Two-piece zirconia implants: where do we stand in 2024?
In 2024, two-piece zirconia implants have been one of the central topics at the annual meetings of renowned associations as well as in the dental community. The satellite symposium of the European Society for Ceramic Implantology (ESCI) 2024 highlighted important clinical aspects of zirconia implants such as soft tissue integration and health, implant material and implant surface, prosthetic options with conventional and digital workflow and gave a positive assessment of the state of ceramic implantology in 2024.
Zirconia implants are a reliable alternative in everyday practice
The scientific evidence for zirconia implants has grown steadily in recent years: in addition to clinical reports that increasingly show the clinical success of implant treatments with multi-year follow-ups, there are now more studies and meta-analyses that focus on zirconia implants. Thanks to continuous further development, the latter have come closer to titanium implants in terms of material stability, surface design and success rates1. Systematic reviews show the average 5-year survival rate for one-piece and two-piece zirconia implants of 97.2%2 and the cumulative 10-year survival rate of 95.1%3. Clinical observations demonstrate that micro-rough zirconia implants have identical soft tissue integration and faster epithelial and connective tissue maturation compared to titanium implants4. In addition, with zirconia implants users can largely adopt the known surgical and prosthetic protocols5. ‘Predictable results can be achieved with zirconia implants in everyday practice,’ emphasizes PD Dr. Stefan Röhling, Vice President of the European Society for Ceramic Implantology (ESCI).
Zirconia implants are stable enough for clinical use
‘Zirconia implants are generally stable enough for clinical use,’ explains Prof. Dr. Ralf Kohal, Head of the Clinic for Dental Prosthetics at the Freiburg University. Several in-vitro studies on the two-piece zirconia implants Zeramex P6 and Zeramex XT6.7 show this. ‘Zirconia 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,’ says Prof. Kohal.
Two-piece implant concept is suitable for clinical use
The two-piece implant concept offers users advantages in terms of prosthetic flexibility and clinical indications. At the same time, one-piece and two-piece zirconia implants show the same degree of osseointegration and biological integrity4 , can withstand masticatory forces6 , show high survival rates after 5 and 10 years2,3 and are suitable for clinical use10.
Zirconia implants are not just a trend
Clinical advantages such as improved aesthetics, healthier soft tissue thanks to better blood circulation8, fewer inflammatory infiltrates, less plaque accumulation9 and growing scientific evidence on the success and survival rates of two-piece zirconia implants contribute to this. The clinical cases presented at the symposium show stable bone and soft tissue conditions after 2 to 7 years. ‘Zirconia implants are not just a trend, they will establish themselves in the long term,’ argues Dr. Jens Tartsch, President of the European Society for Ceramic Implantology (ESCI).
In order to achieve clinical success, Dr. Tartsch says, implantologists should be critical but open-minded when selecting and using zirconia implants, choose suitable indications, adhere to manufacturer's guidelines, follow biological principles and involve patients in the decision-making process.
Outlook 2025
The year 2025 promises even more scientific evidence for the two-piece Zeramex XT implant system: Several retrospective studies led by Dr. Dr. Thomas Mehnert, Dr. Elisabeth Jacobi-Gresser and Dr. Thomas Franke are to be published next year.
References
1 Tartsch J, Blatz M. Ceramic Dental Implants: An Overview of Materials, Characteristics, and Application Concepts. Compend Contin Educ Dent. 2022 Sep;43(8):482-488; quiz 489. PMID: 36170627.
2 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
3 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.
4 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.
5 Tartsch, J. (2023). Die restaurativen Versorgungen mit Keramikimplantaten. Quintessenz publishing, Implantologie, (3).
6 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.
7 Spies BC, Fross A, Adolfsson E, Bagegni A, Doerken S, Kohal RJ. Stability and aging resistance of a zirconia oral implant using a carbon fiber-reinforced screw for implant-abutment connection. Dent Mater. 2018 Oct;34(10):1585-1595. doi: 10.1016/j.dental.2018.08.290. Epub 2018 Sep 1. PMID: 30180975.
8 Kajiwara Net al.: Soft tissue biological response to zirconia and metal implant abutments. Implant Dentistry 24 (1), (2015).
9 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.
10 ESCI Statement 2021. The clinical application of two-piece zirconia implants. Internet: https://esci-online.com/wp-content/uploads/2021/10/ESCI-Statement-2-piece-zirconia-implants-final-engl.pdf
