Bio-inertness of zirconia appears to be beneficial for peri-implantitis prevention and soft tissue quality, Tartsch & Blatz (2022) say
Periimplantitis is another important aspect addressed in the paper by Tartsch & Blatz (2022). “This inflammatory pathological condition with progressive loss of peri-implant hard and soft tissues can ultimately lead to the loss of the implant,” the authors note.
Derks et al. (2016) cited in the overview showed that nearly 14.5% of implant patients developed moderate-to-severe peri-implantitis after nine years (Derks et al. 2016). The literature review by Mombelli et al. (2012) reported peri-implantitis in 10% of implants and 20% of patients within 5 to 10 years post-implantation
Therefore, periimplantitis represents a serious risk for implant patients.
There are several risk factors in the development of periimplantitis, among them bacterial biofilm (Berglundh et al. 2017) and plaque which lead to inflammation and tissue recession (Tartsch & Blatz 2022).
There is also evidence suggesting that titanium plays a role in this process (Albrektsson et al. 2014). As a metal, titanium is susceptible to corrosion, and titanium particles have consequently been found in peri-implant tissues (Olmedo et al., 2008). Also, particles were distributed in a pattern consistent with the tub-shaped bone defects characteristic of peri-implantitis (He et al., 2016)
Further studies cited in the overview showed that this corrosion is facilitated by the use of various metals (Foti et al. 1999) or the presence of bacterial lipopolysaccharides from bacterial walls (Peterson et al. 2017; Yu et al. 2015). Besides that, intraosseous abrasion from titanium implant particles may result from implant insertion and the subsequent functional micromovements within the bone (Tartsch & Blatz 2022).
Compared to titanium, the bio-inertness of zirconia appears to be beneficial for peri-implantitis prevention and soft tissue quality: zirconia shows lower plaque accumulation and bacterial adhesion (Scarano et al., 2004; Ichikawa et al., 1992), lower thickness of deposited biofilm (Roehling et al., 2017) as well as circular blood flow that is more similar to that around a natural tooth (Kajiwara et al., 2015) which results in healthier soft tissues (Tartsch & Blatz 2022).
The authors point out that cementitis caused by incomplete removal of excess cement (Vindasiute et al., 2015), overheating during implant insertion (Zipprich et al. 2019) as well as patient-related aspects such as smoking, diabetes, and local mechanical influences can be additional risk factors.
“While more scientific evidence showing a lower tendency toward peri-implantitis may still need to be provided for ceramic implants, the essential argument for these implants based on clinical experience is the excellent and almost consistently inflammation-free peri-implant soft-tissue condition,” the authors conclude.
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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.
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