The latest scientific and clinical studies confirm that ceramic implants are more biocompatible than titanium implants. There is less accumulation of bacterial biofilm on ceramic implants, and virtually no signs of peri-implantitis (chronic or acute inflammatory changes and bone loss) are found during clinical follow-up examinations. Moreover, no corrosion processes occur as the material is completely neutral.
Even the most experienced clinicians are amazed by how both bone tissue and soft tissue accumulate around one-piece zirconia implants without causing inflammation, so much so that new clinical evaluations based on recently collected scientific data have been carried out. The findings of these follow-up analyses of the soft tissue around ceramic implants have led to the development of innovative measurement methods. These have proved that ceramic implants have higher aesthetic soft tissue generation rates than comparable titanium implants.
Due to the difficulty of aligning the axis when inserting one-piece implants, two-piece ceramic implants are in higher demand among clinicians. The systems currently available on the market still need to be subjected to long-term studies. In particular, the connection between the implant and abutment needs critical attention. The implant base can be connected to the abutment by adhesion. However, given that this is not a particularly convincing method from a long-term perspective, it has since been replaced by a connection using carbon screws.
In the meantime, ceramic implants with a reduced diameter have also been developed for restricted indications for narrow front teeth. One material-specific advantage of titanium over ceramic here is the superiority of thinner titanium implants for narrow alveolar ridges.
Nevertheless, the one-piece design of zirconia implants has obvious benefits compared with two-piece implants: there are no micro-gaps underneath the gingiva, and the biological width of the surrounding tissue is no longer interfered with during final prosthetic restoration, following the bone healing phase of the implant. The rigidity of the one-piece ceramic implant also guarantees stability and resistance to fracture.
Histomorphometric studies relating to biological width have demonstrated that one-piece implants bear the greatest similarity to natural tooth structures. In this respect, one-piece ceramic implants are also closer to the “natural” tooth model as two-piece teeth do not exist naturally.
During the three-month-long ossification phase, the ceramic implants protruding from the gingiva must be protected from incorrect loading or early loading. For some critics of ceramic implants, this is another factor as to why preference should be given to titanium implants for reasons of clinical convenience. However, in our many years of working with one-piece implants, our clinical experience has shown that protection of the implant can be ensured by means of small protective splints or temporary dentures which are produced before or after surgery. At this stage, it is important to brief patients in order to ensure that they take care of the newly inserted ceramic implants when eating.
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