Tartsch & Blatz (2022): "The aesthetic problem can be avoided with the use of ceramic implants"
The comparison of esthetics that can be achieved with ceramic and titanium implants is one of the material-relevant aspects addressed and clinically documented in the overview by Tartsch & Blatz (2022).
"The possibility of a grey hue shining through the gingiva is a potential disadvantage of titanium implants. Conversely, because of the white colour of zirconium dioxide, this aesthetic problem can be avoided with the use of ceramic implants," the authors note.
Jung et al. (2007) cited in the overview showed that titanium induces “the most prominent color change” while zirconia does not induce visible color change in 2.0-mm-thick and 3.0-mm-thick mucosa. However, with a mucosal thickness of 3.0 mm, no visible colour change could be detected in any specimen by the human eye.
If the required thickness is insufficient, a connective tissue graft—typically harvested from the palate—can be used to augment the mucosa. However, this involves an additional surgical procedure, placing an extra burden on the patient (Tartsch & Blatz 2022).
An alternative solution is the use of all-ceramic implant abutments. However, micromovements of the hard zirconia abutment against the softer titanium implant may cause abrasion and potentially compromise the implant-abutment connection (Tartsch & Blatz 2022). This is in line with the results of the comparative in-vitro study by Stimmelmayr et al. (2012) in which they demonstrated that titanium implants show higher wear at the implant interface following cyclic loading when connected to zirconia abutments compared to titanium abutments.
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About the authors
Jens Tartsch, DMD is President of the European Society for Ceramic Implantology (ESCI), Board Member of the Swiss Society for Anti-Aging Medicine and Prevention (SSAAMP) and Chairman of the German Society for Environmental Dentistry (DEGUZ). He is also author of numerous publications on metal-free implantology and immunology in dentistry and runs a private practice in Kilchberg (near Zurich, Switzerland).
Markus B. Blatz, DMD, PhD is Professor of Restorative Dentistry, Chairman of the Department of Preventive and Restorative Sciences and Assistant Dean for Digital Innovation and Professional Development at the University of Pennsylvania School of Dental Medicine in Philadelphia, United States.
References
Jung RE, Sailer I, Hämmerle CHF, et al. In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent. 2007;27(3):251-257.
Stimmelmayr M, Edelhoff D, Güth JF, et al. Wear at the titanium-titanium and the titanium-zirconia implant-abutment interface: a comparative in vitro study. Dent Mater. 2012;28(12):1215-1220.
Tartsch J, Blatz MB. 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.
