People are becoming more aware and concerned about the materials that they come in contact with and the impacts it can have on their overall safety and health. When choosing dental implants, patients want materials that are minimally toxic and reactive. In addition, evaluating the manufacturer quality, clinical success, strength, and design are important when selecting which implant system to use.
Given the heightened concerns regarding health and safety, the trend is moving away from using metal in the body. Zirconia is one metal-free alternative to titanium for dental implants that patients are increasingly curious about. Often, patients want to know if zirconia implants are superior to titanium dental implants. To better answer this question, this article will examine the benefits, risks, limitations, and availability of zirconia dental implants.
Zirconia Dental Implant Overview
Dental implants are restorations designed to replace lost teeth. Since the 1960s, titanium has become the industry standard material for dental implants because of its ability to fuse with bone. Given several decades of clinical research, development, and innovation, titanium implants have success rates of 94 to 97 percent making them one of the more successful long-term treatments in medicine.
Developed and released in the late 1980s, Zirconia dental implants offer a metal-free substitute to titanium. With demand for holistic and Biomimetic dentistry increasing, Zirconia has gained attention in recent years. New clinical research is ongoing to investigate improvements in design and manufacturing processes.
What is Zirconia Made of?
A white ceramic material, Zirconia dental implants are often marketed as non-metallic substitutes for titanium. Many are surprised to learn that in actuality, Zirconia contains both non-metals and metals. Also called Zirconium dioxide, Zirconia is a ceramic that consists of the elements Oxygen (2 atoms) and Zirconium (1 atom). As such, Zirconia dental implants are not considered metal because of their metal oxide structure despite containing metallic Zirconium atoms. As an oxide, the composition name, behavior, and structure are changed.
Are Zirconia Dental Implants Superior to Titanium?
The answer to this question will depend on what the patient prioritizes. Because it has been in use longer, titanium has the benefit of decades of clinical studies showing its efficacy and reliability as a successful biomaterial in dental implants.
However, Zirconia is showing promise as an alternative to titanium dental implant systems. Some studies indicate Zirconia has superior esthetics, biocompatibility, and soft-tissue response compared to titanium implants. In addition, studies show that zirconia and titanium implants have similar abilities to fuse with the jawbone. Known as osseointegration, this fusion process is vital to the implant’s long-term success and determines how stable the implant is in the mouth and when functioning.
As with any medical or dental treatment, there are benefits and drawbacks to consider when evaluating Zirconia dental implants.
Benefits of Zirconia Dental Implants vs. Titanium
Superior Esthetics: Because they match the color of natural teeth, Zirconia implants do not run the risk of dark colored material being visible through the gumline. In the esthetic zone, this is an advantage over titanium which carries the risk of tissue grayness or discoloration showing through the gums.
Suitable for Patients with Metal Allergy: An allergy to titanium or the other metals used in titanium implants is often a primary reason patients opt for Zirconia implants. Although exceptionally rare, there have been reported cases of patients experiencing allergic reactions to the titanium in dental implants. Despite implants containing between 89-99% titanium, they also contain varying amounts of metals like Manganese, Iron, Tin, Chromium, Vanadium, Zinc, Tungsten, Molybdenum, Nickel, and Zirconium. While implant labels should list their composition, the is unfortunately not the norm.
Reduces Plaque Buildup Around Implants: Certain studies suggest Zirconia dental implants result in less plaque and calculus buildup than titanium. This can help promote gum health and lower the risk of infection developing around the implants. This is particularly true when a single-piece Zirconia implant system is used.
Resists Corrosion and Thermal Conduction: Zirconia implants have no battery or galvanic effects associated with them making them poor thermal and electrical conductors. In addition, Zirconia has shown excellent corrosion resistance.
Drawbacks of Zirconia Dental Implants vs. Titanium
- Limited Design and Component Options: Because they have not been in use as long as titanium implants, the development cycle of Zirconia implants is still somewhat early. Certain important design improvements, like two-piece screw-retained abutments, only have been available in US markets since 2019. As such, the options for Zirconia dental implant parts and designs are limited in comparison to titanium. With challenging restorations, particularly if replacing several teeth, this limitation can make optimal results impossible to achieve. For single tooth replacements, this is typically not a major concern.
- Questionable Long-Term Efficacy: The long-term success and efficacy of titanium implants is bolstered by several decades of clinical research and development. Because they have undergone years of innovation and design improvements, they have long-term rates of success between 94-98%. Because Zirconia lacks this historical track record, there are questions about its long-term survival and potential for complications when used in dental implants.
- Fracture and Strength Resistance: Compared to titanium, Zirconia has lower flexural and fracture strength and is more brittle. Despite being strong when compressed, Zirconia is more prone to fracture under flexing or bending forces than titanium. As such, Zirconia may have higher risks of fractures or long-term complications.
- Limited Applications: For patients missing all their teeth or who require implant dentures, Zirconia implants are typically not suitable. Treatments of these types require significant planning and a variety of components. Because titanium comes in a wider variety of components in various sizes, purposes, and angulation, they are more versatile when compared to Zirconia.
- Small Diameter Zirconia Implants Risk Fracture: Often when placing dental implants, oral surgeons have to use small diameter implants when patients have small space between their teeth or thin jawbone density. Typically, implants between 3.0-3.75mm must be employed in these cases. However, one research study indicated that every Zirconia implant less than 4mm that was placed, resulted in catastrophic failure (Clinical Oral Implant Research, Thoma et al 2015).