Zirconia Dental Implants
Dental implants are used to replace missing teeth. In the early 1950s, a Swedish scientist discovered that titanium is highly biocompatible and non-corrosive, and, since the 1960s, dental implants have been made of titanium. However, growing numbers of patients have begun to seek non-metallic alternatives to titanium for their dental implants. With this in mind, dentists have adopted the use of zirconia as an alternative option for dental implants. Zirconia implants were first introduced in 1987 and were approved by the United States Food and Drug Administration for use in the United States in 2011, following their extensive use and demonstrated biocompatibility and stability in Europe. Since zirconia implants received FDA approval, more and more clinicians are researching the qualities of zirconia and improving the manufacture and design of zirconia dental implants. While zirconia is not a good option for everyone or for all implant procedures, for some patients and in some clinical situations, zirconia may be preferable to titanium. Zirconia has been found to be non-reactive and non-toxic, strong, and biocompatible, though it has not been in use long enough to accurately determine its average lifespan. Because titanium has been used longer, there are more clinical studies that support its use, as well as years of evidence that prove its long-term efficacy and success.
Zirconia is a ceramic material. Also known as zirconium oxide, zirconia is white and luminous. Although it is presented as a non-metallic alternative to titanium, zirconia does contain some metallic materials; however, because of the atomic structure of the material, these metallic materials are inert and do not behave in the same way as metals. This makes zirconia a good option for patients who prefer not to have metal in their bodies, either out of fear of allergy or resistance or simply as a matter of preference. Zirconia is also highly responsive to soft tissues, biocompatible, and, in many cases, a better aesthetic choice than titanium. It is a promising alternative to titanium dental implants for many patients, for a variety of reasons. When weighing the pros and cons of titanium and zirconia dental implants, a number of factors come into consideration.
First, zirconia implants may provide better aesthetic results than titanium implants. This is due to the white color of zirconium. Sometimes, dental implants can be seen, even slightly, through the thin tissue of the gums. Titanium, which is silver or gray, can cause a grayish cast to appear through the gum tissue, while zirconia implants do not allow any darkness to appear through the gums. Second, zirconia appeals to patients who are allergic to titanium or to other metals that may be present in titanium implants. Although allergies to titanium are extremely rare, they do exist. Additionally, depending on the manufacturer and the type of implants, implants that are billed as titanium can be made of as much as 10% other metals. These other metals can include chromium, iron, manganese, molybdenum, niobium, nickel, tin, tungsten, vanadium, zinc, and zirconium. While more reputable manufacturers list the composition of their implants, not all manufacturers provide this information, adding to the risk of titanium implants for patients who have allergies or reactions to certain metals. In addition to aesthetics and allergies, zirconia implants can help resist the amount of plaque and dental calculus that build up around implants, as well as reducing the likelihood of infection around implants. Zirconia strongly resists corrosion, and it does not conduct electricity or heat, which prevents the risk of galvanic or battery effects when zirconia implants are present.
While zirconia does confer some significant benefits, it is not without its limitations. Because they are relatively new on the U.S. market, different types of zirconia implants are still being developed. There are currently only limited options for the designs and parts of zirconia implants, though more and more are developed regularly. It was only as recently as 2019 that a two-piece zirconia implant with a screw-retained abutment was introduced onto the market, and similar innovations will continue to develop as both implants themselves and zirconia implants gain in popularity. However, the limitations in the number of available designs and components can pose limitations on the use of zirconia implants. It may be impossible to arrange the optimal configuration of implant-based restorations when zirconia components are preferred, and this is especially difficult when several teeth need to be replaced; for single-tooth restorations, zirconia is often a suitable option. Additionally, simply due to their novelty, the long-term success of zirconia implants has not yet been proven. While titanium implants have been improved upon for decades, helping increase the success rates with titanium implants throughout the years, there is insufficient evidence to support the long-term success rates of zirconia implants, and complications that may arise over the long term are as yet unknown.
Zirconia is also more brittle than titanium and is more likely to fracture when bent than titanium. Therefore, zirconia can be expected to carry a higher risk of fractures and complications in the long term. This can be especially problematic when the implants themselves are smaller in diameter, which may be necessary when the patient’s bone is thin or when there are small spaces between the teeth; studies indicate that implants that are smaller in diameter than 4 mm are more likely to fail. Zirconia implants are not often recommended for particularly complicated dental restorations or for use with implant-supported dentures, and they are not favored for patients who are missing all of their teeth. These treatments require extensive planning and can rely on a number of different types of implant components, with varying sizes and angulations, many of which are not currently available in zirconia.
While clinical studies indicate that zirconia is safe and can be considered a valid alternative to titanium dental implants, it is not a perfect alternative and carries its own limitations and risks. A consultation with a dental implant specialist can help you determine if zirconia implants are recommended for your dental restoration needs, or whether you may want to stick with tried-and-true titanium for your permanent dental restoration needs. As more and more patients choose zirconia, more evidence will arise, and more innovations will take place, helping potential patients determine whether zirconia dental implants are a good option for them.