Journal of Dentistry and Oral Care Medicine

ISSN: 2454-3276

Open Access
Short Communication
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Dental Implantology: From Titanium to Zirconia Ceramic

Received Date: September 20, 2015 Accepted Date: November 04, 2015 Published Date: November 05, 2015

Copyright: © 2015 Khiari A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The successful use of zirconia ceramics for the fabrication of tooth-supported restorations has encouraged clinicians to extend its application for implant-supported restorations. CAD/CAM technology in combination with zirconia ceramic has increasingly gained popularity in implant dentistry [1]. Zirconia implants were introduced into dental implantology as an alternative to titanium implants. Zirconia seems to be a suitable implant material because of its opacity, mechanical properties, biocompatibility, and low plaque affinity.

Apical bone loss and gingival recession associated with implants often uncover portions of the metal implant, revealing a bluish discoloration of the overlying gingiva. The use of zirconia implants avoids this complication and accedes to the request of many patients for metal-free implants. The inflammatory response and bone resorption induced by ceramic particles are less than those induced by titanium particles, suggesting the biocompatibility of ceramics [2].

Today, the majority of implant manufacturers offer zirconia abutments for aesthetic implant-supported restorations. Abutments are available in prefabricated or customized forms and can be prepared in the dental laboratory either by the technician or by utilizing CAD/ CAM techniques. The biocompatibility of zirconia toward soft connective and epithelial tissue is essential [1]. Moreover, Y-TZP abutments may promote soft tissue integration, while favorable peri-implant soft tissues may be clinically achieved adjacent to zirconia abutments and zirconia healing caps.

Besides strength considerations, Y-TZP implant abutments offer metal-like radiopacity for better radiographic evaluation, and, ultimately, reduced bacterial adhesion, plaque accumulation and inflammation risk. A systematic review revealed that zirconia abutments could maintain an equivalent bone level in comparison to titanium, gold and aluminum oxide ones [3]. In a randomized controlled trial, 20 customized non HIPed-based zirconia single-tooth implant abutments and 20 customized titanium singletooth implant abutments were followed for 3 years, with no fractures or loosening of abutments in both group and a 100% survival rate reported [4].

Journal of Dentistry and Oral Care

Figure 1: Brass master die, A. proximal view, B. occlusal viewMaterials
Figure 2: Stainless steel form with a 45o and 60o angled surface; A. top view, B. profile view
Figure 3: Wax pattern design, cross-section view with occlusal margin angles noted
Figure 4: Cemented restorations with 45º (A) and 60º (B); proximal views showing occlusal margin profile
Figure 5: Instron Univeral Testing Machine (Instron 5565)/Protractor, Custom jig
Figure 6: e.maxTM inlay (45º angle) with the highest value a: 682.5 MPa, b: 762.7 MPa) showing a ''c'' shape fracture pattern
Figure 7: EmpressTM inlay (60º angle) with the lowest value (a: 129.9 MPa, b: 255.9 MPa) showing immediate bulk fracture pattern
Figure 8: Cross-section view of cemented inlay (e.maxTM 60º) after fracture. Divisions below model represent 1 mm increments
Figure 9: Cross-section view of cemented inlay (EmpressTM 45º) after fracture. Divisions below model represent 1 mm increments
Figure 10 Cross-section view of non-cemented and non-loaded inlay (e.maxTM 45º). Divisions below model represent 1 mm increments
  60o 45o P
IPS e.maxTM 494.46 (80.5)a 592.06(103.2)a 0.03
IPS EmpressTM 274.76 (49.9)a 455.31(67.4)a <0.01
p <0.01 <0.01  
a: statistically significant difference (p<0.05) using independent t-tests
Table 1: Mean values (SD) of margin fracture strength (MPa)
Source Sum of Squares Degrees of Freedom Mean Square F-Ratio P-Value
Material 195930.006 1 195930.006 52.598 52.598
Angle 119301.006 1 9301.006 32.027 0.000a
Material*Angle 10611.306 1 10611.306 2.849 0.100b
Error 134101.025 36 3725.028    
a: statistically significant difference (p<0.05), b: no interaction (p>0.05)
Table 2: 2-way Analysis of Variance