ESCI Satellite Symposium ‘Ceramic Implantology’: Update on the evidence base, practical knowledge at expert level, strong community
From left to right: Prof. Andrè Chen, Dr. Frank Maier, PD Dr. Dr. Stefan Roehling, Dr. Jens Tartsch, Dr. Lars Boerner, Prof. Sebastian Kuehl
On 19 September 2024, everything centered around the topic of ceramic implantology at the Kursaal Bern (Bern, CH). In several lectures and presentations, Dr. Jens Tartsch, PD Dr. Dr. Stefan Roehling, Prof. Dr. Ralf Kohal, Dr. Frank Maier and Prof. Andrè Chen addressed questions such as whether ceramic implants are just a trend, whether they represent a reliable alternative in everyday practice or offer sufficient stability for clinical use. In the second part of the symposium, Dr. Jens Tartsch, Prof. Sebastian Kuehl, Dr. Frank Maier and Dr. Lars Boerner reported on their clinical approaches and experiences with ceramic implants.
The satellite symposium of the European Society for Ceramic Implantology (ESCI), which was part of the programme of the 6th Swiss Implant Congress, highlighted important aspects such as soft tissue integration and soft tissue health, implant material and implant surface, prosthetic options with conventional and digital workflow and offered participants a scientifically sound and experience-based perspective on the use of ceramic implants.
Ceramic implants are not just a trend
Ceramic implants are not just a trend, they are here to stay, says Dr. Jens Tartsch, President of the European Society for Ceramic Implantology. Clinical advantages such as improved aesthetics, healthier soft tissue owing to better blood circulation (Kajiwara et al. 2015), fewer inflammatory infiltrates, less plaque accumulation (Scarano et al. 2004) and growing scientific evidence on the success and survival rate of two-piece ceramic implants all contribute to this. The clinical cases with 2- to 7-year follow-ups presented at the symposium show stable bone and soft tissue conditions.
One-piece and two-piece ceramic implant concepts
During the symposium, it was confirmed that the two-piece ceramic implant concept has advantages over the one-piece concept in terms of prosthetic flexibility and clinical indications. One-piece and two-piece zirconia implants have the same degree of osseointegration and biological integrity (Roehling et al. 2019). Two-piece ceramic implants can withstand chewing forces (Kohal et al. 2023). The ESCI Scientific Advisory Board also confirms that the two-piece zirconia implant concept is suitable for clinical use.
Ceramic implants are stable enough for clinical use
According to Prof. Dr. Ralf Kohal, Senior Physician at the Clinic for Dental Prosthetics at the Universitätsklinikum Freiburg, ceramic implants are in general stable enough for clinical use. Prof. Dr. Ralf Kohal demonstrated this in several in-vitro studies on the zirconium oxide implants Zeramex P6 and Zeramex XT. Furthermore, according to Prof. Kohal, Prof. Kohal, the cumulative 10-year survival rates of 95.1% (Mohseni et al. 2024) for ceramic implants can also be regarded as good. Ceramic implants can therefore be seen as an addendum to titanium implants for certain indications and can be recommended for patients who do not want to have metal in their bodies.
Ceramic implants are a reliable alternative in everyday practice
One of the main messages from PD Dr. Dr. Stefan Roehling, Vice President of the European Society for Ceramic Implantology, was that predictable results can be achieved with ceramic implants in everyday practice. Dr. Stefan Roehling demonstrated this using several clinical documentations, studies and meta-analyses that prove their reliability. According to Dr. Roehling, clinical observations show that microrough zirconia implants have identical soft tissue integration capacity and faster maturation of the epithelial and connective tissue compared to titanium implants (Roehling et al. 2019). Several studies provide a scientific perspective on the use of ceramic implants. For example, the retrospective follow-up of two-piece Zeramex XT ceramic implants shows a success and survival rate of 97.3% after a mean loading time of 24 months (Gahlert et al. 2024). And after 5 years, the mean survival rate for ceramic implants is 97.2 % (Roehling et al. 2023).
Dr. Frank Maier, member of the ESCI Board, addressed the exciting topic of hard and soft tissue management for ceramic implants. His clinical approach: limit the number of surgical interventions, implant immediately, protect and preserve tissue.
Today, ceramic implants can be seamlessly integrated into a completely digital workflow. Prof. Andrè Chen, member of the ESCI Board, used several clinical cases to demonstrate how a digital workflow can be professionally integrated with ceramic implants as well as shared his practical knowledge with the participants.
For clinical success, Dr. Tartsch says, practitioners should remain critical but open-minded when selecting and using ceramic implants, choose suitable indications, adhere to the manufacturer's guidelines, follow biological principles and involve patients in the decision-making process.
About European Society for Ceramic Implantology (ESCI)
The European Society for Ceramic Implantology (ESCI) is an association of experienced and renowned experts as well as interested and motivated users from practice and academia. The society is a hub for outstanding scientific research as well as clinical and practical experience in the field of ceramic implantology. As a specialist dental society, the ESCI is active throughout Europe.
References
Gahlert M, Stürz N, Engelhard Wölfler H, Röhling S (2024). Retrospektive Nachuntersuchung von 2-teiligen Keramikimplantaten aus Zirkondioxid nach einem mittleren Belastungszeitpunkt von 24 Monaten (Manuskript in Publikation).
Kajiwara Net al.: Soft tissue biological response to zirconia and metal implant abutments. Implant Dentistry 24 (1), (2015).
Kohal RJ, Schikofski T, Adolfsson E, Vach K, Patzelt SBM, Nold J, Wemken G. Fracture Resistance of a Two-Piece Zirconia Implant System after Artificial Loading and/or Hydrothermal Aging-An In Vitro Investigation. J Funct Biomater. 2023 Dec 15;14(12):567. doi: 10.3390/jfb14120567. PMID: 38132821; PMCID: PMC10743638.
Mohseni P, Soufi A, Chrcanovic BR. Clinical outcomes of zirconia implants: a systematic review and meta-analysis. Clin Oral Investig. 2023 Dec 23;28(1):15. doi: 10.1007/s00784-023-05401-8. PMID: 38135804; PMCID: PMC10746607.
Roehling S, Gahlert M, Bacevic M, Woelfler H, Laleman I. Clinical and radiographic outcomes of zirconia dental implants-A systematic review and meta-analysis. Clin Oral Implants Res. 2023 Sep;34 Suppl 26:112-124. doi: 10.1111/clr.14133. PMID: 3775052
Roehling S, Schlegel KA, Woelfler H, Gahlert M. Zirconia compared to titanium dental implants in preclinical studies-A systematic review and meta-analysis. Clin Oral Implants Res. 2019 May;30(5):365-395. doi: 10.1111/clr.13425. Epub 2019 Apr 16. PMID: 30916812.
Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A.J Periodontol. 2004. Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study. Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A.J Periodontol 2004.
