex Zirconia Impant Case on Tooth 13

    • David Sandak says:

      The patient that opts for this particular treatment with those specific irritants and grafting materials, opts out of RCT as a procedure filled with ‘contaminants’. I agree, it’s most predictably treated w endo and a crown. But more and more patients in my practice, with ‘material issues’ and history of Lyme’s Disease are contacting me directly for ceramic, ‘non-metal’ fixtures.

      • Dr. Luis A. Alicea says:

        I respect you point of view, however any periapical lesion, gran negative infection the pH will be below 7. I used ozone infusion to decontaminate the area the best I could. This create an irritation. The bone graft I used was Augma B- TCP the pH is 8 to 10.8 it is more biological compatible, create a minor irritation for the difference in pH but the bone healing and neutralize the gran negative bacteria.

  1. Ian says:

    I don’t understand the reason for extraction on this tooth. It is possible a root canal did not have to be done. Even if it did, it looks to be restorable.

  2. Susan says:

    I’m a periodontist. I also think this looks nice, poss a bit deep, but I would yield to the judgement of the clinician there. Truly, i would have encouraged endo and a crown as well.

  3. David Levitt says:

    Why PRF and collagen? One or the other would be more than adequate. Ozone infusion and a non-metallic implant? Are you one of those dentists who doesn’t “believe” in endodontic therapy? Is there a history of endodontic therapy failing on this patient? I am a frequent expert witness in malpractice trials and I’d have a tough time defending that extraction, especially without a periapical x-ray.

  4. Dr. Luis A. Alicea says:

    Not really the patient came this week with pain as emergency. The initial x-ray was from December 2017. The patient does not like over exposure of x-ray and I consider not necessary another one, only with percaution know what the tooth are in problem. All the options were explained to the patient and she said that she does not want the root canal treatment. If the nerve was exposure. She like to replace by metal free implant (zirconia dental implant) only. We are a holistic office and the patient too. Even we are holistic office we explain all options and if the patient want to keep the tooth with RCT, we do not do RCT in our office and refer the patient to Endodontic Specialist. The tooth #12 was repaired with DO composite filling, However, tooth #13 the decay was in the pulp chamber and for that reason was replaced by Zirconia dental implant.

  5. Dr AZ says:

    Thumbs up on presentation. You would have had a better arguement had you left out the “holistic” approach. Dentistry is evidence and fact based. Holistic sounds very bs to me. I’m sure I’m not the only one who feels this way.

    • drdave says:

      You say Potato, I say Patahto. There is actually no specific accepted definition of holistic dentistry. It means different things to different people. Usually it’s patients that drive much of what is marketed as “holistic” dentistry. As long as you provide these patients with clinically sound treatments, as is the case here, that’s all that ultimately matters.

  6. Julian O'Brien says:

    I have placed implants for 25 years and done endodontics for 45 years.
    There is an undefined demarcation line wherein the best option is an implant. Any tooth with major decay or endodontic problems down the years can pose the patient with vexing complex expensive problems whereas a simple extraction and immediate placement with immediate loading has its merits in simplicity and financial comparison.
    An excellent restored tooth may be only one bite away from splitting whereas a successful implant has a simple future: failure can often be painless, and an oversized implant can be placed immediately. A good implant outcome will be less trouble than a tumultuous endodontic restorative election.
    Me? I would opt for an implant rather than the sequence of pus, extirpation, dressings, obturation, post and core, crown impressions then a pork gristle or toffee and all is lost. It is certainly the patient’s decision yet it behooves others to not judge the multi-factorial reasons why that decision was and remains valid.

  7. Luis A. Alicea says:

    I respect your point of view! I because had the same of you three year ago ! One of my best friend was intoxicated with Mercury, 400% more than a person live in Alaska and the diet is wild catch fish. He only removed Amalgams and replace by filling or crown without any protection. Sorry, with protection a mask with level 1 filtration. He lost gran portion of his hair and felt dissy all the time. He stop to work for a few months and the only work to reduce the high level of mecury was IV infusion of EDTA ( chelation therapy) . Yes!!!!!! the same we used.
    The ADA said !!!The mercury is safe in amalgams !!!!!!bbbbbbbssssss!!!! Now the Depart of Health require for 2020 All dental office in US with Amalgam separators and need to change every 10 years. Why???? Because the mercury level in the water is super high. Who sallow and take a shower with ???? you and me😝😝😝 I started to feel like my friend and I started losing hair. I started looking for information and learn from them. My recommendation if you like to take it! is protect yourself because when you are pushing flower inside a sarcophagus it will be too late. The RCT is another theme, I respect the endodontic specialist point to safe the tooth but I saw other point in the patient health. My friend open your eye!!!!then you will validate the word Holistic !

  8. Sam says:

    Option implant should not have been mentioned to patient in this case at all unless you think that’s one of the good options.
    Would you have done this to your first family?

      • Ernest Agajanyan says:

        I was wondering as to what type of an explanation or an excuse a holistic dentist would follow and provide in the event when someone needs heart stent or titanium screw or joint replacement surgery. Would you advise on to have you leg cutoff or accept cardiovascular event only because you do not believe in titanium prosthesis, only because u think it causes headache, depression and possibly linked with material issues and Lyme’s disease. Certainly, in my practice if not the filling, it would have been RCT, Post/Core, Crown and with no mention of implant surgery. Also, if you are too concern of toxicity posed by endodontic sealer maybe you could look into resin-based sealers, for example, AH26, AH Plus, Diaket, they maybe not be as toxic.

        • Michael Foley says:

          I think in a modern practice, ‘holistic dentistry’ is simply a mindset or an approach to life that attempts, as much as possible, to make the healthiest of choices. It would obviously be impossible to avoid metal in some instances, ie. a titanium screw in a broken hand… For dental implants this is not the case, Zirconia implants have evolved to offer identical success rates, similar treatment plans and clinical ease of use as titanium. Why fault the clinician or patient for making an informed choice?

  9. Ed Dergosits says:

    Does this patient know that the screws used to attach the abutments to the implants are made of Titanium? Lets get real. This whole “metal free” thing may sound appealing to the weak minded but is actually a complete farce. Zirconium oxide is a METAL.

    • docs says:

      With all due respect, it is not weak minded to believe in the truth of modern physics and chemistry. Zirconium oxide is a ceramic, not a metal.

      According to modern science, when you combine elements you form new compounds with new properties that don’t share the properties of the individual elements. So, for example, when you add oxygen to hydrogen, it becomes water. When you add oxygen to carbon it becomes carbon dioxide. The compounds have different properties than the original elements and they are different.

      So while Zirconium is a metal. Zirconium dioxide, which is formed with the addition of oxygen to zirconium, is not a metal. It is known in physics/chemistry as a ceramic, and it has different properties than metals (e.g. ceramics don’t conduct electricity, they are insulators, while metals conduct electricity). Yes, adding oxygen to a metal, changes it into a ceramic. Magical, but that’s atomic theory.

      Of course, you are free to deny the above truths of modern chemistry, and continue to deny the existence of ceramics, but then you might try subsisting on a diet of hydrogen and carbon dioxide. Better yet, learn about ceramics: http://ceramics.org/learn-about-ceramics/structure-and-properties-of-ceramics

      • Julian O'Brien says:

        I just cannot believe that a dentist would NOT know the difference between a metal and a ceramic. Must have been written by his mum?

    • Michael says:

      The screw is actually really interesting! The VICARBO screw is comprised of carbon-fiber threads that are continuous and running vertically down the screw. Having many threads, we can achieve enormous strength.
      Modulus of elasticity: >160 GPa.
      Flexural strength: >1100 MPa.
      Tensile strength: 2000 MPa.

  10. michael says:

    The ‘Wellness’ movement will not be stopped. Americans are educating themselves and choosing products that are the least harmful. This is occurring in every daily decision from the foods people select, to the travel destinations, to their medical choices.

    Every dentist would be remiss to not incorporate and encourage some wellness concepts and treatments into their practice.

    Those who do not evolve with consumers’ changing demands will wake up one day realizing:
    ‘This isn’t niche anymore . It’s eating into my share’

  11. roadkingdoc says:

    After having done dentistry for forty years, I always suggest treatment I think is in best interest of the patient. This case looked to me like a simple endo and ceramic crown. If after having explained all options the patient request removal and implant I can live with that. My experience is that not all implants are successful, they can fail but not at the rate of endo teeth. Complexity of the endo and restorability of remaining tooth structure have a big influence on what treatment I suggest. A well done implant vs a well done endo ,my money is on the implant in ten years, particularly if the endo is a molar. Great discussion here thanks to all contributors!

  12. Implant Guy says:

    I am a 100% ceramic guy and have seen and try all teh systems out in the market, this is for sure a challenge of a case.

    I have had my doubts on the pastic screw and seen breakage BUT metal screws also break and both cause micro leakage.

    Thanks for sharing!

    • Michael Foley says:

      @Implant Guy The VICARBO screw is the key to the success of this system. It has been in the worldwide market for 6 years with tremendous success. The screw is exceptionally strong.
      Where as titanium screws are one solid piece, the VICARBO screw is comprised of many carbon-fiber threads that are continuous and running vertically down the screw. These threads are bound together with medical PEEK. From an engineering perspective, carbon fiber is very strong, lightweight and flexible. By having many threads, we can achieve enormous strength and it works to efficiently handle the stress in between the two parts of very hard zirconia.
      Again, here are the stats on the VICARBO screw:
      Modulus of elasticity: >160 GPa.
      Flexural strength: >1100 MPa.
      Tensile strength: 2000 MPa.
      – As a comparison point, the tensile stregth of titanium is 1200! This screw is nearly double the tensile strength of titanium.

      • Michael Foley says:

        I can guarantee that in the US market, ZERO screws have been sent in for evaluation! The only broken screws that I have seen is when the lab screw was incorrectly used in place of the definitive VICARBO screw.

      • Michael Foley says:

        Regarding the microleakage, this is one of the major benefits and differences of ZIRCONIA vs. TITANIUM!
        Titanium is a very soft, malleable metal. Under occlusion, as we have all seen, the connection of the implant to abutment will have considerable micro-movement.
        ZIRCONIA has different properties and different mechanical strengths and weaknesses. Regarding micro-movement and micro-leakage: these are two reasons that ZIRCONIA implants will change the dental implant market.
        First, ZIRCONIA is exceptionally hard and inflexible. The connection of implant and abutment is like two pieces of glass laying flat onto each other. The micromovement is nearly non existent.
        Second, bacteria and plaque do not adhere to the surface of ZIRCONIA as with titanium. So any potential leakage is diminished.

  13. Dear DDS says:

    I think somebody here was thinking more about his daily production than patient’s benefit.
    Please, be honest to yourself, doctor.

    • Dr. Luis A. Alicea says:

      First, The patient no believe in RCT and by the way she is a PA assistant of a holistic office, I did as a courtesy! You do not need to do an extensive research only place in Goggle search; Root canal and cancer and show more than 22 million of articles and 97% of cancer patient had Root canals. I treat a lot of Cancer patient and I can relate these information. If you read the book of Dr. Meing, Maybe you change your mind. If you like to continuing place the health of your patient in jeopardy. I respect your opinion,.

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