Ceramic implants are dental implants made of a ceramic material that are shaped like a small screw. These are inserted into the jawbone of the tooth gap and serve to replace the lost tooth.
Ceramic implants are becoming an progressively important part of implantology and their use in dentistry is steadily increasing. Due to the excellent health compatibility, it is clear that ceramic implants can ideally be integrated into biological dentistry.
A fixed prosthesis on a ceramic implant has many advantages and is the ideal solution after tooth loss.
In this article we would like to give our patients an all-round insight into the subject of ceramic implants.
How is ceramic different from metal?
Ceramic is defined as an inorganic, non-metallic material that is hardly soluble in water.
This clearly distinguishes ceramics from metals.
The first positive property of ceramic is that it is “hardly soluble”. A material that is difficult to dissolve is more compatible than a highly soluble material of the same composition.
Ceramics consist of metal oxides, i.e. compounds of metal and oxygen. Due to this combination, ceramic materials do not have the properties of metal.
The strong bonds between metal and oxygen cause the atoms and electrons to be held in place. As a result, ceramics have no tendency to react further, are therefore inert and biologically neutral.
Dental metals are always metallic alloys in which several metals are mixed together. This significantly improves the properties of the metallic material. The metals added are, for example, copper, iron or nickel.
Unlike ceramics, there is no internal bonding with oxygen, which means that the internal bonding forces are weak. Consequently, the atoms and electrons are only lightly bound and can move and be released more easily.
Due to the free movement of electrons, metals have the property of conducting electricity. Due to the weak internal bonds, metallic ions can be easily released from the alloy and react with the surrounding oxygen. High solubility in water and increased corrosion (rusting) are detectable.
Therefore, ceramics and metal have completely different properties:
- Ceramics break when force is applied. Metals, on the other hand, deform.
- Metals conduct electricity and heat. Ceramics act like electrical and thermal insulators.
- Ceramics are inert and have no tendency to react with other substances. Metals are reactive and particularly like to react with oxygen-containing compounds.
- Ceramic materials show almost no solubility in water or saliva. Metals tend to dissolve, which is further intensified by corrosion.
- Having several types of ceramics in the oral cavity does not have a negative impact on the biology of the body. Having several different alloys in the oral cavity creates a kind of battery effect, which greatly increases corrosion and solubility.
Zirconia and Titanium
Like biological dentistry, the environmental dentistry and holistic dentistry also considers the mouth and the body as one interconnected unit. For example, an inflammation in the jaw, a diseased tooth or a toxic dental material in the mouth can lead to chronic inflammation in a joint.
Biological dentistry, as well as holistic dentistry and environmental dentistry, aim to reduce the triggers and irritants that affect the body. These concepts focus on strengthening the body as best as possible.
In our practice we combine all proven and effective methods of these dental disciplines, in order to offer the most ideal concept.
Ceramic implants are made of zirconium dioxide, also known as zirconium oxide. The element zirconium belongs to the group of metals, however it loses all metallic properties after reacting with oxygen. In addition, the lattice structure is stabilized by yttrium oxide, which improves the breaking strength tremendously. This yttrium-stabilized zirconia the preferred material in the manufacturing of ceramic implants and is established in implantology.
Titanium implants consist of approximately 99 to 99.9% pure titanium. Depending on the quality and make, the other components can vary greatly. Nickel, aluminum or tin may be present, amongst others. An oxide layer (passivation layer) forms on the surface of the titanium implant, which protects the implant from corrosion. However, this layer becomes unstable when the environment becomes acidic, e.g. in the case of inflammation or pathological flora in the oral cavity.
The released titanium particles lead to an inflammatory response by activating macrophages (located in the jawbone and gums). These produce various cytokines (immune messengers), which initiate local and systemic inflammation. In addition, there is increased bone resorption around the titanium implant.
Such local inflammations around the implant are called peri-implantitis.
In our dental practice, we use only ceramic implants that are clinically proven and 100% clean.
Cleanliness of the implant is certified by the Clean Implant seal.
This is the only way to reliably exclude contamination of the wound.
Long-term experiences and prognosis
The first ceramic implant was presented in 1967 by dentist Professor Sami Sandhaus. At that time the material aluminum oxide was used, which had an insufficient prognosis and consequently could not be established in implantology.
Around the year 2000, the first zirconium dioxide dental implants were manufactured and implanted. Since then, implant shapes, ceramic composition and surgical techniques have been continuously developed. Dental implants made of ceramics have therefore become more and more popular in dentistry and implantology.
Ceramic implants are now very advanced and optimized, so that success rates of over 98% are achieved.
Zirconium dioxide (also known as zirconia) is biologically compatible
Although a ceramic implant made of zirconia is a material foreign to the body, its harmful and stressful effect is negligible. Numerous studies have shown that it has excellent tolerability – both from a toxicological and allergological point of view.
Due to the insignificantly low solubility in watery solutions and the reaction inertness, the biological properties are ideal.
Gums love ceramics
Fewer bacterial biofilms and plaque accumulate on ceramic implants than on titanium implants. Consequently, the surrounding gums adhere very well to ceramic and the risk of gingivitis is significantly reduced (Rimondini et. al 2006). Ceramic implants are even less prone to gingivitis than natural teeth (Blaschke, Volz, 2006).
The adjacent gum shows better blood circulation than with titanium implants and forms a strong bond with the ceramic.
This gum-ceramic connection prevents the penetration of oral bacteria into the bone and thus into the blood circulation system. Therefore, the “immunological door” is closed. This is an important prerequisite for health. This is because various oral bacteria, which enter the bloodstream in large numbers, can strongly promote atherosclerosis.
Integration in the bone
In addition to the excellent gum attachment, ceramic implants are also excellently absorbed and integrated by the bone.
The good osseointegration has been proven in many studies and is comparable to titanium implants. Integration into the bone is strongly dependent on the surface roughness of the ceramic implant. Recent studies, with very rough ceramic surfaces, show complete osseointegration after approximately 4 weeks.
After only a few minutes, a buildup of fibrin forms on the ceramic surface. The formation of such a fibrin network is a requirement for optimal healing in the bone.
Since the entire ceramic implant does not deform due to chewing forces, it remains rigid and immobile in the bone. Therefore no pressure is exerted on the surrounding bone and the existing bone height is preserved.
Ceramics can be customized
The abutment (implant abutment) is cemented onto the ceramic implant, completely gap-free. After that, both the implant and the abutment can be grinded individually for the crown. The procedure is the same as for a natural tooth. This is a great advantage, because the crown can be perfectly adjusted to the margin of the gum. Grinding the ceramic does not reduce the stability of the material. This has been confirmed in recent studies.
With titanium, however, individual grinding in the mouth is not possible.
Excellent aesthetics
Ceramic implants are white, which is a significant advantage for aesthetics.
If the gums recede a little, the visible white margin is not as noticeable and blends in.
A metallic-grayish color, on the other hand, as with titanium implants, always looks unattractive in the visible area.
Even if the soft tissue around the implant becomes thinner, the grayish color shimmers through and influences the natural appearance.
The overall cost of ceramic implants is higher than that of titanium implants. This is due to the fact that the manufacturing process is very complex. In addition, more steps need to be considered when placing ceramic implants.
Another disadvantage is the somewhat higher susceptibility to breakage.
Ceramic implants are harder than titanium dental implants, but they can break under heavy load. With titanium, on the other hand, usually bending occurs instead of breakage. With today’s implants made of yttrium-stabilized zirconia, the probability of breakage is low.
In the past, ceramic implants took longer to heal. With today’s ceramic materials and implantation techniques, ceramic implants heal as quickly as titanium implants. Depending on the situation and implant system, you should wait 4 weeks to a maximum of 4 months before putting pressure on the implant.
In addition to the biological and physical properties of the materials, the shape of the implants is also very important.
Ceramic implants can be categorized into one-piece and two-piece implants.
One-piece ceramic implants consist of one complete piece, implant body and implant abutment combined. These mainly replace anterior teeth and are used less frequently in the posterior region.
Two-piece ceramic implants have an implant body, which is the actual screw, and a separate abutment. These two components are later connected with a cement, fixed and immovable. This means that no gap is formed at the connection point, resulting in a gap-free implant-abutment unit.
Both the one-piece and the two-piece ceramic implants are inserted in such a way that the subsequent crown margin is located in the area of the gum line – just like with your own teeth.
Two-piece systems have become established for titanium implants. The abutment is attached to the implant body with a titanium screw. Since no cement is used, this connection is not gap-free.
In addition, titanium implants are inserted in such a way that the edge of the implant body is located at the bone margin. The small gap between the implant and abutment is located precisely at this bone margin. This gap can form a dirty area, become colonized by bacteria, and cause the bone to become inflamed and recede.
When chewing and applying force, a small movement and deflection may occur at the implant-abutment connection of titanium implants. This movement creates pressure on the surrounding bone, causing additional bone loss of the areas near the crown.
There are different manufacturers of ceramic implants. All of these systems have their individual advantages and disadvantages
This is an alphabetical list of ceramic implant manufacturers:
Since each ceramic implant system offers advantages and disadvantages, we are flexible and unbiased in our selection.
We always look at each situation individually and decide which system is most suitable. This allows us to offer the optimal result for our patients.
If you have questions about the implant systems please feel free to ask us.
Ceramic implants never heal under inflammatory conditions. A ceramic implant only heals if the bone inflammation is thoroughly cleaned after the tooth has been removed. In addition, a thorough wound disinfection, e.g. with ozone, should take place before placing the implant.
Titanium implants, on the other hand, heal even if inflammation of the bone or soft tissue is left in place. In such a case, the inflammation does not heal, but remains chronically under the implant. This results in permanent, chronic strain on the body.
Since ceramic is not able to dissipate heat as much as titanium, care should be taken when screwing in the implant, to not overheat the bone.
Although the production of implants is subject to the strict MDR (Medical Device Regulation), attention should always be paid to cleanliness when selecting an implant. A good guide to implants are the dental implants that have been certified by Clean Implant.
An immediate implant is an implant that is placed in one session immediately after tooth extraction. This requires very clean and precise work, otherwise the healing prognosis is greatly reduced/affected.
In our practice, we insert almost all implants immediately and give the patient the guarantee that the implant will heal.
Immediate implantation has advantages that one would not want to do without.
With immediate implantation, no bone is long and the aesthetic conditions are excellent – the placed implant keeps the bone and gums in place.
If, on the other hand, a tooth is extracted and time passes before implant placement, the bone loses height and width. In addition, one loses the beautiful garland-shaped gum line – a visibly indented area forms in the area of the removed tooth. In the second operation, after several months, there is less bone available for the implant and complex bone graft/augmentation may be necessary.
The time factor is a clear advantage of immediate implant placement. Immediate implant placement eliminates the need for further surgeries – patients reach their goal faster and unnecessary multiple procedures are avoided.
For more information on the technique of immediate implant placement, see the main article Immediate Implants:
Ceramic implants take one to 4 months to be firmly incorportated into the jawbone. During this time, they should be loaded as little as possible.
If implants are necessary in the front, the patient is provided with fixed temporary provisional restorations made of composite, which ensure an attractive aesthetic appearance during the healing period.
In general, ceramic implants with a higher surface roughness heal faster and show better bone-to-implant contact.
After healing, the ceramic implants including the abutments are grinded in such a way that the subsequent crown margin lies at the gum line (as with the patient’s own tooth).
Individual ceramic crowns are then cemented onto the implant/abutment without any gaps, taking into account the correct relation of the jaws.
The best restoration of a tooth gap must always be decided individually. Usually, ceramic implants offers the most advantages and are clearly superior to other dental prostheses. However, there are situations where a different dental prostheses would be more suitable.
A ceramic dental bridge connects two adjacent teeth, which is also a fixed prosthesis. For this, the respective teeth must be ground in such a way that tooth stumps remain. The bridge is then cemented onto these tooth stumps and closes the gap in that row of teeth. Grinding the neighboring teeth is the main disadvantage of this method and only makes sense if the neighboring teeth are already severely pre-damaged, need a crown anyway or already have a crown. In terms of costs, a treatment with a ceramic bridge is about the same as a ceramic implant.
Orthodontic gap closure is also a possible alternative. However, this is a lengthy process and only makes sense for certain teeth and in certain situations.
Leaving the gap between the teeth is also an option and can make perfect sense. However, it can cause neighboring teeth to tilt into the gap and teeth of the opposing jaw to grow into the gap In addition, bone resorption of the corresponding region always occurs, making subsequent implantation more difficult and bone grafting/augmentation may be required.
A removable prosthesis is another alternative treatment for the gap. Despite the low cost, this dental prosthesis has serious disadvantages. The feeling of having a foreign body in the mouth, pressure points on the mucosa and visible clasp edges are usually a no-go for the patient.
In which case should implants not be placed?
When and whether a ceramic implant can be placed must always be examined individually and all suitable alternatives must be considered and included in the decision.
The following list of various contraindications refers not only to ceramic implants but also to titanium implants.
Poor general health with certain pre-existing conditions can have a negative effect on the outcome of the implant treatment. In particular, pre-existing bone diseases with previous use of various medications, such as bisphosphonates, must be taken into account.
Before implantation, the oral flora should be optimized and inflammation of the gums should be treated. If too little attention is paid to this, both the prognosis of healing and the long-term prognosis of the placed implants will decrease.
In our dental practice, the health of our patients is strengthened before implantation and bone and wound healing are supported. The oral flora is improved with various measures. This allows us to place immediate implants, even in chronically ill patients, and ensure a good prognosis.
FAQ about Ceramic Implants
Is the risk of breakage higher with ceramic implants?
Provided the dentist knows how the implants should ideally be placed and later ground, the risk of fracture is not higher than with titanium implants.
Is the longevity of ceramic implants higher than that of titanium implants?
In our opinion, ceramic implants have a much better longevity and prognosis than titanium implants.
The reasons for this is:
- Implants made of ceramic show a very good, inflammation-free connection with bone and gums.
- Ceramic is clearly superior to titanium from a toxicological and allergological point of view.
- Our systems are gap-free, like a natural tooth, so there are no unhygienic gaps.
Do our dental practices also use titanium implants?
No, we only offer implants made of zirconium oxide.
Which implant brands are used in our dental practices?
Bisphosphonates and Dental Implants. Can complications occur?
Bisphosphonates are medications that affect bone metabolism and are administered for osteoporosis or various tumor diseases.
Bisphosphonates are administered orally as tablets, in the form of injections or intravenously as infusions.
If the patient has received bisphosphonates in the past, jaw necrosis may occur after operations on the jawbone. These are also referred to as bisphosphonate-associated osteonecrosis of the jaw.
Such jaw necrosis is very dangerous and can lead to the need to remove large parts of the jaw bone.
For patients who have received bisphosphonates in the form of injections or i.v. in the past, jaw surgery must be avoided as much as possible. In this case, ceramic implant placement is not possible.
For patients who have taken bisphosphonates in the form of tablets, the situation is reviewed individually. If implantation is possible, it must be done in two sessions and a strict antibiotic treatment is necessary.
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