Dental implants have become an essential part of the therapeutic arsenal in dentistry. Titanium implants have proven their efficacy over the last 4 decades, and this treatment option is highly predictable as long as the treatment considers proper patient selection, treatment planning, operator skills and patient expectations.
The use of ceramics dates back to the beginning of implant dentistry. However, it has been the development of new zirconia-based ceramics that has increased the mechanical, esthetic and biocompatible performance of ceramic implants. Recently, zirconia implants have been recommended for very demanding esthetic cases, situations involving mainly the maxillary anterior area, for areas with compromised soft tissue and for patients suffering from metal sensitivity.
Can patients be allergic to titanium dental implants?
Allergy or hypersensitivity is sometimes raised as a drawback of titanium implants. However, it is important to note that allergic reactions appear to be very rare. In one study, only 0.6% of patients showed reactions to titanium in an allergy test.
If the patient is concerned that he or she may be allergic to titanium, it is advisable to refer the patient to an allergist and exercise caution in informing the patient that this is the definitive reason for placing a zirconia implant instead of titanium. If the patient has experienced implant failure and considers titanium allergy as a possible reason, note that “rejection” is most commonly associated with patient factors (such as smoking or hygiene), failure of the osseointegration bioprocess, or challenges of surgical technique.
However, should there be any concern about a possible patient reaction to titanium, a zirconia implant may provide a reassuring alternative.
Benefits of ceramic implants
- Aesthetics
Perhaps the most distinctive but simple difference between titanium and ceramic implants is color. As a white material, the esthetic properties of ceramic are evident, especially in patients with a thin or delicate soft tissue biotype or in cases of soft tissue recession.
Zirconia implants also lead to less mucosal discoloration than titanium. For patients who are very concerned about the potential visibility of titanium, especially in the anterior region, a ceramic implant can be a reassuring solution.
- Soft tissue friendly
Several studies have shown that ceramic implants have better soft tissue adhesion. This advantage is achieved while maintaining an osseointegration (bonding to bone) similar to that observed with titanium implants.
- Less bacterial plaque retention
Ceramic implants show a low or weak inflammatory response as a consequence of lower bacterial plaque retention. These data suggest that the risk of peri-implantitis or bone loss is lower in ceramic implants than in titanium implants.
Challenges of ceramic implants
- Fewer clinical indications
At present, clinical indications are limited compared to titanium implants. The current use of ceramic implants as a solution for tooth loss is primarily for single tooth replacement cases and bridges. There may be additional limitations in surgical and loading protocols.
- Predominantly cemented systems
Zirconia and titanium have very different material characteristics, so ceramic implants cannot simply replicate titanium implants. Until recently, zirconia implants have been cemented systems, which present several drawbacks and create problems during implant placement, in the design of the restoration and in the types of forces that can be exerted. ICOA has led the development of the first ceramic implant that replicates the same prosthetic system as titanium, but with all the biological advantages of zirconia.
- Cost of ceramic implants
The complex industrial process of manufacturing zirconia implants affects price.