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90 Dental Implantology and Biomaterial

5].

Mobilio Nicola, Mollica Francesco and Catapano Santo

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/64066

#### **Abstract**

Titanium is the gold standard material to produce dental implants from more than 30 years, showing high success rate in different clinical scenarios. Zirconia implants were recently introduced to overwhelm some aesthetic and biological problems that can arise from titanium. Preclinical studies show that, from a mechanical point of view, zirconia may be a suitable substitute for titanium in implant fabrication. Three-dimensional finite element analysis (FEA) models found no difference between titanium and titaniumzirconium alloy implants, neither for early nor conventional functional loading. Nevertheless, zirconia presents the same osseoconductive properties of the titanium, even if the few clinical studies show survival and success rates slightly inferior for zirconia implants comparing to titanium ones, and long-term follow-ups are missing. For these reasons, the majority of authors agree to be cautious for proposing zirconia implants as widespread substitute of titanium implants.

**Keywords:** dental implants, one-piece implant, zirconia, zirconia implant

### **1. Introduction**

Commercially pure (CP) titanium is the gold standard material used to produce dental implants over more than 30 years [1], showing a high success rate in different clinical scenarios [2–4].

Nevertheless, titanium implants may present some esthetic issues: the gray color of titanium implant may be visible in the presence of thin peri-implant tissue, leading to esthetic concern, especially in the anterior area [5]. This aspect can get dramatically worse In case of peri-implant

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mucosa recedes over time. The availability of a "white" implant may be crucial in those clinical cases in which esthetic result is mandatory.

Furthermore, titanium particles due to wear and corrosion products may be released in tissues close to implants, and they were found in regional lymph nodes [6]. In some cases, this may lead to host reaction or sensitization [7]. Some cases of allergic reaction to titanium are documented, even if rare [8, 9]. So, using some nonmetallic material as an alternative to the titanium implant may be useful and, in some cases, critical. Last but not least, always more patients request completely metal-free prosthetic reconstructions.

Ceramic implants were introduced to overwhelm some esthetic and biological problems that can arise from titanium. The first ceramic dental implant was made from alumina (i.e., aluminum oxide, Al2O3) between 1960s and 1970s, and that was the only ceramic material used until recently. However, alumina presented some biomechanical problems (like low fracture toughness), and it was then completely abandoned and replaced with zirconia that is nowa‐ days the only alternative ceramic material to titanium for dental implants (**Figure 1**) [5].

The aim of this chapter is to review the existing literature regarding zirconia dental implants, highlighting the strong points and stressing the so far unclear aspects.

**Figure 1.** A one-piece zirconia implant (courtesy of Prof. Andrea Enrico Borgonovo, University of Milan).
