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.

Biological Dentistry Winterthur Switzerland

Ceramic implants are becoming an increasingly 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 prosthetic 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 sparingly soluble in water.

This clearly distinguishes ceramics from metals.

The designation “sparingly soluble” shows the first positive property of ceramics. 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 mixed metals are e.g. copper, iron or nickel.

Due to the weak internal bonds, metallic ions can easily be released from the alloy and react with surrounding oxygen. Due to the free movement of electrons, metals have the property of conducting electricity.

Due to the free movement of electrons, metals have the property of conducting electricity. Due to the free movement of electrons, metals have the property of conducting electricity. Due to the weak internal bonds, metallic ions can easily be released from the alloy and react with surrounding oxygen. A high solubility in water and increased corrosion (rusting) are detectable.

Therefore, ceramics and metals have completely different properties.

  • Ceramics break when force is applied. Metals deform. Metals deform.
  • Metals conduct electricity and heat. Ceramics, on the other hand, act like electrical and thermal insulators.
  • Ceramics are inert and have no tendency to react with other substances. Metals, however, are reactive, particularily with oxygen-containing compounds.
  • Ceramic materials show almost no solubility in water or saliva. Metals dissolve, which is further intensified by corrosion.
  • Several different ceramics in the oral cavity do not have a negative impact on the biology of the body. Several different alloys in the oral cavity create a kind of battery effect, which greatly increases corrosion and solubility.
Zirconia and Titanium

The concepts of environmental dentistry and holistic dentistry consider the mouth and the body as a connected unit. For example, 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 affecting the body. The biological organism should be strengthened as best as possible.

In our practice, we combine all proven and effective methods of these dental disciplines in order to offer you the 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 zirconium dioxide is the preferred material in the manufacturing/production of ceramic implants and has become firmly 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 event of inflammation or unhealthy 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.

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 inserted. Ever since then, the implant shapes, the composition of the ceramics and the surgical techniques have been developing continuously. Dental implants made of ceramics have therefore become more and more popular in dentistry and implantology.

In the meantime, ceramic implants are very advanced and optimized, so that a success rate of over 98% can be achieved.

Advantages of Ceramic Implants


Zirconium dioxide is biologically compatible

A ceramic implant made of zirconium dioxide is a material that is foreign to the body, but it is hardly a burden or has any harmful effects on the body. 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 interness, the biological properties are ideal.

Gums love Ceramics

There is less bacterial biofilm and plaque buildup on ceramic implants compared to titanium implants. As a result, the surrounding gums can attach very well to the 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 gums show better blood circulation than with titanium implants and form a firm connection with the ceramic.

This gum-ceramic connection prevents penetration of oral bacteria into the bone and thus into the circulatory system. Therefore, the “immunological door” is closed. This is an important requirement for health. This is because various oral bacteria which enter the bloodstream in large numbers, can greatly accelerate arteriosclerosis.

Biological dentistry safe amalgam removal

Integration into 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. The integration into the bone depends strongly on the roughness of the ceramic. New studies with very rough ceramic surfaces show complete osseointegration after about 5 weeks.

Biological dentistry Resins with high compatibility

After only a few minutes, a buildup of fibrin forms on the ceramic surface. Fibrin deposits form on the ceramic surface after just a few minutes.

Since the entire ceramic implant can’t be deformed by chewing forces, it remains rigid and immobile. As a result, no pressure is exerted on the surrounding bone and the existing bone height is preserved.

Ceramics can be customized

The abutment (piece that connects implant and crown) is cemented onto the implant without any gaps. After that, both the implant and the abutment can be grinded individually for the crown. The procedure is the same as with a natural tooth. This is a great advantage, since the edge of the crown can be perfectly adapted to the gums. Grinding the ceramic does not reduce the stability of the material. This has been confirmed in the latest studies.

With titanium, on the other hand, individual grinding of the implant in the mouth is not possible.

Ozone on the Biological Dentistry

Excellent Aesthetics

Ceramic implants are white, which is a significant advantage in terms of aesthetics.

If the gums recede a little, the visible white edge is not disturbing, but blends in with the overall picture.

Ozone on the Biological Dentistry

 

On the other hand, a metallic-greyish color, as with titanium implants, always looks unattractive in the visible area.

Also, when the soft tissue around the implant things, the greyish color shows through and affects the natural appearance.

Ozone on the Biological Dentistry
Disadvantages of Ceramic Implants


The overall cost of ceramic implants is higher than titanium implants. This is because the manufacturing process is very complex. In addition, more steps must be taken into account when placing the ceramic implants.

Another disadvantage is the slightly higher susceptibility to breakage.

Although ceramic implants are harder than titanium dental implants, they can break under heavy loads. Titanium, on the other hand, usually does not break, but bends. With today’s implants made of yttria-stabilized zirconia the probability of breakage is negligible.

Ceramic implants used to take longer to heal. With today’s ceramic materials and implantation techniques, ceramic implants heal just as quickly as titanium implants. Depending on the situation and the type of implant system, there should be a wait of 4 weeks to a maximum of 4 months before the implant can be loaded.

Jaw Inflammation – A Chronic Burden


There are a variety of different forms of jaw inflammation.

In x-ray images, e.g. in the digital volume tomography (DVT), they appear as dark areas that can be easily distinguished from the healthy bone.

  • Inflammation of shifted or partially erupted wisdom teeth
  • Inflammation of damaged or root canal treated teeth
  • Inflammation of foreign bodies remaining in the bone, such as metal splinters, overpressed root filling material, tooth fragments, etc.
  • Other forms of jaw osteitis

Such inflammatory processes in the jawbone can be a permanent burden on one’s health. The immune system is put into a continuously active state, which means that it requires more energy. This energy is then missing for daily activities – the person affected feels tired and exhausted.

Due to the proximity to the brain and the very good blood circulation in the head, the negative influence of jaw inflammation on the body is quite pronounced.

In biological dentistry, inflammation of the jaw is completely removed. The wound healing is ideally supported by minimally invasive surgical techniques using A-PRF and ozone. If teeth are removed, compatible ceramic implants can be placed immediately – bone resorption and bone grafts can be avoided.

Shape and Structure of Ceramic Implants and Titanium Implants


In addition to the biological and physical properties of the materials, the shape of the implants is also of great importance.

WIth ceramic implants, a distinction is made between one-piece and two-piece implants.

The one-piece ceramic implants consist of one complete piece, implant body and abutment combined. These mainly replace anterior (front) teeth and are rarely found 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 connected with a cement, solid and immovable. As a result, no gap forms at the connection point, creating a gap-free implant-abutment unit.

PATENT ceramic implants - with abutments and bridge

Both the one-peice and the two-piece ceramic implants are inserted in such a way that the future crown edge is in the area of the gum line – just like one’s own teeth.

Two-part systems have become established in titanium implantology. 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 is at the edge of the bone. The small gap between the implant and the abutment is located precisely at this edge of the bone. This gap can create a dirty area that can become colonized by bacteria and cause the bone to become inflamed and recede.

When chewing and applying force, small movements and deflections can occur at the implant-abutment connection of the titanium implants. This movement created pressure on the surrounding bone, which also leads to bone loss in the areas near the crown.

Which manufacturers of ceramic implants are there?


There are different manufacturers of ceramic implants. All of these systems have their individual advantages and disadvantages

The listing is purely alphabetical.

Bredent medical
CAMLOG
CERAROOT
DENTALPOINT
FairImplant
Indi Implant System
Medical Instinct
SDS
Straumann
TAV Dental
WITAR
COHO BIOMEDICAL TECHNOLOGY
Zircon Medical
Z-Systems

What should be considered when using ceramic implants?


Ceramic implants are different from titanium implants in many ways, which requires dentists to rethink implantology.

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, before the implant is placed, the wound should be thoroughly disinfected, e.g. with ozone.

Titanium implants, on the other hand, heal even if inflammation of the bone or soft tissue is left in the oral cavity. In such a case, the inflammation does not heal, but remains chronically under the implant. The result is permanent, chronic stress 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 strict MDR (Medical Device Regulation), attention should always be paid to cleanliness when selecting the implant. A good guide to implants are the dental implants that have been certified by Clean Implant.

Immediate Implantation – Tooth out, Implant in


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 elapses before implantation, there is a loss of bone height and

bone 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.

Biological dentistry and sustainable prophylaxis
Losing a tooth activates bone healing in the fresh wound, which has a very positive effect on the healing of the implant that is placed immediately. This is another reason why the implant should be placed immediately after the tooth is extracted.

It is clear that the time factor is also very crucial. In the case of immediate implantation, all further operations are omitted – the patients reach their goal faster and unnecessary multiple interventions are avoided.

Prosthetic Care


Ceramic implants take one to four months to be firmly incorporated into the jaw bone. During this time they should be stressed as little as possible.

If implants are necessary in the front, the patient is given fixed temporary provisional restorations made of composites, which ensure an attractive aesthetic appearance during the healing time.

In general, ceramic implants with a higher roughness heal faster and show better contact between bone and implant (bone-to-implant contact).

After healing, the ceramic implants, including the abutments, and ground in such a way that the future crown edge comes to rest on the gum line (just like one’s one tooth).

Individual ceramic crowns are then cemented onto the implant/abutment without gaps, taking into account the correct relation of the jaws.

Biological dentistry and sustainable prophylaxis
What are the alternatives to ceramic implants?


The best solution to a tooth gap must always be decided individually. As a rule, most ceramic implants offer the most advantages and are clearly superior to other dentures. However, there are situations in which other dental care makes more sense.

The ceramic dental bridge connections the two adjacent teeth with each other and also offers a fixed denture. The ceramic dental bridge connections the two adjacent teeth with each other and also offers a fixed denture. The bridge is then cemented onto these tooth stumps and closes the gap in the row of teeth. he grinding of the neighboring teeth is the main disadvantage of this method and only makes sense if the neighboring teeth are already severely 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.

Leaving the tooth gap is also an option and can make sense. However, it can lead to neighboring teeth tilting into the gap and teeth of the opposing jaw to grow into the gap.

Leaving the tooth gapis also an option and can make sense. However, it can cause neighboring teeth to tip into the gap and teeth of the opposing jaw to grow into the gap. In addition, there is always bone resorption in the corresponding region, which makes later implantation more difficult and bone grafting/augmentation may be required.

Removable prosthesisis another alternative treatment for the gap. Despite the low cost, this denture has serious disadvantages. A foreign body sensation, pressure points on the mucous membrane and visible clamp edges are usually no-gos for the patient.

In which case are implants not to be placed? When should implants not be placed?


Whether and when a ceramic implant can be placed must always be assessed individually and all suitable alternatives must be included/considered in the decision.

The following list of various contraindications not only refers to ceramic implants, but also to titanium implants.

A poor general condition/health with certain previous illnesses 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 the 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 implants placed decrease.

In our dental practice, the patients are strengthened before the implantation and the bound and wound healing is stimulated. The oral flora is permanently idealized through various measures. In this way, we can place immediate implants, even in chronically ill patients, and guarantee a good prognosis.

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