Surface Modifications for Zirconia Dental Implants: A Review

Zirconia-based bioceramic is a potential material for dental implants developed and introduced in dentistry 30 years ago. However, some limitations still exist for zirconia implants caused by several factors, such as manufacturing difficulties, low-temperature degradation (LTD), long-term stability, and clinical experience. Several studies validated that some subtle changes on the zirconia surface might significantly impact its mechanical properties and osseointegration. Thus, attention was paid to the effect of surface modification of zirconia implants. This review generally summarizes the surface modifications of zirconia implants to date classified as physical treatment, chemical treatment, and surface coating, aiming to give an overall perspective based on the current situation. In conclusion, surface modification is an effective and essential method for zirconia implant application. However, before clinical use, we need more knowledge about these modification methods.

Full Zirconia Implant-Born Prosthetic Rehabilitation with CAD/CAM Technology after Accurate Digital Planning. A Case Report

CAD/CAM technology can enhance the dentistry application of ceramic materials that meet the more relevant biocompatibility and aesthetics demands. In implant-borne prosthesis rehabilitation, yttria-stabilized zirconia appeared to be a valid alternative to metal-alloys and titanium, with comparable mechanical properties and even better interaction with bone and soft tissues. The improvement of monolithic CAD/CAM manufacturing allows for a reliable, predictable, and rapid workflow that can correspond to a holistic treatment philosophy associated with zirconia fixtures. This reported clinical case highlights the advantages of this approach in resolving particularly functionally and aesthetically complex situations. A 40-year-old patient with permanent canine impaction and the persistence of a deciduous tooth compromised by caries was successfully rehabilitated with the surgical removal of the enclosed tooth, the seating of a mono-phase zirconia implant after the deciduous extraction and its loading with a zirconia single crown, without any clinical or radiographical alteration up to seven years follow-up.

CBCT image artefacts generated by implants located inside the field of view or in the exomass

Objectives: To compare artefacts in cone-beam computed tomography (CBCT) arising from implants of different materials located either inside the field-of-view (FOV) or in the exomass, and to test different image-acquisition parameters to reduce them. Methods: CBCT scans of a human mandible prepared with either a titanium, titanium-zirconium, or zirconia implant were acquired with the Planmeca ProMax utilizing FOV sizes of 8 × 5 cm and 4 × 5 cm, which placed the implant inside the FOV (8 × 5 cm) or in the exomass (4 × 5 cm). The scanning parameters considered three conditions of metal artefact reduction (MAR), disabled, low, and high, and two kVp levels (80 and 90). The standard deviation (SD) of grey values of regions of interest was obtained. The effects of implant material, implant position, MAR condition, kVp level, and their interactions were evaluated by Analysis of Variance (α = 5%). Results: The zirconia implant produced the highest SD values (more heterogeneous grey values, corresponding to greater artefact expression), followed by titanium-zirconium, and titanium. In general, implants in the exomass produced images with higher SD values than implants inside the FOV. MAR was effective in decreasing SD values, especially from the zirconia implant, only when the implant was inside the FOV. Images with 80 kVp had higher SD values than those with 90 kVp, regardless of the other factors (p < 0.05). Conclusions: Implants in the exomass lead to greater artefact expression than when they are inside the FOV. Special attention should be paid to scanning parameters that reduce metal-related artefacts, such as MAR activation and increasing kVp. This is especially important with a zirconia implant inside the FOV.

Prosthetically Driven Computer-Guided One-Piece Zirconia Implant Placement and Restoration Replacing Missing Central Incisor: A Case Report

Currently, the gold standard materials of choice for dental implants are the commercially pure titanium. However, these materials may have suboptimal anterior esthetic outcome due to the dark grayish burnout. To enhance the esthetic outcomes, zirconium dioxide materials, with reported long-term success in medical uses and with its tooth-like color, was introduced as a dental implants material. This case report describes the fully guided planning and placement of one-piece zirconia implant replacing missing central incisor. A 21-years-old male patient, non-smoker in excellent general health, presented with a missing tooth #21. Straumann PURE® (4.1x10 mm) Ceramic implant was placed. Three months post-surgery, the soft tissues architecture has been achieved and stabilized, healing was satisfactory around the zirconia implant and provisional restoration. The final layered zirconia crown was fabricated. Two-step cementation technique was used to minimize the excess cement during final delivery of the crown. After delivery of the final restoration, the patient was followed up after 1, 3, 6, and 12 months.