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REVIEW ARTICLE

Zirconia versus titanium dental implants:

A systematic review
Rahul Patil

ABSTRACT

Esthetics has taken a prime position in dentistry today.People are getting more diverged to tooth
coloured materials for good esthetics.This article stresses on newer metal free implant materials which
have been developed due to increased demand for improved esthetics and biocompatibility along with
the preference among the general population for non-metal implant materials.

KEY WORDS: Zirconium oxide,biomaterial,biocompatible,bone implant contact

INTRODUCTION What are zirconium/zirconia/ceramic dental

Esthetics has taken a prime position in dentistry today.
People are getting more diverged to tooth‑colored
materials for good esthetics. This article stresses on
newer metal free implant materials that have been
developed due to increased demand for improved
esthetics and
biocompatibility along with the preference among the
general population for nonmetal implant materials.
What are metal free implants?
Implants made of nonmetal materials usually placed in
the esthetic zone. Ceramic tooth implants, specifically
known as zirconium or zirconia dental implants, are
one of these newer forms of dental implants. They are
tooth‑colored, compatible with oral tissues and made of
the hardest stuff next to diamonds Figure 1.
Department of Prosthodontics, SDDC dental college , parbhani,
Maharashtra, India.
Address for correspondence: Dr. Rahul Patil,
B‑208, Mansarovar, Chincholi Phatak, Malad West,
Mumbai ‑ 400 064, Maharashtra, India.
E‑mail: dr.rahulp13584@gmail.com
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implants?
Zirconium oxide
It is a metal oxide identified in 1789 by German Chemist
Martin Heinrich Klaproth. Zirconium oxide is ivory in
color making it similar to the color of the natural tooth,
which is important for restoring teeth in the mouth
especially in the anterior region Figures 2,3. In addition,
its ability to transmit light makes zirconia a suitable
material for esthetics. Zirconium oxide implants have
outstanding mechanical properties, good stability, a high
biocompatibility and a high resistance to scratching and
corrosion.[1]
EVOLUTION OF METAL FREE IMPLANTS
Zirconia evolved as:[2]
• Sandhaus‑first to report on aluminum oxide ceramic
implants
• 1976 Schulte and Heimke ‑ aluminum oxide Tubingen
implant
• 1987 Sandhaus ‑ Cerasand system
• 1988 Kyocera ‑ Bioceram system
• 1990 Muller, Piesold and Glien ‑ Bionit implant system
• 1993–1999 Akagawa, Dubruille – first to try zirconia
implants experimentally
• 2004 Kohal and Klaus‑first case of zirconia implant.
PROPERTIES

Zirconium oxide[3]
DOI: • Good chemical and dimensional stability (Figure 4)
10.4103/0974-6781.154430 • No effect of magnetic fields
• Mechanical strength and toughness similar to

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Patil: Zirconia versus titanium dental implants

Figure 1: Zirconia crystal Figure 2: Zirconia discs

Figure 3: Zirconia chemical structure Figure 4: Excellent hard tissue healing

Figure 5: Excellent soft tissue health Figure 6: Easy implant insertion

stainless steel alloys • Low porosity

• No cytotoxic effects on cells • High density
• Poor chemical and electric conductor • High compressive strength.

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Patil: Zirconia versus titanium dental implants

Figure 7: Cera root – Barcelona Figure 8: Sigma – Switzerland

Figure 9: White Sky – Germany Figure 10: Zit‑Z – Germany

Figure 11: Zi Unite – Nobel Biocare Figure 12: Z‑Systems

What are the advantages of zirconia dental • Biocompatible

implants?[4] • Preservation of bone
• Excellent esthetics as metal free (Figure 5) • Better gingival health (Figure 6)
• Natural white color • Neutral

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Patil: Zirconia versus titanium dental implants
• First choice in patients with titanium allergy.
Zirconia as biomaterial
Results on fibroblasts, lymphocytes, monocytes,
macrophages, connective tissue, immunologic and bone
tissues revealed that the various forms of zirconia tested
on in vitro tissues do not induce any adverse reaction or
global toxic effects.[5]
Microbiological analysis
The prevalence of cocci, few short rods, and no long
rods on ZrO2 surfaces were suggestive of an immature
plaque which shows that early adhesion/colonization
of bacteria on zirconia surfaces was significantly less
compared to titanium, which proves that zirconia and
its derivatives have the capacity to reduce plaque on
implant and tissues, favoring better soft tissue healing
and implant success at bone level.[6]
Zirconia dental implants versus titanium dental
implants
Titanium is regarded as the “gold standard” for
dental implant materials. Numerous studies have
affirmed the high success and survival rates of
titanium implants in many different applications. One
disadvantage is that it can result in poor esthetics,
especially in the anterior region, because of its greyish
color and exposure of the implant body due to soft
tissue recession or if the individual has thin gingival
biotype. Titanium and zirconium are the only two
elements that don’t block implants from integrating
into the bone. In regards to integration with the bone,
zirconium implants appear to offer the same success
rates as titanium implants.[7] Zirconium implants have
an obvious esthetic advantage over titanium implants
being “pure white”, making them indistinguishable
from natural teeth.
Bone implant contact[8,9]
Weeks Titanium (%) Zirconia (%)
4 23.5±7.5 27.1±3.5
8 53.3±27.6 51.9±14
12 58.5±11.4 57.1±12.4
Days Titanium (%) Zirconia (%)
14 36 45
28 45 59
Implant systems providing zirconia implants
Commercial zirconia implant systems currently available
are the following:[9]
42 Journal of Dental Implants | Jan - Jun 2015 | Vol 5 | Issue 1
• Ceraroot (Oral Iceberg, Barcelona, Spain) (Figure 7)
• Sigma (Incermed, Lausanne, Switzerland) (Figure 8)
• White Sky  (Bredent Medical, Senden, Germany)
(Figure 9)
• Z‑Systems  (Z‑Systems, Konstanz, Germany)
(Figure 10)
• Zit‑Z (Ziterion, Uffenheim, Germany) (Figure 11)
• Ziunite (Nobel Biocare) (Figure 12).
CONCLUSION
Titanium, as a biomaterial of choice, has been and is still
largely employed in dental implantology. However, its
corrosion products and individual sensitivities to it are
still controversial. Zirconia can prove a viable alternative
in replacing titanium. A  need for references concerning
resistance to failure in long‑term clinical trials is of
paramount importance for zirconia implants. The only thing
that is constant in life is change. When all restorations are
changing to metal free, why implants should lag behind!!!
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viable alternative to titanium implants? A systematic literature
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How to cite this article: Patil R. Zirconia versus titanium dental implants:
A systematic review. J Dent Implant 2015;5:39-42.
Source of Support: Nil, Conflict of Interest: None.