High fracture rates & metallic aluminum – prejudices about zirconia implants
There are several prejudices about zirconia implants. One of them addressed in the paper by Tartsch & Blatz (2022) is, for example, their high fracture rates.
Tartsch & Blatz (2022) note in their overview “Ceramic Dental Implants: An Overview of Materials, Characteristics, and Application Concepts” that high fracture rates of early alumina implants are often wrongly extrapolated to modern zirconia implants made from ATZ (alumina-toughened zirconia) and TZP-A (alumina-toughened tetragonal zirconia polycrystal) with much higher flexural strength (flexural strength of ATZ is 2’000 MPa, flexural strength of ATZ is 2’000 MPa; comparison: flexural strength of titanium is 400 MPa, flexural strength of alumina is 550 MPa).
Furthermore, Roehling et al. (2018) cited in the overview showed in their meta-analysis that the previous high fracture rates of ceramic implants have been reduced from 3.4% to 0.2% (Roehling et al. 2018). This improvement was also confirmed in both static and dynamic fracture resistance tests according to ISO 14801, which allow the conclusion that artificial loading and hydrothermal aging do not reduce the fracture resistance of the investigated implant systems (Kohal et al. 2023; Joda et al. 2018; Spiess et al. 2018).
Another one pointed out by the authors is that alumina, which is contained in ATZ and TZP-A, is often confused with the metallic form of aluminum. “It plays no role in the current holistic discussion about metallic aluminum as a potential contributor to neurodegenerative diseases… aluminum oxide, as a metal oxide, is by definition a ceramic. Its reaction with oxygen is complete and irreversible; no metallic aluminum can be released,” the authors note.
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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
ISO 14801:2016; Dentistry—Implants—Dynamic Fatigue Test for Endosseous Dental Implants. European Committee for Standardization: Brussels, Belgium, 2017; pp. 1–14.
Joda T, Voumard B, Zysset PK, et al. Ultimate force and stiffness of 2-piece zirconium dioxide implants with screw-retained monolithic lithium-disilicate reconstructions. J Prosthodont Res. 2018;62(2):258-263.
Kohal, R.-J., Schikofski, T., Adolfsson, E., Vach, K., Patzelt, S. B. M., Nold, J., & Wemken, G. (2023). Fracture Resistance of a Two-Piece Zirconia Implant System after Artificial Loading and/or Hydrothermal Aging—An In Vitro Investigation. Journal of Functional Biomaterials, 14(12), 567. https://doi.org/10.3390/jfb14120567
Roehling S, Schlegel KA, Woelfler H, Gahlert M. Performance and outcome of zirconia dental implants in clinical studies: a meta-analysis. Clin Oral Implants Res. 2018;29(suppl 16):135-153.
Spies BC, Fross A, Adolfsson E, et al. Stability and aging resistance of a zirconia oral implant using a carbon fiber-reinforced screw for implant-abutment connection. Dent Mater. 2018;34(10):1585-1595.
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.
