Everything About Ceramic Implants & Zirconia Dental Implants
The Page You Are About to Read is the top resource page for Zirconia Dental Implant Information Online. There is a lot to read and so much to learn, so kick off your shoes, grab a comfortable seat, and bookmark this page!
If you take the time to read the unrivaled informational resource (THIS PAGE!) about ceramic dental implants, also known as zirconia dental implants, you will no doubt find it to be the most comprehensive informational website on zirconia dental implants anywhere. Zirconia implant information is meant as a resource to help educate patients on the difference between ceramic dental implants and titanium implants and to help patients understand the alternatives and options to conventional implants.
The Natural Dentistry website has expertly curated information available delves into a deeper understanding of ceramic implants:
- zirconia implant types (1 piece, 2-piece, cementable, screw-retained, brands, sizes)
- zirconia oxide material properties
- zirconia implant costs
- titanium inflammatory factors
- titanium toxicity
- titanium host response reactions
- zirconia implant studies and research
- zirconia dental implant osseointegration
- mechanical strength and durability
We always encourage you to seek out multiple sources of information to help determine and empower you to choose the best zirconia implant dentist for you, whether locally or a flight away!
To learn more about front tooth zirconia implants and a gallery of before and after front tooth ceramic implant cases, we recommend you review our Front Tooth Zirconia Implants page.
To learn more about full mouth and full arch cases with ceramic implants, we have an entire page dedicated to full mouth reconstruction with zirconia implants with examples of All on X full arch cases with zirconia dental implants.
To learn more about zirconia implant research, success rates, and costs, jump to our page on Zirconia Implant Success Rates & Research!
To learn more about zirconia dental implant costs read the page all about costs and how to better understand which ceramic dentist to work with for your ceramic implant dental needs.
Page Table of Contents:
- Jump to Are Zirconia Implants Better than Titanium Implants?
- Jump to Zirconia Implants for Front Teeth and Tooth Replacement
- Jump to History of Zirconia Dental Implants
- Jump to Are Zirconia Dental Implants Safe, Durable, Long Lasting? Zirconia Implants FDA approved?
- Jump to Research Studies for Zirconia Dental Implants
- Jump to Types of Zirconia Dental Implants
- Jump to Zirconia Implants: FDA-Approved Brands in the US and Dr. May’s favorites
- Zirconia Implants are Ceramic Implants – they are synonyms!
- Zirconia Implants vs. Titanium Implants: Long-Term Comparison in Wet Environment
- Do Zirconia Implants contain metal? Is there any metal in zirconia implants?
- Titanium vs. Zirconia Implants Actual Materials: Titanium is a Metal Alloy
- Full Mouth Reconstruction with Zirconia Implants: All on 4, All on 6, All on 8+ Zirconia Implant Cases
- Biocompatibility & Dental Material Selection (Zirconia vs. Titanium Implants)
- Why Natural Dentistry for your Zirconia implants? Dr. May is one of the most experienced Zirconia Implant Dentists in the US
- Jump to Zirconia Dental Implant Costs (vs Titanium Implant Cost vs Bridge Cost)
- Titanium Allergies & Metal Dental Implant Reactions
- Zirconia Implants Materials Properties & Chemistry
Zirconia Implant FAQs
What is a Zirconia Dental Implant?
A zirconia Dental Implant is a metal-free, allergy-free dental implant that is made of white ceramic material and is preferred as a hypoallergenic dental implant for highly sensitive patients. A zirconia dental implant is a metal-free, ceramic white implant used in permanent tooth replacement that is ideal for front tooth replacements and patients with metal sensitivities and autoimmune disorders. These hypo-allergenic dental implants also are an excellent replacement for molar teeth and can be used for full mouth reconstruction for All-on-6, All-on-4, and any variation of All-on-X full arch. Zirconia implants are made of a combination of zirconia oxide (ZrO2 ) and yttria-oxide (Y2O3 ) that is combined into a Y-TZP form (yttria tetragonal zirconia polycrystals), forming a high-strength ceramic material with excellent long-term results in the field of medical and dental implants.
Zirconia implants have been FDA-approved since 2007 in the USA. A zirconia implant is ceramic and is entirely metal-free, unlike its metal implant mainstream counterpart made entirely of Titanium (Ti) alloys. Ceramic implants are preferred by patients for their reduced plaque adhesion, beautiful esthetic white color, reduced inflammatory response in the body, lowered host response (autoimmune reactions), no allergic responses, no metal rust or corrosion, no metal disturbances or “galvanization” and long term success rates as high as 100% success after ten years of placement in some research studies (See research here!). The opposite of this can be unfavorably said about titanium implants. Zirconia ceramic dental implants are made from Zirconia Dioxide (ZrO2) and ARE NOT MADE OF “Zirconium“ which is “Zr” on the periodic table of elements and is an elemental metal.
What are the components of a dental implant?
Zirconia implant illustration shows the main parts of a zirconia implant, depending on whether it’s a 1 piece zirconia implant or a 2 piece zirconia implant. The main components are the abutment and the zirconia implant body (the portion that screws and fuses into the jawbone). 
How are Zirconia Implant Parts different than Titanium Implant Parts?
Zirconia Implants typically have one solid piece where the abutment and the implant screw are fused together, a 2 piece implant design where the abutment is permanently cemented to the zirconia implant base or a 3 piece design (which is not as popular) with a zirconia abutment, a carbon fiber screw (Zeramex) or metal screw (Straumann Pure) that screw retains the abutment into the zirconia implant base.
Titanium implants typically come in at least 3 metal components, the metal abutment, the metal screw that attaches the abutment to the titanium implant base, and the implant base itself. On occasion, for anterior front tooth cases, a zirconia abutment can be attached with a metal screw to the titanium implant base. Mini dental implants made out of titanium come in a one-piece design.
Are Zirconia Implants as Strong as Titanium Implants
Zirconia implants are incredibly strong and durable, with long-lasting success rates and no less stability than titanium implants. SDS’s zirconia implant 2019 annual assessment revealed a fracture rate of 0.2% across all zirconia implant types, both one and 2-piece implants, which is considered excellent among implant types. Fractures are statistically an extremely rare occurrence at 0.2% per the SDS 2019 Implant Assessment.
Dr. May specializes in Zirconia Implants for:
Front Tooth Zirconia Implants | Full Mouth Zirconia Implant Cases | Root Canal Replacement with Zirconia Implants
Zirconia implants are Dr. May’s career passion and clinical expertise, with one of the highest front tooth zirconia implants placed in the USA. More than any other implant placing dentist, Natural Dentistry Center performs front tooth zirconia implant surgery placement and restorations with extremely esthetic and natural clinical restorative results.
What is a front tooth implant?
Upper Front Tooth Implants: Central incisors #8, #9 | laterals incisors #7, #10 | Canines #6, #11)
Lower Front Tooth Implants: Central incisors #24, #25 | Laterals incisors #23, #26 | Canines #22, #27)
Front tooth implants placed to replace front upper or lower teeth due to infection, trauma or infected root canals are considered specifically the most difficult implants to place and restore. The reasons for extreme difficulty and expertise in front tooth implant placement include: thin bone compared to jaw bone around molars, the gingiva/gum line is very sensitive to surgery and could easily recede if not handled properly, the gingiva is typically thinner than other areas of the mouth and implant show through is higher risk, dental implants in the front tooth area are more likely to fail due to bone type and bite forces. The most difficult aspect of front tooth ceramic implant expertise is the requirement for highly esthetic results, which allow the zirconia implant dentists like Dr. May barely any margin of error. Front tooth zirconia implant placement requires a highly surgically skilled and restoratively experienced biological dentist like Dr. May. We have an entire page on front tooth ceramic implants with before and afters!
Front Tooth Ceramic Implants Before & After
Dr. May’s Zirconia Implant Protocol:
- Review CBCT / 3D Conebeam for bone levels, sinuses, nerve location, and implant size/type determination
- Send patient for a blood test for Vitamin D to check levels
- Supplementation with Vitamin D and other minerals that support bone formation and healing is recommended if levels are low
Why is Vitamin D Important for Dental Implants?
To understand how vitamin D is related to dental implants, it’s important to understand how critical Vitamin D is for systemic health and the role it plays in the body. Minerals such as calcium and phosphorus can only be absorbed through the large intestine when vitamin D is present in the body. This makes vitamin D a critical component in both maintaining bone health and promoting new bone growth. Individuals with vitamin D deficiencies often have decreased bone mass and bones that can fracture easily, in addition to being more susceptible to dental implant failure.
After a zirconia dental implant is placed, the process of osteogenesis, also known as bone formation, occurs around the implant area. The formed bone is part of the healing process post-surgery and is highly dependent on the body’s resources to aid in the healing and bone formation after the surgery. The bone forming around the implant site will fill in the surgical site and fuse the implant to the rest of the jawbone. In order for the implant to be successful and maintain stability in the jaw, it must osseointegrate or “fuse with the bone” in the jawbone. The process of osteogenesis depends in part on the bioavailability of Vitamin D in the body and the presence and abundance of other minerals such as phosphorous and calcium. Those with low vitamin D levels may not develop enough new bone to hold the implant in place. Patients that follow Dr. May’s protocol and have sufficient vitamin D levels along with other minerals supporting their healing will have a better chance of developing healthy, new bone and may reduce their risk of implant failure.
Do Zirconia Ceramic Implants Have Metal?
First let’s correct the comment and state the fact: There is no metal whatsoever in a ceramic implant, which is why it’s called “ceramic” and not “metal.” Zirconia dental implants are 100% metal-free in their chemical composition and in their material properties.
Second, let’s address the source of the myth you were told: Plainly speaking, you have been provided incorrect information by a practitioner who is under-educated on the topic of metal-free implants. If your dentist isn’t a biological holistic dentist who has placed over 500 zirconia implants, then it’s safe to say the dentist you spoke with isn’t a zirconia implant expert and has sadly provided you with incorrect clinical information. If you’re reading this page, and you find yourself stuck with titanium implants that you wouldn’t have chosen if you were given the correct clinical information, you understandably might be upset. We empathize with you because it is certainly frustrating when someone in a position of authority (DMD or DDS) who has the trust of patients provides misleading information and fails to appropriately educate the dental patient about their implant options. We believe a dental professional in a position of authority, someone with a dental degree who should have the knowledge of available FDA-approved dental materials, should make the utmost effort to educate patients and inform them of their clinical options and alternatives to those options as part of their day-to-day profession. Long story short – don’t believe what you hear from a conventional dentist about zirconia dental implants since many don’t know how to provide patients with proper, educated, and correct information. Please remember this incorrect knowledge and/or lack of knowledge applies to the majority of conventional dentistry practitioners who are simply uneducated on this topic but often still act like a source of knowledge, NOT just to the specific dentist/periodontist/oral surgeon who you heard the myth from. The Lesson? Do your own research! And here you are 🙂
Do Zirconia Ceramic Implants Have Metal In Them?
Why Does My Conventional Dentist, Periodontist or Oral Surgeon Claim that Titanium Dental Implants are better than Ceramic Implants? Simply put, most conventional dentists in the USA aren’t trained in or exposed to, premium or alternative dental materials although they are all FDA-approved, rigorously tested and used by biological and holistic dentists. Usually, the reason that conventional dentists and oral surgeons aren’t familiar with ceramic implants falls back on the politics of industry and big business.
Titanium metal implants are the “big business” of the dental implant market and thus metal implants are the “mainstream” dental implants in the dental industry. Titanium is manufactured and distributed by largest manufacturers of dental implants, which sponsor implant research and programs in all dental schools, which then train dental students and specialists like periodontists and oral surgeons based on the sponsorship of their “affiliates” such as Nobel, Straumann, etc. After dental school indoctrination of “titanium implants as the gold standard and only standard of care”, new dentists and specialists can go off and sign up for continuing education, where they learn about many additional subjects and treatment options not covered in dental school. Again, the most well-attended and popular “mainstream” continuing education courses and workshops are sponsored by the “Big 5” Titanium implant manufacturers and have the most advertising, visibility, and the highest location access and calendar frequency. For smaller, more niche, and less popular continuing education courses such as zirconia implants, many new dentists simply do not pay attention as they are not as well advertised, they occur much less frequently, and the awareness just isn’t there from young dentists. Generally, if the dentist “next door” isn’t aware of it of a specific service like zirconia implants and isn’t offering it either, there is nothing to make the younger dentists aware of that fact that it’s even an offering based on dental school knowledge, popular dental conference, mainstream dental publications and competitive forces.
Another key reason why so few dentists are familiar with zirconia implants is economics, better known as the cost/profit equation: ceramic implant dentists like Dr. Yuriy May, who become experts in zirconia implants spend years training in zirconia implant placement and biological surgery and to achieve restorative expertise which is all an out-of-pocket expense for the zirconia implant dentist. The investment into highly specialized training is not something many dentists want to invest in as the demand for zirconia dental implants is tiny, competition is almost non-existent among dentists, and thus the investment to gain the niche knowledge and the low chance for growth in their dental clinic is a turn-off. Like few dentists who know about zirconia dental implants, even fewer patients are aware of zirconia dental implants as many depend on knowledge from their local dentists (chicken or the egg circle!)The metal-free dental implant market is highly specialized and different from titanium implant training due to the nature of the different surgical techniques and material science. At the end of the day, when a conventional dentist does have awareness of the zirconia dental implant market, the extraordinary amount of travel, and weekend time required, together with the high cost of training, is a deterrent. For those very few implant dentist few who pursue zirconia implant specialization and training like Dr. May, its about the belief in biocompatibility, long-term clinical viability for the patient and overall the best material available for dental restorations and health. Ultimately, any zirconia implant dentist will who has invested an incredible amount of investment and time into this niche field will need to recoup the costs over time, which is one of the few reasons why zirconia implants have a premium when compared to titanium implants.
Next, the basic costs of materials are another discouraging factor for most conventional dentists. The cost of FDA-approved zirconia dental implants is sometimes more than 10x that of FDA-approved titanium dental implants. As an example, some of the cheapest titanium no-name brand dental implants can be purchased for as little as $50 while the lowest cost zirconia dental implants are at least 10x per implant – that means if the dentist is charging patients a fixed implant fee (usually determined by market forces and competition), many dentists would naturally want to purchase the lowest cost implants to reduce their costs and improve their profit margin. Understandably, economics drive certain medical professionals and it remains a fact that zirconia dental implants are significantly more expensive for the dentist to purchase and keep in stock than much cheaper titanium dental implants.
Based on the lack of knowledge that both seasoned and young graduating dentists have about zirconia dental implants, the comment most give patients as to why they aren’t offering them is “zirconia implants are new and unproven,” which is untrue and incorrect. As you will read in the Zirconia Dental Implant History section, zirconia implants have been FDA-approved in the USA since 2007. They have been in use in Europe with a CE mark for over 17+ years and European clinical papers date back 70 years showing ceramic dental implant placement, development, clinical studies, and use in patients. Most dental implant research is only considered relevant for the last 5-10 years, and anything older is too different in the engineering of the models/designs/materials as of 10 years ago, numerous zirconia implant brands have been FDA-approved in the USA market with more brands receiving approval every year (since zirconia dental implant market is quickly growing due to patient demand for metal-free dental implants. We have an entire page on ceramic implant success rates and zirconia dental implant research studies!
Ceramic vs Titanium Implants
Are Ceramic Zirconia Dental Implants better than Titanium implants?
Are zirconia implants better than titanium implants?
In short, Yes, for many health-conscious people
In short, zirconia dental implants are considered more biocompatible, more esthetic, hypoallergenic, and more tissue-friendly compared to metal implants. Zirconia implants are the implants of choice of biological and holistic dentists, naturopaths, functional MDs, integrative physicians and the clear choice for patients with autoimmune disorders, allergies, and those who are health conscious. From the biological and holistic dental perspective, zirconia implants are considered superior to titanium implants.
- zirconia dental implant is 100% metal-free, allergy-free
- zirconia dental implants are white in color like a tooth, far more esthetic than grey metal
- ceramic implants are biocompatible (zirconia implants not stimulate a host response like metal implants can)
- ceramic implants are bioinert (non-reactive reducing chances of host response, less inflammation around gums)
- zirconia does not corrode (oxidation of metal, rust) and break down like titanium can
- zirconia implants do not have galvanizing effects (electrical conductivity) as metal implants do and prevent potential EMF antennae issues
- zirconia implants have not been found to cause potential systemic side effects like titanium implants may cause
- zirconia implants have over 10 years of research studies at 96%+ success after 1o years
- zirconia implants have been FDA since 2007 in the USA and CE approved since 2005 in Europe
What are zirconia dental implants used for?
Uses of Zirconia Implants in Dentistry
What are zirconia dental implants used for?
Zirconia Implants for Front Teeth, Molars & Other Uses
Zirconia implants are best used for any missing tooth in the mouth, front tooth, back tooth, canine, molar, and every tooth in between. The most popular ceramic implant usage is for front tooth implants. Dr. May places more front tooth zirconia implants than just about any holistic dentist or conventional oral surgeon in the country as of 2023. At Natural Dentistry, the specialty is front tooth ceramic dental implants to replace infected root canals, bridges, and extracted or lost front teeth.
Why are front tooth anterior implants done with ceramic instead of titanium implants? Unlike titanium dental implants, zirconia implants look absolutely beautiful and natural in the front teeth underneath the gums and help promote bone growth on the buccal bone. Unlike titanium implants which can cause more pronounced bone loss, grey-metal show through the thing gums around the front teeth and are more likely to cause gingival irritation and gum recession on the front teeth. Conclusively, zirconia material is a better implant because it doesn’t have the same metallic properties as titanium, is just as strong/stronger than titanium, has ideal biocompatibility, stimulates bone formation, eliminates galvanic current, has less thermal conductivity, and doesn’t corrode/break down long term.
Secondly, a zirconia dental implant is preferable to a titanium implant for EVERY TOOTH in the mouth, including the molars. Why? Zirconia implants are incredibly strong, they do not corrode or oxidize, they are predicted to have a lower incidence of peri-implantitis than metal dental implants, zirconia implants are observed to experience less bone loss over time compared to metal implants, the gum tissue is healthier around ceramic implants relative to titanium plants, and ceramic implants to replace the back molars accumulate less plaque (and therefore bacteria and biofilm which causes gingivitis), unlike titanium implants. This last point is especially important as the back molars is where hygienist and dentist typically see more accumulation of plaque because its notoriously harder to brush and keep clean the back of teeth and the large molar regions than the front anterior teeth.
Thirdly, ceramic implants are a better choice for replacing ANY TOOTH or a full mouth of teeth as zirconia implants are biocompatible implants without corrosion, potential inflammatory responses, exacerbated bone loss, and long-term implant failure compared to titanium implants.
History of Ceramic Dental Implants & Ceramic Dental Implants
70 Years of History of Zirconia Dental ImplantsDental implantology is a field dominated in Europe from a pioneering and invention standpoint. The first titanium implant was invented by a Swedish inventor Per-Ingvar Branemark, but not tested in human trials until the 1960s. Ceramic implants were introduced into dental implantology around the same time, in the early 1960s as an alternative to titanium implants, as metal implants had potential immunologic, allergic, and possible esthetic compromises. Variations of ceramic implants have been around for almost 70 years in documented clinical dentistry since their inception in the late 1960s.
The first ceramic implant was developed in 1967 in Europe by a Swiss dentist named Sami Sandhaus and not too far behind the first human trials of titanium implants conducted in the same decade. Dr. Sandhaus considered ceramic to be far more suitable as a dental implant material because of zirconia’s near-perfect characteristics such as its tooth-like color, mechanical properties, biocompatibility, and low plaque affinity. In 1977, Klawitter published the first paper on alumina dental implants in animal studies, followed by research in 1980 of the very popular Tübinger immediate implant, which was a ceramic implant made of aluminum oxide (Al2O3). Alumina ceramic implants had developed side by side as an alternative to titanium implants in the 1960s because of its attractive dental implant characteristics and the alumina implant one of the earliest dental implants trialed, due to its high bioinertness (superior to all metals, which are more reactive), its esthetic appearance as a white implant and its proven capacity for osseointegration (to heal and fuse with the bone). Simply stated, early ceramic implants made of aluminum oxide (Al2O3) hold over 70 years of history and clinical research as an ideal alternative treatment for improved esthetics, osseointegration, no galvanic effects, reduced plaque adhesion, and reduced incidence of peri-implantitis (otherwise known as gum inflammation around implant sites).12–14
Over time, the original alumina ceramic implants of decades past were ultimately supplanted in the dental implant market by titanium (primarily) and by zirconia (secondarily) due to the superior toughness of titanium and zirconia. Zirconia has the advantage that, like alumina, it is pearly white, but zirconia has much higher toughness than alumina.
In the 1980’s, zirconia toughened alumina (“ZTA”) implants replaced the alumina implants in research and development and were the precursor to today’s zirconia dental implant materials. Current zirconia dental implants are made of zirconia (Y-TZP; yttria tetragonal zirconia polycrystals), a high-strength ceramic material with excellent long-term results in the field of medical and dental implants. The zirconia implants placed today are made of Y-TZP, which is a high-strength ceramic material comprised of zirconia oxide (ZrO2 ) and yttria-oxide (Y2O3 ), which has significant advantages over the ceramic aluminum oxide of the past research, such as much higher resilience and flexural strength, while still capturing all the same favorable benefits of the ceramic implants discovered over 70 years ago. 27–33
Both metal-free implants and metal titanium implants did not gain wide acceptance from dentists in Europe or the USA until the 1980’s, as the “dental bridge” had long been embraced as the most well-known solution for missing teeth. The first of many positive clinical outcomes for ceramic dental implants were reported by Sami Sandhaus in 1997 for alumina, ZTA, and zirconia implants and he was a widely known lecturer, researcher, and dentist in the ceramic metal-free dental implantology field until his death in 2019.
Are Ceramic Implants safe? Are the zirconia implants FDA-approved?
Zirconia implants have been CE approved in Europe for over 17 years and FDA-approved in the USA for just over 15 years, with the first zirconia implant approved in 2007. Ceramic implants have over 70 years of clinical research and development in the dental implant field. However, the history of ceramic implants shows that innovation, research, testing, and development dates back as far as titanium implants to the 1960s. A misdirected myth often told by conventional dentists, periodontists and oral surgeons placing regular titanium implants has been propagated based on early alumina prototype research, which is that ceramic implants can fracture and break. This is an untrue statement as zirconia dental implants rarely fracture and break (less than 0.2%*) and have the same survivability rates in research as titanium implants. This is a misinformed mistake that many mainstream dentists make because they lack knowledge of current zirconia implant research, zirconia implant dental implant types, and the updated FDA-approved brands and models. In fact, more and more ceramic implant companies are being approved by the FDA and entering the US market. In the last 3 years over 6 new zirconia ceramic dental implants have been approved in the USA (as they are more popular and used by more and more dentists.) “Since the end of the 1990s, the form of partially stabilized zirconia (Y-TZP) has been promoted as suitable for dental use due to its excellent strength and superior fracture resistance as a result of an inherent transformation toughening mechanism.” (61)
What kinds of ceramic dental implant types are there?
There are two types of zirconia implant types, and they are available in 3 variations:
- 1-piece zirconia implants are a single solid implant piece where the implant body (the portion implanted into the jaw bone) and the abutment (area protruding from the gums) are together
- 2-piece zirconia implants have an implant body and a separate abutment piece that is cemented into the implant body after implant integration
- 3-piece zirconia implants which have a zirconia implant body, a zirconia abutment and a screw that attaches the implant body to the abutment. Ther screw is either carbon fiber screw (Zeramex) or a metal screw (Straumann Pure, Tav Dental)
While 2-piece zirconia implants tend to be more versatile and are easier to use, 2-piece ceramic implants have a higher incidence of breakage at the abutment/implant connection point but are still an excellent option for certain clinical situations where their use by Dr. May is determined to be the best solution. One-piece zirconia implants are the chosen favorite of an expert zirconia implant dentist and tend to be better in terms of long-term stability, enhanced bacterial profile long term and overall virtually little to no chance of breakage.
Zirconia Dental Implant Brands Available in USA – FDA Approved
There are over 8 approved FDA brands available on in the US as of 2021, and Dr. May uses almost ALL the implants based on each clinical situation. My like any implant expert, he has his favorites.
SDS Zirconia Dental Implants (♥️ Dr. May’s favorite!)
Ceraroot Zirconia Dental Implants (♥️ Dr. May’s favorite!)
Z-Systems Zirconia Dental Implants (aka Zirkolith)
Zeramex Zirconia Dental Implants
Straumman Zirconia Dental Implants
Nobel Pearl Zirconia Dental Implant (Same design as Zeramex)
Zibone Zirconia Dental Implants
Tav Dental Zirconia Implants
Which FDA-approved Zirconia Implants Does Dr. May Use?
Read below to know more than MOST DENTISTS about which ceramic implant brands are available in the US, where they are manufactured, and their technical specifications.
Dr. May uses predominantly SDS Zirconia Implants imported from Switzerland as their specific material and variety of shapes and designs allow for the most targeted and stable clinical application. Prior to SDS becoming approved in the USA in 2019 (they have been available in Europe for over 20 years) Dr. May heavily relied on another Switzerland-manufactured implant by the brand Z-Systems. Prior to the availability of SDS Zirconia dental implants, Z-Systems and Ceraroot had been the most versatile implant available on the market and has now been available for over 15 years in the USA.
Another longtime favorite of Dr. May is the Ceraroot implant, which is his top pick for large molar replacements, and he prefers this ceramic implant due to its tooth-like and wide emergence profile when replacing large molars (back teeth). Ceraroot ceramic implants have been available in the USA since 2011 and are only available in a 1 piece design and manufactured in Spain. While the Ceraroot material is manufactured differently than its Swiss-made metal-free dental implant counterparts, Ceraroot Zirconia Dental Implants have the most favorable emergence profile and anatomical shape, considered excellent options for posterior dentition restoration (large molars). Ceraroot 1 piece implants have also been a long-standing leader in Europe since 2004 and in Canada since 2011. In 2017, Zeramex received FDA approval and offered 2 piece unique zirconia implant solutions.
Zeramex implants are also manufactured in Switzerland and co-owned by Nobel (a large titanium implant manufacturer) was introduced and Dr. May placed Zeramex implants in clinical cases that called for its unique features, specifically being the only two-piece screw-retained zirconia dental implant in the USA at that time. Both Z-Systems Ceramic Implants and Zeramex Implants are available in 2-piece zirconia dental implants and are manufactured in Switzerland, and both are considered to be reputable zirconia materials and have been placed by Dr. May as soon as they have been FDA approved. The Straumann Pure has a solid 1 piece implant design which is used by Dr. May and a less popular 2 piece zirconia design contains a metal screw and metal abutment therefore is it not used at Natural Dentistry as the goal is to avoid metal. Like Strauman Pure, TAV Dental Implants also come in either a 1 piece solid zirconia design and a two-piece metal screw-retained version, which is not as popular for metal-free dental implant patients. Various risk factors are considered in the selection of the optimal zirconia metal-free dental implant for each patient, for each clinical indication, for each tooth location. New FDA-approved zirconia implants are constantly being evaluated by Dr. May and he is occasionally approached to beta test experiential ceramic dental implants being evaluated for the USA market. He is currently a beta tester for certain SDS abutments and new-to-market implant shapes (like the oval and the balcony).
Why are Zirconia dental implants referred to as ceramic dental implants?
General properties of ceramics include high melting temperature, high hardness, high toughness, no electric conductivity, low elasticity, chemical resistance and low ductility but once we think about the medical realm, we also add that ceramics are generally bio-inert (non-reactive) and biocompatible (do not cause the inflammatory host response seen with metal int the body). There are several elemental properties that gain their basics from the periodic table of elements (remember high school chemistry?) The main misinformation that is spread about FDA and CE-approved zirconia implants by conventional dentists is that they are made of ZIRCONIUM which IS WRONG. Yes, it’s easy to confuse the word ZirconIA and ZirconIUM but let’s clarify: zirconia dental implants or made from “ZrO2” and NOT Zr – those are two different materials – when Zr (zirconIUM) is processed and converted into “ZrO2” it transforms (remember transitions in chemistry?) and becomes a CERAMIC, which means it losses all of its original metal properties. Zirconia is chemically defined as (Y-TZP; yttria tetragonal zirconia polycrystals), which is a high-strength ceramic material comprised of zirconia oxide (ZrO2 ) and yttria-oxide (Y2O3). Enough with the boring chemistry, (more on the deep chemistry later in the page if you want to get super nerdy with it!) let’s bring the focus back – why are zirconia dental implants called CERAMIC implants and not metal implants? Zirconia “ZrO2” has no electro-conductivity like a metal material does – which means no galvanism – no electro current disturbances – no effects from EMF and “antenna” effects. The opposite is true for patients with titanium alloy implants who can experience and complain about PEMF / EMF disturbances such as headaches and nausea when in high radio magnetic fields or EMF zones. Like glass and like wood, a ceramic material DOES NOT conduct electricity. Another property of zirconia implants is they do not CORRODE – corrosion is another word for “oxidation” which means the breakdown of materials and we often see that as “rust” in metal. Zirconia implants are made from zirconia oxide powder layered in various steps under intense heat and pressure into a solid Y-TZP block after which it is machine milled into their final implant shape. This process significantly increases resistance to breakage and aging, allowing the ceramic implants to be prepped in the mouth similar to a natural tooth. Zirconia implant experts like Dr. Yuriy May use the process of shaping the implant in the mouth to give the implant a natural and customized emergence profile like a real tooth prep.
In-Depth Knowledge Section: Study of Corrosion, Oxidation and Rust in Titanium vs Zirconia Ceramic Implants
Let’s go back in time the famously tragic Titanic ship built of mostly of steel (a metal alloy), decaying at the bottom of the ocean which has almost entirely oxidized and corroded, with little left but rust, dust, and seashells (the ship sunk in April 2012.) Now think of the Roman/Greek liquid containers “Amphorae” used initially by Etruscans to transport mostly wine by ship, are made of ceramic and date back to as early as 5th century BC. The ceramic containers were constructed mostly of clay, specifically terracotta, and fired at high temperatures at a kiln to seal them. Unlike the metal broken down Titanic which drowned in 1912 and was nearly fully corroded by the 1980s, the ceramic amphora wine containers have been recovered from the bottom of the ocean floor after THOUSANDS of years fully intact and STILL found to contain liquid. The CERAMIC containers did not oxidize, corrode or rusk after thousands of years at the bottom of the same (not geographically) ocean. And similar to the ocean, our mouth, is a wet and harsh environment – so which material sounds more time-proof and durable for a dental implant? The metal implant made of Titanium alloy that corrodes and breaks down or the ceramic material, defined as a hard, heat-resistant, and corrosion-resistant material made from a non-metallic mineral, and processed at a high temperature?
Does a pure Titanium dental implant exist? No, it does not. All titanium dental implants are made of titanium alloy, which means titanium metal is always mixed with other metals and never pure titanium.
Why are Titanium Dental Implants made of other metal materials, not just Titanium?
Titanium which is the main material for metal dental implants but NEVER the stand-alone material, is a METAL (Ti) element, just like Nickel (Ni), Aluminum (Al), Cadmium (Cd) and Vanadium (V). What do all those metals have in common? Those are ALL elemental metals, and most of them are found in metal dental implants, 100% of which are METAL ALLOYS. What is a metal ALLOY? An alloy is a mix of at least two materials – which means metal implants are NEVER pure Titanium, pure titanium dental implants don’t exist because chemically and functionally, Ti or Titanium does not have the strength, flexural, and corrosion profile to support a dental implant on its own. 
For this reason, it is 100% of the time mixed with other metals, often the precipitating factor in metal allergies to titanium implants as Cadmium, Vanadium, and Nickel are metals we never want to come into contact with our bodies, especially 24/7 and especially when exposed to liquid and heat like in the mouth.
Full mouth reconstruction with zirconia implants? All on 4 Implants or All on 6+ Implants with Ceramic Implants?
Dr. May is one of the top dentists in the country for full mouth ceramic implants, and All on 4/6/8/10+ – many patients and colleagues consider him to be one of the best zirconia implant dentists in the USA. Natural Dentistry completes extremely challenging full mouth ceramic implant cases regularly and it has become one of Dr. May’s subspecialties – we see patients from all over the globe and all across the states for these specific, intense, and life-changing All on X procedures with specializing in the Biological Surgery “All In One Surgery” Concept.
Full Mouth Ceramic Implant All on 4/6/8/10+ Cases: (Click on the thumbnail images for full-size images & case details )
Why do most patients prefer ceramic implants to titanium implants after doing research?
A lesser-known fact is that up to 30%+ of titanium, implant patients develop perio-implantitis (the #1 cause of long-term implant failure) from the titanium alloy material itself. This is exactly the type of inflammatory response that patients want to avoid short-term and long-term, in addition to titanium allergies and autoimmune responses, which will be addressed later in the article.
While patients all over the world use Dr. Yuriy May’s ceramic implant page as an informative resource for zirconia dental implant information, Dr. May’s innovative surgery techniques, new approaches to grafting with PRF, and full mouth reconstruction completely 100% metal-free with zirconia implants that led to notoriety among the top echelons of biological dentists across the world. This has propelled Dr. May to become one of the most respected ceramic implant dentists, with many choosing either Dr. May in the Northeast USA or Dr. Volz in Switzerland, Europe, for their full mouth ceramic reconstruction implant needs. Finding an experienced ceramic implant dentist like Dr. Yuriy May will allow you to access treatment with an internationally published, top USA biological zirconia implant dentist performing BOTH the surgery and designing the beautiful restorations/crowns/bridges! If you are a patient in the northeast USA, you’re lucky, as Dr. Yuriy May, one of the top ceramic dental implant experts in the USA, is responsible for 90%+ of all metal-free dental implant placements and surgeries locally but also has patients from all over the USA and globaly. If you are a traveling patient, please see our travel info page…
Zirconia Implants vs. Titanium Implants
Why is the selection of Dental Implant Material so important for biocompatibility?
Teeth, restorations, or any dental prosthesis, including dental implants in the oral cavity, have to function in one of the most inhospitable environments in the human body. They are subject to larger temperature and pH variations than most other parts of the body. Corrosion, also known as the breakdown of metal when exposed to oxygen (think rusty metal), is officially defined as “the graded degradation of materials by the electrochemical attack. “Corrosion of titanium alloy dental implants is of concern, particularly when dental implants are placed in the wet, hot, moist mouth, also known as a ” hostile electrolytic environment” provided by the human mouth. Allergic reactions may occur from the presence of ions produced from the corrosion of implants. The present article describes various manifestations of allergic reactions due to implant material in the oral cavity.50 Well-educated patients understand the critical importance of appropriate, biocompatible, and dental material selection and thus research dental implant professionals like the acclaimed Dr. May very carefully. Before selecting a dental implant material for dental applications, it is necessary to remember that the choice of the material depends on a number of factors such as
- Metal Particle Corrosion & Galvanization Prevention Metal titanium implants break down and rust (corrode) and zirconia implants do not
- Mechanical Properties & Durability Titanium and Zirconia Implants break less than 1% with correct implant placement. How long has it been FDA approved?
- Cost & Investment Decision Criteria Zirconia Implants are approximately 10-20% more expensive than titanium implants (see our page on cost and research)
- Success Rates & Complications Both titanium metal and zirconia have 96% survivability rates at 12-year point history research studies
- Biocompatibility & Autoimmune Response Metal Titanium is considered to be a more inflammatory material and not biocompatible compared to ceramic implants
- Esthetic Appearance & Tooth-Like Feel Metal implants are unsightly, grey, show through the gingiva, and don’t look like teeth, unlike perfectly white zirconia implants
Thus, for the application of existing and new dental materials, it is essential for the patient and especially the dentist to have a comprehensive knowledge of these attributes.
Titanium Dental Implants vs Zirconia Dental Implants: Which is better?
For years, there have been concerns among oral surgeons and implant dentists that titanium might evoke an unwelcome host reaction, known as “inflammation.” However, biological dentists like Dr. May have known for decades that not only do titanium dental implants actually cause inflammation, they can also lead to bone loss, severe infections and chronic systemic inflammatory issues for patients. For decades, the discussion on titanium metal side effects has been documented in medical, dental, and material research that a strong association between surface corrosion of titanium, alongside hypersensitivity reactions. It is well understood by those who study inflammatory responses in patients and host responses in patients (whether allergists, rheumatologists or holistic biological dentists like Dr. May) that when titanium dental implants make contact with mucosal tissues of the mouth, metal ions will be released from the dental implants, which then form complexes with native proteins and act as allergens, causing hypersensitivity reactions. In addition to the host response generated by allergens in the metals of the titanium implants, literature has time and time again detected increased concentration of titanium peri-implant tissues (the gingival tissues touching the dental implant as opposed to intraosseous which is inside the bone), regional lymph nodes, and pulmonary tissues in animal models with failed implants. (See footnotes 51-60) Peri-implantitis is the number one cause of titanium implant failure – unlike zirconia dental implants which have a less than 2% instance of peri-implantitis long term.
In the dental implant market, the ceramic dental implant is considered the “Tesla” or “BMW M Series” or “Mercedes AMG” (you get the idea of premium car brands, right?) of dental implants compared to titanium implants which can be compared to your everyday budget car. The question every patient must ask themselves, “do I want to risk putting ‘budget’ materials into my body, blood supply, tissues and cranial structures or is my health worth the premium metal-free clinical solution on the dental implant market?”
Zirconia Dental Implants – 100% Metal-Free Implants Placed & Restored by Dr. Yuriy May
The superior alternative to traditional, metal dental implants are zirconia dental implants which have been available as FDA-approved, rigorously tested, metal-free dental implants for over 15 years. Zirconia implants, also known as ceramic implants, are durable, beautiful, tooth-like in color, biocompatible, have no electro-conductive properties, and are 100% METAL-FREE. Zirconia dental implants were introduced into dental implantology as an alternative to titanium implants. While metal dental implants made of titanium and titanium alloys have been widely used among traditional dentists, they pose a number of disadvantages, such as potential immunologic (allergic) and esthetic (cosmetic) compromises. For this very reason, ceramic implants have been researched since the 1960s in an effort to bring patients healthier alternatives to metal in the jaws and mouth. Natural Dentistry focuses on non-toxic, safe, healthy, premium materials in dentistry and has been placing zirconia implants for nearly a decade. Zirconia dental implants are a healthier alternative to titanium dental implants and are proven to match or exceed the benefits that titanium implants have offered patients with their long-term durability and safety. Zirconia is an optimal dental implant material because of its tooth-like color, mechanical properties, biocompatibility within the body, and low plaque affinity. After years spent placing titanium dental implants, Dr. May’s experience in biological and regenerative dentistry, along with years of post-residency advanced surgical training in bone and tissue augmentation, has earned him the reputation of being one the country’s foremost ceramic implant specialist providing dental implant candidates across the world with a superior alternative to titanium metal through the use of zirconia dental implants.
As one of the most sought-after dental implant dentists in the USA performing complex zirconia implant treatments, Dr. May places ceramic dental implants for patients from ALL OVER THE COUNTRY: West Coast, Mid-West, South-West, South-East – Dr. May places has been placing more zirconia dental implants than many other holistic dentist and oral surgeons on the East and West Coast combined
Dr. May has placed hundreds of zirconia dental implants and is one of the most experienced and sought-after ceramic dental implant surgeons in the USA, with patients flying in from all across the country ( anywhere from California, Texas, Florida, Michigan, Kentucky, North Carolina, Tennessee, and everything in between!) and locally from Connecticut, New York, New Jersey, Massachusetts, Rhode Island for ceramic and zirconia dental implants. Dr. May lectures around the country, helping other top implant dentists refine their dental implant placement techniques. As a leader across multiple dental implant societies, he is a member of the International Congress of Ceramic Implantology (IOCI), International Academy of Ceramic Implantology (IAOCI), and American Academy of Implant Dentistry (AAID). Dr. May is a founding board member of the ASCI (American Academy of Ceramic Implantology).
Why Dr. Yuriy May for Zirconia Dental Implants?
It remains a matter of both fact and opinion that Dr. May continues to be one of the country’s top zirconia implant dentists performing surgery that exclusively focuses on the placement and restoration of ceramic dental implants. His lectures and training courses further the body of knowledge of other dental professionals and help more patients find qualified dentists who understand the benefits of and are trained in placement techniques of metal-free dental implants. Since 2015 Dr. Yuriy May has been the most prominent ceramic dental implant specialist in Connecticut, servicing patients from all across the states for clinically challenging implant cases or front tooth zirconia implant treatment. To date, Connecticut’s leading zirconia implant dentist has helped place hundreds of dental implants and is considered one of the top dental implant dentists for ceramic dental implants in the Northeast. Natural Dentistry Center has impressively accumulated over 500 hours in specific biocompatible dental implant placement techniques, focusing on tissue integration, tissue biocompatibility, papilla preservation, and bone grafts using the most natural, animal-free materials, including the optimal healing and growth treatment: Platelet Rich Fibrin (PRF) made from patient’s own spun blood serum concentrating growth factors and deriving stem cells. It is no wonder that Dr. Yuriy May has grown his private biological dental practice to become the top dental implant center in the Northeast USA, offering international and local patients remarkable customization and options designed for optimal health, ultimate durability, and celebrity-worthy beauty. At Natural Dentistry, achieving beauty and health is possible.
Dr. Yuriy May is one of the top metal-free dental implant experts in the country for Metal-Free, Zirconia Dental Implants which is the optimal implant material that over 90% of Osteopaths/Functional MDs/Chiropractors and Naturopaths recommend!
Zirconia Dental Implant Costs
Dental Implant Process & Education
All patients are urged to learn about the entire process of having teeth replaced with superior dental implants and the tremendous health benefits offered with unique and very targeted optimizing procedures done at Natural Dentistry by Dr. Yuriy May. Reading below, patients will learn about elements of diagnosis, treatment planning, 3-D CAT scan analysis, surgical site preparation, bone grafting, ridge expansion/bone expansion, surgical placement of one or multiple dental implants, abutment placement and ultimately, final crown restoration process through the 3D Smile Design technologically advanced process, where patients help design their perfect smile appearance from beginning to end. Is critical to understand and discuss how the surgery and planning can prevent long-term complications such as peri-implantitis, also known as plaque accumulation, gum inflammation, and ultimately bone loss adjacent to dental implants.
The Search for a Better Dental Implant – Why Titanium Isn’t Ideal
Ceramic dental implants, specifically known as zirconium or zirconia dental implants, are one of the more modern (progressive) forms of dental implants in the oral reconstruction market, generated from the search for a better alternative to titanium dental implants.
What is Titanium? What lurks in the metal of a titanium dental implant?
Titanium is a chemical element with the symbol Ti and atomic number 22. It is a lustrous transition metal with a silver metal color, low density, and high strength. While titanium is resistant to corrosion, it cannot be used as a single unbound molecule to make a 100% titanium metal dental implant. Thus 100% of titanium dental implants are alloys that include nickel (Ni), a corrosive and known metal allergen, along with copper, steel, vanadium, and aluminum. Initially, zirconia dental implants became highly sought after by heath-conscientious patients and biological dentists alike for their metal-free and biocompatible properties, in addition to their exceptional tooth-like aesthetics.
Titanium Implants – Sub-optimal Cosmetic Results in the Esthetic Smile Zone
In fact, it is well documented in dental literature that using conventional titanium dental implants to replace missing teeth may yield cosmetically flawed results. The use of titanium implants in the aesthetic zone (typically considered in dentistry to refer to the anterior teeth and gums that are easily visible during smiling) often becomes visible through the thin gum tissue covering the front teeth (peri-implant mucosa) thus impairing desired clinical outcomes. This, in turn, can cause unaesthetic smile defects in the tooth color and gum appearance due to the transparency of a dark gray color of a titanium metal screw showing through.5,6,7 In addition, the implant endpoint closest to the abutment may become undesirably visible due to soft tissue shrinkage, gum recession, and peri-implant lesions (also referred to as perio-implantitis).5,8
Titanium Implant Risks: Corrosion – Metal Particle Displacement – Allergic Reactions
Further, although titanium has had documented resistance to corrosion, continued investigations have shown increased titanium concentration in the bone near titanium implants9 with clinical findings10 that describe especially alarming findings. It is reported that an accumulation of titanium particles has been found in tissues close to dental implant surfaces42 local lymph nodes, 43 and elsewhere 44,45 in the body. While exploring the studies and their reported negative findings with regards to titanium implants, it is important to point out that there is general agreement among dental implant professionals on the absence of local or systemic toxic effects after the implantation of zirconia ceramics (zirconia dental implants) into muscles or bones of different animals. 46,47,48,49
Titanium Dental Implants Can Cause Galvanization and Galvanic Side Effects
And yet still, there is another cautionary flag documented in numerous studies demonstrating the galvanic side effects of titanium, after metal components of the dental implant come into contact with the cellular matrix of the body, including saliva, blood cells, tissue cells and bone particles.11
Titanium Implant Allergies
Titanium toxicity & genetics
There is up to 3-5% of the population that is thought to be genetically predisposed to titanium reactions, which manifests itself as titanium implant toxicity. This is because certain genes belonging to liver detoxification pathways that normally deal with titanium detoxification have been deleted. In some of these cases, various genetics tests and metal sensitivity tests can confirm the presence of polymorphism and/or IGG IGA antibody reactions.
Titanium Allergy Symptoms
Symptoms of titanium toxicity
Common symptoms can be based on numerous factors, including the source of titanium, other metal alloy exposure, accumulation of titanium in the local tissues (around metal implants), duration of titanium exposure, and individual health factors.
- Skin diseases (Eczema, psoriasis)
- Vertigo
- Brain Fog
- Headaches/Migraines
- Peri-implantitis around metal implants
- Sinus congestion
- Cancer
- Vision problems
- Lung diseases
- Libido Changes & Sexual Male Oversensitization During Activity
- Bright’s disease (a disease involving chronic inflammation of the kidneys)
- Lupus (any of various diseases or conditions marked by inflammation of the skin)
In-Depth Knowledge Section: Galvanism – What is it and Why Does it Happen in Our Mouth?
Galvanization occurs in the oral cavity in large because of the presence of several factors all combined in one inhospitable environment known as the mouth:
- Saliva – an electricity conductor
- Various Metals – Amalgam Fillings, Titanium Implants, Porcelain Fused to Metal Bridge, Gold Crown, Surgical Steel Post, Etc
- Intercellular and intracellular electric currents
The 3 factors together create a phenomenon akin to an unwanted battery that disturbs (rather than helps) the body’s biological processes. The different metals connected through saliva and charged from the internal cellular matrix create electro-current disturbances, otherwise known as galvanization. This is why a metal-free mouth – is the most natural mouth with uninterrupted natural microcurrent flow to optimize health and regeneration processes within the body. Unlike Titanium dental implants, Zirconia implants do not corrode and will not have any impact on the taste in the mouth, importantly, they avoid the health-disturbing effects of galvanization (electro-current disturbance), which naturally disturbs the body’s energy meridians, inter-cellular electric currents, and causes or accelerates disease processes. Zirconia dental implants are the ultimate alternative for patients who are not comfortable with or are not able to tolerate metal (titanium) implants.
What is Zirconia?
Understanding the Superior Metal-Free Biocompatible Dental Implant Material and its Effects on Your Health, Beauty, Function and Life Zirconia is a very hard material and has great strength.
Zirconia – Chemical Definition
- Zirconia (ZrO2) is a high-performance ceramic dental implant material made out of ceramic powder with no metal properties
- Zirconium (Zr) can be found on the periodic table of elements as #40 in the metal family. Zirconium is a metal in its elemental form with metal properties
Zirconia is chemically defined as Y-TZP, which is a high-strength ceramic material comprised of ZrO2 and Y2O3 particles. It forms a stable tetragonal structure at room temperature after sintering. The transformation toughening mechanism is one of the main reasons for the high strength and toughness of Y-TZP.28,31,34
Zirconia Implant Material Properties
Y-TZP is a bioinert and non-resorbable metal oxide that has excellent resistance to corrosion and wear, high flexural strength, exceptional hardness, high fracture resistance, high radiopacity (definition: the inability of electromagnetic radiation to pass through a material), low thermal conductivity, ivory coloring similar to that of the natural tooth, ability to be machined, transmission of light, and the most superior biocompatibility.1,2,7,12,27,28,35–41Because of its high biocompatibility, it is used in medicine (auditory, finger and hip prostheses) and dentistry (posts, crown and bridge restorations, implants, implant abutments). Zirconia has a similar color to teeth and is bio-compatible making it an alternative material in dentistry. Zirconia dental implants were approved by FDA in 2007 and have over 50 published clinical studies. They have been booming in popularity among the European elite and quickly gaining popularity in the US among the most cutting-edge and leading progressive dentists concerned with using the highest quality materials for patient restorations and implantation.
Reported advantages of ceramic implants:
- Used over 40 years in medicine, mainly for prosthetic joints and dental implants, with great success
- Bio-compatible (completely tissue-friendly); there are no allergic reactions, no sensitivity to temperature, and no impact on taste.
- Bioinert; do not cause tissue or bone reactions.
- Gum tissue-friendly material with low plaque adhesion and tissue inflammation.
- No galvanization side effects
- No corrosion – the zirconia dental implant material does not corrode or break down into particulate matter like titanium alloy particles, and thus is self-contained, preventing it from leaching into bodily tissues at a microscopic or molecular level like findings have indicated with titanium dental implants.
- Since zirconium is white and more similar to the color of natural teeth, it has distinct aesthetic advantages over titanium. In the rare event of gum tissue recession or shrinkage, ceramic dental implants will not reveal gray shadows/lines like in the case of titanium implants. However, it should be pointed out that while more difficult, similar remarkable aesthetic results can, in fact, be achieved with titanium dental implants if they are placed by and exceptional surgeons who use ceramic abutments and crowns.
Risks with Zirconia ceramic implants?
- Zirconium dental implants are available as both two-piece and one-piece FDA-approved implants and come with a variety of abutments to offer more flexibility in their angulation and aesthetic and functional restoration goals.
- While rare, there have been cases reported of non-integration (less than 2%) similar to rates the failure rate of titanium dental implants and implant/abutment fractures. However, with long-term studies supporting zirconia dental implants’ efficacy and longevity, there is strong evidence to suggest that zirconia dental implants have a superior clinical advantage over titanium implants.
- Zirconia implants may be subjected to hydrolysis (a physiological process) whereby they can absorb water and potentially become more prone to fracture. Although the initial studies are favorable, indicating such occurrence is rare, more investigations are in progress.
The Heart of the Matter: Ceramic Implants vs. Titanium Dental Implants?
The decision to use ceramic or titanium dental implants should be fully discussed between dental reconstruction patients and the country’s prominent zirconia implant dentist, Dr. Yuriy May. On the one hand, many patients visiting Natural Dentistry specifically request ceramic dental implants because of their benefits as a biocompatible (healthier) and beautiful (more esthetic) dental implant material and its notable ‘metal-free’ properties. On the other hand, Dr. May always follows evidence-based dentistry to make proper recommendations for long-term success and safety, depending on the unique situation of each clinical case and patient. The following facts should be considered in the decision process:
- Zirconia dental implants are considered a “special premium implant” in implant dentistry, whilst titanium is regarded as the ‘everyday, low-cost, most versatile option’ for dental implant materials. Numerous studies have affirmed the high success and survival rates of zirconia implants providing a 96% + success rate. Zirconia ceramic dental implants have over 20 years of research and distinguished clinical studies and reports in the dental and medical literature. Although titanium dental implants have shown favorable long-term results, their long-term success remains evaluated at 10-15 years, with more instances of peri-implantitis in cases of long-term failure. (This is based on the interpretation of study results of both zirconia and titanium implants)
- Titanium implants demonstrate a comparable degree of integration with the bone and have an excellent long-term prognosis until signs of peri-implantitis (inflammation of tissues around the implant site) emerge and start to cause implant failures. The long-term integration properties of zirconia remain unparalleled compared to titanium implants, with rare incidents of peri-implantitis due to reducing plaque adhesion (and reduced localized inflammation inflammatory cytokines IL-1).
- Zirconia implants have a definite aesthetic advantage over titanium implants, not just in all areas of tooth replacement but specifically in the esthetic zone. When replacing teeth in the smile zone, Dr. May always uses zirconia abutments and ceramic crowns in conjunction with zirconia ceramic dental implants, providing incredible aesthetic outcomes. When gum tissues are thin, such as is typical with anterior (front of the smile) teeth, titanium’s gray shadow may become more visible, greatly bothering the patients and creating displeasing aesthetics in the smile zone. This potential aesthetic complication can be avoided only by an experienced zirconia implant dentist by proper material (zirconia) and implant size selection, implant site tissue development, proper placement of the implant, and always premium ceramic abutments and with appropriate implant loading after placement and crown design.
- Zirconia implants may not be possible to use in every patient, whether it is because of position, bone quality, autoimmune and chronic degenerative disease processes, and functional challenges.
Dr. May’s Comparison of Titanium vs. Zirconia Dental Implant Materials
Are Zirconia Dental Implants Better than Titanium Implants?
Understanding the Superior Metal-Free Biocompatible Dental Implant Material
Summary of the Desirable Qualities of Zirconia Dental Implants
Bioinert: Does not interfere with biological processes of the body. Neutral to the body. No negative effects, unlike titanium
Nonresorbable: Cannot be reabsorbed into the hard or soft tissue. Does not deteriorate. Non-corrosive: Does not oxidize like metal and does not break down from exposure to oxygen.
Resistant to wear: Highly durable against abrasion and pressure forces.
High Flexural Strength: Ability to “give” when significant pressure forces are applied. Also known as bend strength, a material property defined as the stress in a material just before it yields in a breakage…
High Hardness: Does not have the malleability of metals such as titanium alloys, allowing the material to withstand greater pressure and stronger forces without wear or loss of structural integrity.
Low Thermal Conductivity: Material withstands heat and does not conduct heat to adjacent bone and tissue, unlike titanium which conducts immediate heat transfer as a metal
Light Transmission: material is partially translucent and has the ability to transmit light particles just as a real tooth does, allowing the biomimetic replication of original tooth aesthetics.
Color: White to ivory color resembling the true color of natural teeth, unlike steel and gray metal in titanium implants
References & Citations
- 1. Depprich R, Zipprich H, Ommerborn M, et al. Osseointe- gration of zirconia implants compared with titanium: an in vivo study. Head Face Med. 2008;4,1–8.
- 2. Hoffmann O, Angelov N, Gallez F, Jung RE, Weber FE. The zirconia implant-bone interface: a preliminary histologic evaluation in rabbits. Int J Oral Maxillofac Implants. 2008;23:691–695.
- 5. Oliva J, Oliva X, Oliva JD. One-year follow-up of first consecutive 100 zirconia dental implants in humans: a comparison of 2 different rough surfaces. Int J Oral Maxillofac Implants. 2007;22: 430–435.
- 6. Silva NR, Coelho PG, Fernandes CA, Navarro JM, Dias RA, Thompson VP. Reliability of one-piece ceramic implant. J Biomed Mater Res B Appl Biomater.
- 2009;88:419–426.
- 7. Andreiotelli M, Kohal RJ. Fracture strength of zirconia implants after artificial aging. Clin Implant Dent Relat Res. 2009;11: 158–166.
- 8. Heydecke G, Kohal R, Glaser R. Optimal esthetics in single tooth replacement with the Re-Implant system: a case report. Int J Prosthodont. 1999;12:184–189.
- 9. Bianco PD, Ducheyne P, Cuckler JM. Local accumulation of titanium released from a titanium implant in the absence of wear. J Biomed Mater Res. 1996;31:227–234.
- 10. Weingart D, Steinemann S, Schilli W, et al. Titanium deposition in regional lymph nodes after insertion of titanium screw implants in maxillofacial region. Int J Oral Maxillofac Surg. 1994;23:450–452.
- 11. Tschernitschek H, Borchers L, Geurtsen W. Nonalloyed titanium as a bioinert metal – a review. Quintessence Int. 2005;36: 523–530.
- 12. Kohal RJ, Wolkewitz M, Hinze M, Han JS, Ba ̈chle M, Butz F. Biomechanical and histological behavior of zirconia implants: an experiment in the rat. Clin Oral Implants Res. 2009;20:333–339.
- 13. Andreiotelli M, Wenz HJ, Kohal RJ. Are ceramic implants a viable alternative to titanium implants? A systematic literature review. Clin Oral Implants Res. 2009;20(suppl 4):32–47.
- 14. Sandhaus S. The Cerasand endosseous implant. Actual Odontostomatol. 1987;41(160 Spec No):607–626.
- 27. Kohal RJ, Klaus G, Strub JR. Zirconia-implant-supported all-ceramic crowns withstand long-term load: a pilot investigation. Clin Oral Implants Res. 2006;17:565–571.
- 28. Hisbergues M, Vendeville S, Vendeville P. Zirconia: Established facts and perspectives for a biomaterial in dental implantology. J Biomed Mater Res B Appl Biomater. 2009;88:519–529.
- 29. Depprich R, Zipprich H, Ommerborn M, et al. Osseointe- gration of zirconia implants: an SEM observation of the bone-implant interface. Head Face Med. 2008;4:1–7.
- 30. Stadlinger B, Hennig M, Eckelt U, Kuhlisch E, Mai R. Comparison of zirconia and titanium implants after a short healing period. A pilot study in minipigs. Int J Oral Maxillofac Surg. 2010;39: 585–592.
- 31. Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials. 1999;20:1–25.
- 32. Piconi C, Maccauro G, Muratori F, Brach Del Prever E. Alumina and zirconia ceramics in joint replacements. J Appl Biomater Biomech. 2003;1:19–32.
- 33. Helmer JD, Driskell TD. Research on bioceramics. Symposium on Use of Ceramics as Surgical Implants, 1969. Clemson University, Clemson, SC.
- 35. Gahlert M, Burtscher D, Grunert I, Kniha H, Steinhauser E. Failure analysis of fractured dental zirconia implants. Clin Oral Implants Res. 2012;23:287–293.
- 36. Mellinghoff J. First clinical results of dental screw implants made of zirconium oxide [in German]. Z Zahnarztl Implantol. 2006; 22:288–293.
- 37. Kollar A, Huber S, Mericske E, Mericske-Stern R. Zirconia for teeth and implants: a case series. Int J Periodontics Restorative Dent. 2008;28:479–487.
- 38. Sollazzo V, Pezzetti F, Scarano A, et al. Zirconium oxide coating improves implant osseointegration in vivo. Dent Mater. 2008;24:357–361.
- 39. Rocchietta I, Fontana F, Addis A, Schupbach P, Simion M. Surface-modified zirconia implants: tissue response in rabbits. Clin Oral Implants Res. 2009;20:844–850.
- 40. Ozkurt Z, Kazazog ̆ lu E. Zirconia dental implants: a literature review. J Oral Implantol. 2011;37:367–376.
- 41. Sennerby L, Dasmah A, Larsson B, Iverhed M. Bone tissue responses to surface-modified zirconia implants: a histomorphometric and removal torque study in the rabbit. Clin Implant Dent Relat Res. 2005;7(suppl 1): S13–S20.
- 42. Meyer U, Buhner M, Buchter A, Kruse-Losler B, Stamm T, Wiesann FI. Fast element mapping of titanium wear around implants of different surface structures. Clin Oral Implants Res 2006;17:206-11.
- 43. Weingart D, Steinemann S, Schilli W. Titanium deposition in regional lymph nodes after insertion of titanium screw implants in the maxillofacial region. Int J Oral Maxillofac Surg 1994;23:450-2.
- 44. Frisken KW, Dandle GW, Lugowski S, Jordan G. A study of titanium release into body organs following the insertion of single threaded screw implants into the mandibles of sheep. Aust Dent J 2002;47:214-7.
- 45. Schliephake H, Reiss G, Urban R, Neukam FW, Guckel S. Metal release from titanium fixtures during placement in the mandible: An experimental study. Int J Oral Maxillofac Implants 1993;8:502-11.
- 46. Piconi C, Maccauro G, Muratori F, Prever BD. Alumina & zirconia ceramics in joint replacements. J Appl Biomater Biomech 2003;1:19-32.
- 47. Griss P, Von Adrian-Werburg HV. Biological activity & histocompatibility of dense Al 2 O 3 -MgO ceramic implants in rats. J Biomed Mater Res 1973;7:453-62.
- 48. Harms J, Mausle E. Tissue reaction to ceramic implant material. J Biomed Mater Res 1979;13:67-87.
- 49. Garvie RC, Urbani C, Kennedy DR, Mcheuer JC. Biocompatibility of magnesia-partially stabilized zirconia ceramics. J Mater Sci 1984;19:3224-8.
- 50. Chaturvedi, TP. “Allergy Related to Dental Implant and Its Clinical Significance.” Clinical, Cosmetic and Investigational Dentistry 5 (2013): 57–61.
- 51. Olmedo, D.G.; Paparella, M.L.; Brandizzi, D.; Cabrini, R.L. Reactive lesions of peri-implant mucosa associated with titanium dental implants: A report of 2 cases. Int. J. Oral Maxillofac. Surg. 2010, 39, 503–507.52. Egusa, H.; Ko, N.; Shimazu, T.; Yatani, H. Suspected association of an allergic reaction with titanium dental implants: A clinical report. J. Prosthet. Dent. 2008, 100, 344–347.53. Flatebø, R.S.; Johannessen, A.C.; Grønningsæter, A.G.; Bøe, O.E.; Gjerdet, N.R.; Grung, B.; Leknes, K.N. Host response to titanium dental implant placement evaluated in a human oral model. J. Periodontol. 2006, 77, 1201–1210.54. Sicilia, A.; Cuesta, S.; Coma, G.; Arregui, I.; Guisasola, C.; Ruiz, E.; Maestro, A. Titanium allergy in dental implant patients: A clinical study on 1500 consecutive patients. Clin. Oral Implants Res. 2008, 19, 823–835.55. Chaturvedi, T.P. An overview of the corrosion aspect of dental implants (titanium and its alloys). Indian J. Dent. Res. 2009, 20, 91–98.56. Siddiqi, A.; Payne, A.G.T.; de Silva, R.K.; Duncan, W.J. Titanium allergy: Could it affect dental implant integration? Clin. Oral Implants Res. 2011, 22, 673–680.57. Javed, F.; Al-Hezaimi, K.; Almas, K.; Romanos, G.E. Is titanium sensitivity associated with allergic reactions in patients with dental implants? A systematic review. Clin. Implant Dent. Relat. Res. 2013, 15, 47–52.58. Hallab, N.; Merritt, K.; Jacobs, J.J. Metal sensitivity in patients with orthopedic implants. J. Bone Joint Surg. Am. 2001, 83, 428–436.59. Frisken, K.W.; Dandie, G.W.; Lugowski, S.; Jordan, G. A study of titanium release into body organs following the insertion of single threaded screw implants into the mandibles of sheep. Aust. Dent. J. 2002, 47, 214–217.60. Jacobs, J.J.; Skipor, A.K.; Black, J.; Urban, R.; Galante, J.O. Release and excretion of metal in patients who have a total hip replacement component made of titanium-base alloy. J. Bone Joint Surg. Am. 1991, 73, 1475–1486.
- 61. Strub, Joerg. “Zirconia in Dentistry: Part 1. Discovering the Nature of an Upcoming Bioceramic.” The European Journal of esthetic dentistry: official journal of the European Academy of Esthetic Dentistry (2009):
