Appropriate selection of the implant biomaterial is a key factor for long term success of implants. The biologic environment does not accept completely any material so to optimize biologic performance, implants should be selected to reduce the negative biologic response while maintaining adequate function. Every clinician should always gain a thorough knowledge about the different biomaterials used for the dental implants. This article makes an effort to summarize various dental bio-materials which were used in the past and as well as the latest material used now.

Implant biomaterials: A comprehensive review.

Currently, zirconia is widely used in biomedical area as a material for prosthetic devices because of its good mechanical and chemical properties. Largely employed in clinical area for total hip replacement, zirconia ceramics (ZrO(2)) are becoming a prevalent biomaterial in dentistry and dental implantology. Although titanium is used in dental implantology currently, there is a trend to develop new ceramic-based implants as an alternative to monolithic titanium. This article reviews the evolution and development of zirconia through data published between 1963 and January 2008 in English language. Articles were identified via a MEDLINE search using the following keywords: zirconia, zirconia/biocompatibility, zirconia/osseointegration, zirconia/periointegration, zirconia/review, and zirconia/bacterial adhesion or colonization. This review of the literature aims at highlighting and discussing zirconia properties in biological systems for their future use in dental implantology. In conclusion, zirconia with its interesting microstructural properties has been confirmed to be a material of choice for the "new generation" of implants, thanks to its biocompatibility, osseoconductivity, tendency to reduce plaque accumulation, and interaction with soft tissues, which leads to periointegration. However, scientific studies are promptly needed to fulfill gaps like long-term clinical evaluations of "all zirconia implants," currently leading to propose an alternative use of "hybrid systems" (i.e., titanium screw with zirconia collar) and also bacterial colonization of zirconia. Moreover, there is a permanent need for consistent information about topography and chemistry of zirconia allowing easier cross-product comparisons of clinical devices.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/jbm.b.31147

Zirconia: Established facts and perspectives for a biomaterial in dental implantology.

Aim: The aim of this systematic review was to screen the literature in order to locate animal and clinical data on bone–implant contact (BIC) and clinical survival/success that would help to answer the question ‘Are ceramic implants a viable alternative to titanium implants?’

Material and methods: A literature search was performed in the following databases: (1) the Cochrane Oral Health Group's Trials Register, (2) the Cochrane Central Register of Controlled Trials (CENTRAL), (3) MEDLINE (Ovid), and (4) PubMed. To evaluate biocompatibility, animal investigations were scrutinized regarding the amount of BIC and to assess implant longevity clinical data were evaluated.

Results: The PubMed search yielded 349 titles and the Cochrane/MEDLINE search yielded 881 titles. Based upon abstract screening and discarding duplicates from both searches, 100 full-text articles were obtained and subjected to additional evaluation. A further publication was included based on the manual search. The selection process resulted in the final sample of 25 studies. No (randomized) controlled clinical trials regarding the outcome of zirconia and alumina ceramic implants could be found.

The systematic review identified histological animal studies showing similar BIC between alumina, zirconia and titanium. Clinical investigations using different alumina oral implants up to 10 years showed survival/success rates in the range of 23 to 98% for different indications. The included zirconia implant studies presented a survival rate from 84% after 21 months to 98% after 1 year.

Conclusions: No difference was found in the rate of osseointegration between the different implant materials in animal experiments. Only cohort investigations were located with questionable scientific value. Alumina implants did not perform satisfactorily and therefore, based on this review, are not a viable alternative to titanium implants. Currently, the scientific clinical data for ceramic implants in general and for zirconia implants in particular are not sufficient to recommend ceramic implants for routine clinical use. Zirconia, however, may have the potential to be a successful implant material, although this is as yet unsupported by clinical investigations.

Are ceramic implants a viable alternative to titanium implants? A systematic literature review

One goal of the American Academy of Fixed Prosthodontics is regularly to publish comprehensive literature reviews on selected topics germane to the discipline of fixed prosthodontics. The following report is the result of this goal and focuses on provisional fixed prosthodontic treatment. Major subtopics include materials science and clinical considerations involving natural teeth and dental implants. The interrelationship between provisional and definitive fixed prosthodontic treatment is multifaceted and significant. Provisional therapy involves numerous materials and techniques that require special knowledge and technical experience. In this analysis, technical, clinical, and investigational articles are detailed and presented as a comprehensive literature review to provide contemporary guidelines. Referenced publications were found by conducting a Medline search and were limited to peer-reviewed, English-language articles published from 1970 to the present. Materials used with provisional treatment are discussed in terms of clinical selection and the influence of their physical properties on treatment outcome. Specific product names and manufacturers are included in this report only when they are cited in the original referenced publications.

A review of selected dental literature on contemporary provisional fixed prosthodontic treatment: report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics.

Titanium and titanium alloys are widely used for fabrication of dental implants. Because of potential immunologic and possible esthetic compromises with titanium implants, novel implant te...

Zirconia Dental Implants: A Literature Review

Titanium is used for many dental applications and instruments, such as orthodontic wires, endodontic files, dental implants, and cast restorations. The popularity of titanium is primarily due to its good mechanical properties, its high corrosion resistance, and its excellent biocompatibility. A thorough review of the medical and dental literature reveals, however, that titanium can also cause chemical-biological interactions. Tissue discoloration and allergic reactions in patients who have come in contact with titanium have been reported. The biostability of titanium is becoming increasingly questioned. At the same time, new technologies and materials, such as high-performance ceramics, are emerging which could replace titanium in dentistry in the not-too-distant future.

Nonalloyed titanium as a bioinert metal--a review.

The replacement of teeth by implants is usually restricted to patients with completed craniofacial growth. Implant insertions in children or adolescents are circumvented due to several unfavorable potential effects including trauma to tooth germs, tooth eruption disorders and multidimensional restrictions of skeletal craniofacial growth. Moreover, the functional and esthetic results of the oral rehabilitation are only temporary acceptable. However, to a small number of pediatric patients suffering congenitally from severe hypodontia caused by syndromes such as ectodermal dysplasia, conventional prosthodontic rehabilitations are insufficient. We report the case of a boy with ectodermal dysplasia who exhibited a severe hypodontia and who was treated with implants inserted into the anterior mandible at the age of 8 years. The implants were functionally loaded and resulted in a high patient satisfaction. We recommend the early insertion of dental implants in children with severe hypodontia. Reviewing the current literature, several aspects of syndromic hypodontia, patient selection and implant planning are discussed.

Implants in children with ectodermal dysplasia: a case report and literature review

The aim of this evaluation was to examine correlations between internal derangement of the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A prospective controlled clinical study was carried out. Thirty patients with signs and symptoms of internal derangement but without any subjective neck problems and 30 age- and gender-matched control subjects without signs and symptoms of internal derangement were examined. The investigation of the temporomandibular system was carried out using a 'Craniomandibular Index'. Afterwards an examiner-blinded manual medical investigation of the craniocervical system was performed. This included muscle palpation of the cervical spine and shoulder girdle as well as passive movement tests of the cervical spine, to detect restrictions in the range of movement as well as segmental intervertebral dysfunction. The internal derangement of the TMJ was significantly associated with 'silent' CSD (t-test, P < 0.05). Patients with raised muscle tenderness of the temporomandibular system exhibited significantly more often pain on pressure of the neck muscles than patients without muscle tenderness of the temporomandibular system (t-test, P < 0.05). As a result of the present study, for patients with internal derangement of the TMJ an additional examination of the craniocervical system should be recommended.

Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine.

The hypothesis of a functional coupling between the muscles of the craniomandibular system and the muscles of other body areas is still controversial. The purpose of this pilot study was to examine whether there is a relationship between the craniomandibular system, the craniocervical system and the sacropelvic region. To test this hypothesis, the prevalence and localization of dysfunction of the cervical spine and the sacroiliac joint were examined in a prospective, experimental trial. Twenty healthy students underwent an artificial occlusal interference, which caused an occlusal interference. The upper cervical spine (C0-C3) and the sacroiliac joint were examined before, during and after this experimental test. The primary outcome with these experimental conditions was the occurrence of hypomobile functional abnormalities. In the presence of occlusal interference, functional abnormalities were detected in both regions examined and these changes were statistically significant. The clinical implic...

The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation.

Titanium is used for many dental applications and instruments, such as orthodontic wires, endodontic files, dental implants, and cast restorations. The popularity of titanium is primarily due to its good mechanical properties, its high corrosion resistance, and its excellent biocompatibility. A thorough review of the medical and dental literature reveals, however, that titanium can also cause chemical-biological interactions. Tissue discoloration and allergic reactions in patients who have come in contact with titanium have been reported. The biostability of titanium is becoming increasingly questioned. At the same time, new technologies and materials, such as high-performance ceramics, are emerging which could replace titanium in dentistry in the not-too-distant future.— Reprinted with permission of Quintessence Publishing .

Harald Tschernitschek

Papers

Nonalloyed titanium as a bioinert metal--a review.

Implants in children with ectodermal dysplasia: a case report and literature review

Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine.

The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation.

Nonalloyed titanium as a bioinert metal—A review