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Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 39-42

Zirconia versus titanium dental implants: A systematic review

Department of Prosthodontics, SDDC dental college, parbhani, Maharashtra, India

Date of Web Publication2-Apr-2015

Correspondence Address:
Rahul Patil
B-208, Mansarovar, Chincholi Phatak, Malad West, Mumbai - 400 064, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-6781.154430

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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.

Keywords: Zirconium oxide,biomaterial,biocompatible,bone implant contact

How to cite this article:
Patil R. Zirconia versus titanium dental implants: A systematic review. J Dent Implant 2015;5:39-42

How to cite this URL:
Patil R. Zirconia versus titanium dental implants: A systematic review. J Dent Implant [serial online] 2015 [cited 2022 Jul 1];5:39-42. Available from:

   Introduction Top

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].
Figure 1: Zirconia crystal

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What are zirconium/zirconia/ceramic dental 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 [Figure 2],[Figure 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]
Figure 2: Zirconia discs

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Figure 3: Zirconia chemical structure

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   Evolution of metal free implants Top

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 Top

Zirconium oxide [3]

  • Good chemical and dimensional stability [Figure 4]
  • No effect of magnetic fields
  • Mechanical strength and toughness similar to stainless steel alloys
  • No cytotoxic effects on cells
  • Poor chemical and electric conductor
  • Low porosity
  • High density
  • High compressive strength.
Figure 4: Excellent hard tissue healing

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What are the advantages of zirconia dental implants? [4]

  • Excellent esthetics as metal free [Figure 5]
  • Natural white color
  • Biocompatible
  • Preservation of bone
  • Better gingival health [Figure 6]
  • Neutral
  • First choice in patients with titanium allergy.
Figure 5: Excellent soft tissue health

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Figure 6: Easy implant insertion

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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 ZrO 2 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]

Implant systems providing zirconia implants

Commercial zirconia implant systems currently available are the following: [9]

Figure 7: Cera root - Barcelona

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Figure 8: Sigma - Switzerland

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Figure 9: White Sky - Germany

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Figure 10: Zit-Z - Germany

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Figure 11: Zi Unite - Nobel Biocare

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Figure 12: Z-Systems

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   Conclusion Top

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!!!

   References Top

Andreiotelli M, Wenz HJ, Kohal RJ. Are ceramic implants a viable alternative to titanium implants? A systematic literature review. Clin Oral Implants Res 2009;20 Suppl 4:32-47.  Back to cited text no. 1
Kohal RJ, Att W, Bächle M, Butz F. Ceramic abutments and ceramic oral implants. An update. Periodontol 2000 2008;47:224-43.  Back to cited text no. 2
Hayashi K, Matsuguchi N, Uenoyama K, Sugioka Y. Re-evaluation of the biocompatibility of bioinert ceramics in vivo. Biomaterials 1992;13:195-200.  Back to cited text no. 3
Hisbergues M, Vendeville S, Vendeville P. Zirconia: Established facts and perspectives for a biomaterial in dental implantology. J Biomed Mater Res B Appl Biomater 2009;88:519-29.  Back to cited text no. 4
Blaschke C, Volz U. Soft and hard tissue response to zirconium dioxide dental implants - A clinical study in man. Neuro Endocrinol Lett 2006;27 Suppl 1:69-72.  Back to cited text no. 5
J Biomed Mater Res Part B 2009;519-9.  Back to cited text no. 6
Schultze-Mosgau S, Schliephake H, Radespiel-Tröger M, Neukam FW. Osseointegration of endodontic endosseous cones: Zirconium oxide vs titanium. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:91-8.  Back to cited text no. 7
Depprich R, Zipprich H, Ommerborn M, Naujoks C, Wiesmann HP, Kiattavorncharoen S, et al. Osseointegration of zirconia implants compared with titanium: An in vivo study. Head Face Med 2008 11;4:30.  Back to cited text no. 8
Kohal RJ, Wolkewitz M, Hinze M, Han JS, Bächle M, Butz F. Biomechanical and histological behavior of zirconia implants: An experiment in the rat. Clin Oral Implants Res 2009;20:333-9.  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]

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