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 However, given that this is not a particularly convincing method from a long-term perspective, it has since been replaced by a connection using carbon screws.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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Step by step treatment

This year, our dental practice will analyse ten years’ worth of data collected during a retrospective long-term study of 170 ceramic implants. In interdisciplinary cooperation with the Bern University Hospital in Switzerland, statistical questions relating to radiological evaluations of ceramic implants will also be addressed. Our retrospective long-term study of these 170 ceramic implants, carried out over a period of five and seven years, is scientifically evaluated and is now published.

The latest generation of ceramic implants (developed by the Institut Straumann, Basel – Switzerland) have been the clinical standard at our practice since 2011, along with well-established titanium implants.
These implants have a micro-rough surface structure which corresponds to that of modern titanium implants, thereby ensuring optimal process safety during the osseointegration of these implants. This medicinal product has been available to all ambitious implantologists Europe-wide since 2014.

The first generations of rotationally symmetrical titanium implants had a relatively smooth, machine-polished surface structure. The clinical disadvantage of this generation of dental implants was that during the early healing phase (the first four weeks after insertion of the implant) there was an increased failure rate in softer bone structures, such as the posterior region of the upper jaw. The roughening of the titanium surface was a big breakthrough: the success rates of these implants increased in comparison with implants with smooth surfaces. Nowadays, it is a scientifically established fact that bone favours surface roughness and bonds better with rough surface structures than with smooth surfaces. The surface of modern implants made of titanium is now machined subtractively in the industrial machining process. Using etching and precisely controlled radiation, the surface is roughened so that the implant is properly prepared for a safe ossification process.

The surface of ceramic implants is also roughened during the manufacturing process. However, it is important to bear in mind that ceramic is an entirely different material with properties which must not be damaged. The latest material science research was able to demonstrate that damage to the surface in the form of micro-cracks resulted from radiation using corundum particles. For this reason, machining the surface of ceramic implants in order to roughen it demands the utmost care and should only be carried out through a safe manufacturing process. The Institut Straumann (Basel, Switzerland) has managed to achieve an implant surface topography that is unique to ceramic implants and appears almost identical to that of titanium implants when looked at under the electron microscope. Scientific evidence confirms that these ceramic implants are just as stable as titanium implants in the ossification process.

Our practice avoids bone substitute materials used by many surgical dentists. Since the establishment of our joint practice in 1990, our approach has consistently and very successfully involved regenerating atrophied jaw structures using bone material from the patient’s own body. By using optimal surgical techniques and innovative instruments, it is possible to treat most patients requiring bone grafting in our outpatient clinic.
In extreme cases of jaw osteoporosis, we have had the option for many years now to graft cancellous bone from the iliac crest or small pieces of bone from the anterior iliac crest onto the prepared section of jaw. This surgical procedure is carried out in interdisciplinary cooperation with an orthopaedic surgeon (Dr Vonderschmid) at the Dritter Orden hospital in Munich. For this procedure, the hospital stay lasts from Wednesday (day of operation) to Friday (day of discharge). Upon discharge, our patients are fully mobile and do not require any walking aids. The majority of our patients reported that they would choose this surgical procedure again as the post-operative stress was not as severe as they had previously expected.
Natural bone material is osteoinductive and therefore best suited to inducing bone regeneration. In the majority of all implants, skilful surgical techniques enable the removal of natural bone which can then be re-used during surgery. As part of our clinical training courses over the last years, we have performed these surgical techniques live on prepped patients in front of colleagues wishing to further their training.