Dental Zirconia Implants

That is a great question. As previously stated, it is a “give and take”, or Yin Yang ☯. It is difficult to really say if Zirconia is better than Titanium because it depends on what the application is and what your personal priorities are. Titanium has been around much longer, has more investigations and clinical studies, and decades of evidence proving it as a reliable and successful biomaterial for dental implants. Titanium alloys have improved since their inception. The greater the grade of the alloy, the less impurities and more biocompatible the titanium is. Grade 5 titanium is now offered as a dental implant.

On the other hand, Zirconia has emerged as a promising alternative to conventional titanium-based implant systems. Zirconia is reported to have superior soft tissue “gum” response in the mouth, is extremely biocompatible, and produce more natural esthetics than titanium implants.

Additionally, studies have shown that titanium and zirconia implants have a very similar bone to implant contact or osseointegration (Manzano et al. 2014). This is a very important consideration in implant success and determines the stability of the implant in the mouth and during function. Consider the following advantages and disadvantages of Zirconia implants below:

Zirconia Implants:

1. Zirconia implants are considered to be Metal Free
   1. Zirconia Implants are made from oxidized zirconium forming zirconium dioxide (ZrO₂)
2. Zirconia implants are Biocompatible
   1. Dental plaque and tartar have difficulty adhering to zirconia implants
   2. Less plaque means less gum inflammation around a zirconia implant
      1. Less inflammation means healthier gums
      2. Peri-Implantitis or inflammation around dental implants is the number one cause of titanium implant failure
         1. 90% of Titanium implants will experience some form of Peri-implantitis in their first 9 years of use, most much less
         2. Zirconia dental implants which have a less than 2% instance of peri-implantitis in the long term
   3. Zirconia implants have more normal and natural blood flow around adjacent gum tissue
      1. Titanium implants can have up to a 20% decreased circulation on adjacent periodontal tissues
   4. Allergies to titanium in dental implants are rare but have been reported
      1. Titanium implants are metal alloys, some of which are very reactive to body tissues
         1. Iron, Manganese, Chromium, Tin, Vanadium, Molybdenum, Zirconium, Niobium, Zinc, Tungsten, and Nickel (Chaubey et al., 2019)
3. Zirconia implants are corrosion-resistant
   1. Titanium implants are composed of titanium and other metal alloys which include Nickel, a highly reactive metal to which, according to the CDC, 10% to 20% of the population has an allergy
   2. Cheap jewelry has high nickel content
4. Zirconia is a poor electrical and thermal (heat) conductor
   1. There is no concern of a galvanic or battery effects with zirconia implants
5. Zirconia implants are attractive
   1. Natural WHITE color like TEETH
      1. Titanium is dark grey
   2. No chance of any dark color showing through the gums.
      1. Black gum shadows
6. Zirconia implants that have a two piece design enjoy the same initial success rate of their titanium counterparts

Zirconia, otherwise known as Zirconium dioxide (ZrO₂), is a ceramic consisting of the elements Zirconium and Oxygen (1 atom of Zirconium & 2 atoms of Oxygen). Zirconium is the 17^th rarest element on Earth, exists as a silver-grey malleable metal, its ductile in nature, corrosion resistant, has an atomic number of 40 making it a transitional metal or Metal Halide and resides just below Titanium on the periodic table of elements. Therefore, Zirconia implants contain metallic atoms of Zirconium, but are not considered a metal due to its metal oxide structure (ZrO₂). The addition of the oxide chemically changes the composition structure, behavior, and name.

Zirconia dental implants are typically marketed as a non-metal alternative to titanium implants. Zirconia is a ceramic material that is white in color. For many, it comes as a surprise that ceramics contain both metals and non-metals.

A ceramic is a solid material comprising an inorganic compound of metal or metalloid and non-metal with ionic or covalent bonds.

Actually, there is no difference! Zirconia is a specific type of ceramic. All ceramic implants are made from zirconia; so in-so-far as zirconia/ceramic relates to dental implants they are synonymous. Ceramic is a more familiar word for most people, so it has been used more in the past. Now that Zirconia as a terminology is developing into more of a household name, you are more likely to hear about “Zirconia” implants because “Ceramic” makes people think of pottery or tiles rather than dental implants!

To know what zirconia implants are, let’s discuss the beginnings of dental implants. The first dental implant was made from titanium alloy and was placed in a human volunteer in 1965, by a Swedish medical orthopedic surgeon, Dr.Per-Ingvar Brånemark. While researching bone healing, he discovered that bone tissue would fuse to the metal titanium in a process called osseointegration. The success of the first titanium dental implant quickly led to significant improvement in the techniques used for tooth replacement. Since its inception, titanium implants have been the dental implant industry standard. With many decades of great clinical success and innovation, titanium implants have become one of the most successful medical devices in all of medicine with long-term success rates between 94-97%. Zirconia implants are the “Metal Free” alternative to titanium implants. Zirconia, or Zirconium dioxide (ZrO₂), is a ceramic material first created in 1975 by a British physicist named Ron Garvie. Zirconia was found to be a highly biocompatible material, used in Europe as a dental implant in 1987. By 2011, the company CeraRoot had the first FDA approved zirconia dental implant here in the United States. Zirconia implants have recently gained much attention with the Biomimetic and holistic-minded dental patients looking for metal free tooth replacement.

Current health trends have been moving towards avoiding the use of metals in our bodies. An alternative dental material to titanium alloys exists in the form of zirconia for dental implants. Patients frequently ask, “Are zirconia dental implants healthier than the titanium?” There is no simple answer to this question. Better, one should consider there is always a give and take to all things and to understand the potential benefits and limitations of zirconia dental implant options. A discussion with a skilled dentist who routinely placed implants is always a good start.