For the past 50 years, titanium alloys have been the material of choice for dental implants, forming the foundation for full-arch, implant-supported restorations, particularly with the introduction of the All-on-4 treatment by Maló et al. two decades ago. However, zirconia implants have undergone substantial advancements in the last 15 years, emerging as a reliable, though more complex, option for full-arch restorations. As these ceramic implants have gained success, there has been a marked increase in patient demand for metal-free implant solutions in full-arch cases.
Rising Demand for Metal-Free Implants
Patients seek metal-free dental implants for various reasons, including metal allergies, concerns about systemic inflammation, exacerbation of chronic conditions, or dissatisfaction with previous titanium implants. On the practitioner’s side, titanium implants are commonly associated with complications such as peri-implant mucositis and peri-implantitis. Studies have indicated that peri-implant mucositis affects 40% to 80% of titanium implant patients, while peri-implantitis occurs in 10% to 56% of cases.
The underlying causes of peri-implant diseases are multifactorial, but growing evidence suggests that the degradation of titanium alloys and the cytotoxic effects of metal particles in local tissues may play a significant role. Research has shown higher levels of dissolved titanium in submucosal plaque surrounding implants affected by peri-implantitis compared to healthy implants, further highlighting the connection between titanium implants and the prevalence of peri-implant disease.
Zirconia Implants: A Promising Metal-Free Alternative
Zirconia implants, in contrast, appear to present a lower prevalence of peri-implant diseases. Clinical studies suggest that peri-implantitis is less frequent with ceramic implants than with their titanium counterparts. In fact, one well-known study indicated no instances of peri-implantitis following a 12-year follow-up period of ceramic implants. These promising results suggest that zirconia implants could potentially offer a solution to the ongoing global issue of peri-implantitis.
Case Report: Full-Mouth Reconstruction with Zirconia Implants
The first two articles in this series (published in March and October 2023 issues of Dentistry Today) discussed various applications of ceramic implants, including single-unit, extended edentulous, and full-mouth removable treatments. This case report illustrates a full-mouth reconstruction using 100% metal-free zirconia implants, achieving predictable and clinically optimal outcomes.
With the increasing success and patient demand for metal-free implants, zirconia implants present a viable, less problematic alternative to traditional titanium implants, especially in patients seeking to avoid metal exposure. As more studies and clinical experiences with ceramic implants accumulate, they are likely to become an even more prominent solution in dental restoration.
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