Case reports & documentations

In this report, Dr. Max Riemann shows an anterior case with immediate implant placement.

Highlights: Immediate implant placement, connective tissue graft, prosthetic restoration.

‘Two-piece Zeramex XT zirconia (ATZ) implants are a proven treatment option. This case demonstrates that Zeramex XT can be used to achieve a highly aesthetic result in the anterior region,’ says Dr. Max Riemann.

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Opitz V. (2024). Möglichkeiten von zweiteiligen Keramikimplantaten. Implantologie Journal 7/8 2024: S. 6-16.

In this report, Dr. Volker Opitz presents several cases that he has solved with the help of Zeramex XT two-piece zirconia implants.

Highlights: Classic late implant placement & single-tooth implant in smaller interocclusal spaces, immediate implant placement & single-tooth implant in smaller interocclusal spaces, sinus lift surgery.

‘[With ceramic implants] primary stability comparable to that of titanium implants can be achieved. The soft tissues in particular show excellent adaptation to ceramic implants. In many clinical situations, patients can be treated with ceramic implants equivalent to titanium implants. Patients should be offered the alternative to titanium implants, especially when it comes to aesthetically demanding anterior restorations,’ summarises Dr Volker Opitz.

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Michl C. (2024). Zweiteilige Keramikimplantate: Individuelle volldigitale Lösung für hochästhetische Ergebnisse im Frontzahnbereich. ceramic implants 2024/1: 6-10.

Highlights: Removal of tooth 11 with simultaneous cystectomy and reconstruction of the bone defect, fabrication of a temporary restoration, insertion of a two-piece Zeramex XT ceramic implant 4 months after augmentation & restoration of the implant with a crown.

The result after insertion of the ceramic crown shows inflammation-free soft tissue conditions. There was no inflammation or problems with the implant or the prosthetic restoration during the 1-year follow-up, says Dr Claudia Michl.

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Tartsch J. (2023). Die restaurativen Versorgungen mit Keramikimplantaten. Quintessence publishing, Implantologie 31(3):269–288. 

Highlights: Implant restoration with Docklocs® in an edentulous patient with a 3-year follow-up for the removable prosthesis and a 5-year follow-up for four Zeramex XT zirconia implants.

The prosthesis has been in situ for 3 years without inflammation. 

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Tartsch J. (2023). Die restaurativen Versorgungen mit Keramikimplantaten: Fall 1: Einzelzahnimplantate. Quintessence publishing, Implantologie 31(3):278–283. 

Highlights: Placement of two Zeramex XT implants in the front tooth region, augmentation with ‘sticky bone’ and umbrella screw, prosthetic restoration (concept of intraoral bonding) and 3-year follow-up.

Three years after the restoration, a CBCT showed stable bone conditions around the implants. Especially in the aesthetic anterior region, there is a risk of a reduced papilla between the implants due to a lack of bone support, even with titanium implants, according to Dr Jens Tartsch. In this case, however, an elongation of the papilla was observed compared to the situation after insertion of the restoration.

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Stanley, M. Full-Arch Rehabilitation With Implant-supported Prosthesis. 2023. Zeramex Clinical Cases. Last accessed on 15/07/2024.

Highlights: full-arch restoration on ceramic implants in the maxilla in a patient with metal hypersensitivity.

The case report shows a documented full-arch rehabilitation with the aid of an implant-supported prosthesis in a 62-year-old female patient with metal hypersensitivity.

The S3 guideline ‘Material incompatibilities with dental endosseous implants’ shows the continuing relevance of the topic. This recommends that dental ceramic implants can be considered as a treatment option if a localised titanium-related inflammatory reaction is suspected. However, the cause of an intolerance reaction may also be the metals or impurities present in the superstructures or alloys.

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Mehnert, T. Vollkeramischer Implantatersatz bei parodontal stark vorgeschädigten Frontzähne. Praktische Implantologie und Implantatprothetik. 2022, Ausgabe 5.

Two-piece ceramic implants are increasingly becoming the focus of clinical application due to their excellent biological and material properties. Due to the low plaque accumulation and very good soft tissue acceptance, the use of ceramic implants should be considered in preference to titanium implants in periodontally compromised patients. Dr Thomas Mehnert uses a clinical case to demonstrate the successful use of two-piece Zeramex XT zirconia implants in the anterior region.

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Patel, P. Aesthetic Transformations Utilizing Zirconia Implants. DentistryToday. 2022. Internet: https://www.dentistrytoday.com/aesthetic-transformations-utilizing-zirconia-implants/. Last accessed on 10/07/2024.

Highlights: use of a reduced-diameter Zeramex XT SB 3.5 mm in the anterior region, surgical phase, soft tissue management, prosthetic phase

Placing implants in the aesthetic zone can be a challenge. Thanks to the white implant colour, a ‘grey’ shadow is a thing of the past. In particular, a thin tissue type is a feature that always poses an aesthetic risk, which can be minimised with white colour. In addition, zirconium dioxide has been proven to optimise blood flow to the implant body, thereby increasing the long-term stability of the peri-implant tissue.

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Mehnert, T. Vollkeramische Implantate: Heute schon eine vollwertige Alternative? Praktische Implantologie und Implantatprothetik pip 1. 2020.

Highlights: extraction of tooth 21, excochleation of the apical granulation tissue via a semilunar incision, insertion of the Zeramex XT ceramic implant.

The examinations after six and twelve months showed completely non-irritated soft tissue conditions. The BOI test was negative in both periods and the Pink Esthetic Score (PES) according to Prof. Fürhauser was twelve out of a maximum achievable 14 points.

Two-piece ceramic implants of the latest generation are now among the alternative treatment options to titanium implants due to their excellent biological and material properties. The handling and workflow now meet the requirements of modern implantology, according to Dr. Dr. Thomas Mehnert. 

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Lohmann, A. Vollkeramische Implantate: Heute schon eine vollwertige Alternative? Praktische Implantologie und Implantatprothetik pip. 2020. S. 28-32.

Highlights: Bone augmentation (GBR), insertion and restoration of 4 Zeramex XT implants in the lateral and anterior region, digital workflow.

Restorations with fixed and removable dentures established as the standard restoration concept. According to Dr Lohmann, the handling, procedure and superstructure correspond to those of two-piece titanium implants. In addition to the familiar standard abutments, the system offers the option of having fully customised abutment components fabricated by the manufacturer using intraoral or extraoral scans. The screw-retained abutment connection allows the abutments to be exchanged at a later date to adapt to a changed prosthetic situation.

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Leistner, M. Neue Keramik «Snap-on» Attachments für zweiteilige Keramikimplantate. Praktische Implantologie und Implantatprothetik pip 5. 2020. S. 8-12.

Highlights: insertion and restoration of four Zeramex XT ceramic implants with Docklocs abutments for bonding a prosthesis,

The case report describes both the surgical procedure for inserting the ceramic implants and the step-by-step fabrication of the final prosthetic restoration for an edentulous patient.

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Jacobi-Gresser, E. Versorgung einer Einzelzahnlücke  im Molarenbereich. 2019. Implantologie Journal 1&2. S. 26-28.

Highlights: replacement of tooth 36, which was endodontically treated years ago, and restoration of a single tooth gap in the mandibular molar region, including surgical and prosthetic phase.

The single tooth replacement, but also the bridge replacement on two implants, is a successful treatment method comparable to the titanium implant restoration. The use of zirconium dioxide implants has significant advantages over titanium implants in terms of gingival tissue preservation by minimising biofilm adhesion, better material stability, better immunological compatibility and, last but not least, the white colour, especially in the visible area.

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Hölldampf, P. Komplett digital versorgt Teil 1 & 2. das dental labor. 2019. S. 78-83 & 2-7.

Highlights: digital workflow for prosthetic restorations with Zeramex XT.

In the first part, MDT Peter Hölldampf describes a prosthetic restoration with a ceramic implant, a customised abutment and a crown made of monolithic zirconium oxide. The second part of the article deals with scanning the model with the customised abutment and the digital modelling of a crown.

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Stiller, M., Peleska, B. Sofortimplantation in der ästhetischen Zone: Möglichkeiten und Grenzen mit Keramikimplantaten. 2018. Implantologie Journal. Ausgabe 7&8.

Highlights Case 2: bone-sparing extraction of tooth root 21, immediate implant placement of Zeramex XT RB 4.2 mm/14mm in the esthetic zone with sagittal deficit (narrow jaw with protruding front).

After completion of the restoration, the periodontal parameters showed irritation-free conditions with a papilla level that was almost unchanged compared to the healthy neighbouring dentition.

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Jacobi-Gresser, E. Hybridversorgung im Unterkiefer auf zweiteiligen reversibel verschraubbaren Zirkonoxidimplantaten. 2018. Praktische Implantologie und Implantatprothetik. pip 4, 2018. S. 20-24.

Highlights: implant-prosthetic planning, hybrid restoration in the lower jaw incl. surgical and prosthetic phase. 

With the new technology of reversible screw-retained zirconia implants, the range of indications can be extended with regard to removable hybrid prosthetics. This means that implant-prosthetic restorations in the edentulous or edentulous jaw are also possible in patients who should not have titanium due to immunological intolerance.

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Leistner, M. Vollkeramische Seitenzahnbrücke auf verschraubten zweiteiligen Keramikimplantaten. DENTALE IMPLANTOLOGIE. Jg. 22, Ausgabe 04. 2018. S. 244 – 249.

Highlights: explantation of titanium implants due to peri-implantitis and bone resorption, insertion and restoration of three Zeramex XT ceramic implants with a bridge, closed impression.

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Tartsch, J. Next Generation – das zweiteilig verschraubte Keramikimplantat. Implantologie Journal 12, 2017. Internet: https://www.zwp-online.info/fachgebiete/implantologie/keramikimplantate/next-generation-das-zweiteilig-verschraubte-keramikimplantat. Zuletzt aufgerufen am 15.07.2024.

Highlights: concept of the two-piece ceramic implant system & patient case in the molar region including a detailed description of the surgical and prosthetic phase, postoperative X-ray control 4 months after restoration.

While ceramic implants have already come much closer to titanium implants due to the rapid development in success rates, material and surface design, the surgical and prosthetic protocols familiar from titanium implants can now also be adopted, as described in this case.

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