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Dental Implants |
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Metal or Ceramic?
Dr. Paul Gilbert
The major function of an implant is essentially to provide a means to anchor a false tooth (called a crown by dentists) in your mouth. The purpose of this page is to help you understand the basics of dental implants, the differences between metal and ceramic dental implants, and which type of implant is better for you and your health.
Let’s start with a brief history of modern dental implants:
In 1952, a Swedish orthopedic surgeon, Dr. Per-Ingvar Brånemark, accidentally discovered a previously unrecognized special characteristic of titanium metal when he discovered he was unable to remove a titanium cylinder he had placed in a rabbit femur bone, during a study of bone healing and regeneration.
Essentially, the bone had grown in such close proximity to the titanium cylinder that it had apparently fused together with the bone. Dr. Brånemark, continued to experiment further, in both animal and human subjects with titanium implant devices, and in 1965 he placed his first titanium dental implant into a live human volunteer.
This unusual property of titanium when imbedded in bone was eventually called osseointegration by Dr. Brånemark, but not until 1976. The phenomenon of osseointegration is the reason why modern dental implants were initially made with titanium. Osseointegration gave titanium a much higher success rate when used as an implant material than previously used implant metals, such as stainless steel.
Below is an x-ray picture of the titanium cylinder used in Dr. Brånemark’s original study.
In 1952, a Swedish orthopedic surgeon, Dr. Per-Ingvar Brånemark, accidentally discovered a previously unrecognized special characteristic of titanium metal when he discovered he was unable to remove a titanium cylinder he had placed in a rabbit femur bone, during a study of bone healing and regeneration.
Essentially, the bone had grown in such close proximity to the titanium cylinder that it had apparently fused together with the bone. Dr. Brånemark, continued to experiment further, in both animal and human subjects with titanium implant devices, and in 1965 he placed his first titanium dental implant into a live human volunteer.
This unusual property of titanium when imbedded in bone was eventually called osseointegration by Dr. Brånemark, but not until 1976. The phenomenon of osseointegration is the reason why modern dental implants were initially made with titanium. Osseointegration gave titanium a much higher success rate when used as an implant material than previously used implant metals, such as stainless steel.
Below is an x-ray picture of the titanium cylinder used in Dr. Brånemark’s original study.
Dr. Brånemark’s 1965 dental implant marked a pivotal moment in dental history. Since then, the design of titanium dental implants has been greatly improved. They are now generally composed of a high-grade titanium alloy shaped somewhat like a screw, often with a roughened surface to improve osseointegration.
.In the late 1980’s ceramic dental implants made of a material called Zirconia were introduced into the United States (having already been used in Europe for several years) as an alternative to titanium based metal implants. The primary reason for using Zirconia instead of titanium was to provide patients with a nonmetal alternative to metal implants.
Both types of implants have long term clinical success - in other words - they both last a long time in the mouth, especially when combined with meticulous oral hygiene to keep the implant as plaque free as possible. Scientific studies confirm that bone grows in intimate contact (osseointrgrates) with either type of implant material. Both types of implant materials are FDA approved and considered safe, at least by the FDA and by traditional dentists.
Below are pictures of the two types of implants, so you can see the physical similarities and differences.
Both types of implants have long term clinical success - in other words - they both last a long time in the mouth, especially when combined with meticulous oral hygiene to keep the implant as plaque free as possible. Scientific studies confirm that bone grows in intimate contact (osseointrgrates) with either type of implant material. Both types of implant materials are FDA approved and considered safe, at least by the FDA and by traditional dentists.
Below are pictures of the two types of implants, so you can see the physical similarities and differences.
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Titanium Zirconia
In spite of what the FDA says, from a biocompatibility standpoint, is there a difference between titanium metal implants and zirconia ceramic implants?
The fact is that there really is a difference. Which type do you think is more biocompatible? If you don’t know the answer, read the rest of this page.
So, what are the biocompatibility differences between metal and ceramic implants?
First, from a biocompatibility standpoint, titanium dental implants lack true biocompatibility because titanium dental implants are rarely made with pure titanium. Instead, they are usually manufactured from a titanium alloy, to make the implant stronger. Unfortunately, the alloy contains a few undesirable metals, including small amounts of aluminum, vanadium and nickel. Nickel is a known carcinogen (causes cancer) and may also, albeit rarely, cause an allergic reaction.
Second, although titanium implants are exceptionally resistant to corrosion, it does occasionally occur. Titanium is a metal and, like all metals, it can possibly corrode. When corrosion occurs, you are exposed to the metals in the implant as the metal degrades, and then these metals may be absorbed into your body.
Third, corrosion may also occasionally cause a galvanic reaction, resulting in the generation of a slight electrical current, which may manifest itself as a metallic taste or some other unpleasant symptom. You can read more about a metallic taste in your mouth on the Metallic Taste page on this website.
In short, metals in the body are almost always problematic to some extent, especially with regard to biocompatibility. The best way to avoid any problems is to avoid the metals.
On the other hand, compared to titanium implants, the newer zirconia implants cannot corrode because they are metal free, which makes them biologically healthier for you, plus they are actually stronger than titanium implants. They are also hypoallergenic. Furthermore, since ceramic implants are white, they eliminate the possibility of any metal showing at the gum line, which can be a problem when upper front teeth are involved. This problem occurs when the implant metal becomes visible as a grey like color through the thin gum tissue covering the jaw bone in the front of the mouth. Although currently, the majority of implants placed in the United States are made of titanium, consumer demand for dental materials that are white, and thus more cosmetic than metals, will likely result in ceramic implants becoming more common, especially for replacing upper front teeth.
Is zirconia truly metal free?
Zirconia is best known as cubic zerconia for its use as an inexpensive alternative to diamonds, especially in jewelry. It is a crystal material that is altered slightly when used in dental implants, to give it a tooth color. The Zirconia used for dental implants is the metal oxide crystal form of the transitional metal element Zirconium. When the zirconium is treated, stabilized and converted into its crystal phase, it becomes a ceramic, and thus, no longer a metal. So yes, zirconia is metal free.
Is zirconia as strong as titanium?
Although this is not a biocompatibility issue, the question of strength is important when considering which kind of implant to choose. After all, no one wants an implant that might break prematurely in their mouth?
As best as can be determined, dental implants, whether they are ceramic or titanium, are both strong enough to last a long time. However, there is some evidence that ceramic implants may be slightly more prone to fracturing than titanium implants. Since ceramic implants have not had as many years for development and improvement as titanium implants, further research may eventually result in the development of ceramic implants that are equal to or stronger than metal implants.
The fact is that there really is a difference. Which type do you think is more biocompatible? If you don’t know the answer, read the rest of this page.
So, what are the biocompatibility differences between metal and ceramic implants?
First, from a biocompatibility standpoint, titanium dental implants lack true biocompatibility because titanium dental implants are rarely made with pure titanium. Instead, they are usually manufactured from a titanium alloy, to make the implant stronger. Unfortunately, the alloy contains a few undesirable metals, including small amounts of aluminum, vanadium and nickel. Nickel is a known carcinogen (causes cancer) and may also, albeit rarely, cause an allergic reaction.
Second, although titanium implants are exceptionally resistant to corrosion, it does occasionally occur. Titanium is a metal and, like all metals, it can possibly corrode. When corrosion occurs, you are exposed to the metals in the implant as the metal degrades, and then these metals may be absorbed into your body.
Third, corrosion may also occasionally cause a galvanic reaction, resulting in the generation of a slight electrical current, which may manifest itself as a metallic taste or some other unpleasant symptom. You can read more about a metallic taste in your mouth on the Metallic Taste page on this website.
In short, metals in the body are almost always problematic to some extent, especially with regard to biocompatibility. The best way to avoid any problems is to avoid the metals.
On the other hand, compared to titanium implants, the newer zirconia implants cannot corrode because they are metal free, which makes them biologically healthier for you, plus they are actually stronger than titanium implants. They are also hypoallergenic. Furthermore, since ceramic implants are white, they eliminate the possibility of any metal showing at the gum line, which can be a problem when upper front teeth are involved. This problem occurs when the implant metal becomes visible as a grey like color through the thin gum tissue covering the jaw bone in the front of the mouth. Although currently, the majority of implants placed in the United States are made of titanium, consumer demand for dental materials that are white, and thus more cosmetic than metals, will likely result in ceramic implants becoming more common, especially for replacing upper front teeth.
Is zirconia truly metal free?
Zirconia is best known as cubic zerconia for its use as an inexpensive alternative to diamonds, especially in jewelry. It is a crystal material that is altered slightly when used in dental implants, to give it a tooth color. The Zirconia used for dental implants is the metal oxide crystal form of the transitional metal element Zirconium. When the zirconium is treated, stabilized and converted into its crystal phase, it becomes a ceramic, and thus, no longer a metal. So yes, zirconia is metal free.
Is zirconia as strong as titanium?
Although this is not a biocompatibility issue, the question of strength is important when considering which kind of implant to choose. After all, no one wants an implant that might break prematurely in their mouth?
As best as can be determined, dental implants, whether they are ceramic or titanium, are both strong enough to last a long time. However, there is some evidence that ceramic implants may be slightly more prone to fracturing than titanium implants. Since ceramic implants have not had as many years for development and improvement as titanium implants, further research may eventually result in the development of ceramic implants that are equal to or stronger than metal implants.
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How are dental implants actually placed in your mouth?
Dental implants, whether metal or ceramic, are surgically inserted into the jaw where the tooth used to be, and is then allowed a period of healing (osseointegration). Sometimes additional bone is grafted into the jaw bone to provide more bone thickness and support for the implant. The process of osseointegration and healing takes about four to six months to occur. Generally speaking, once the implant has fused to the jaw, a post (called an abutment) is attached to the top of the implant to support the false tooth which is then screwed or cemented on to the abutment.
In summary, the health advantages of ceramic implants compared to metal implants are:
So, if a dentist recommends implants for you, make sure they are of the newer, non-metal zirconia type. If your dentist says that they do not use ceramic implants, then find and go to a holistic dentist because a holistic dentist is more likely to be familiar with and offer zirconia implants, than a traditional dentist. Need help with finding a holistic dentist? Look at the Resources and Referrals page on this website.
Do you want further help or advice from Dr. Gilbert regarding dental implants or any other dentally related concerns you may have? All you have to do is go to the Dental Advice Consultation page on this website and fill out a simple form to arrange for a consultation.
Are the false teeth that are attached to implants biocompatible?
To be biocompatible, the tooth or teeth that are attached to the implant(s) should be fabricated with a zirconiia ceramic for the foundation, with a more translucent, natural looking lithium disilicate porcelain on the exterior. This combination of ceramic and porcelain works best for teeth in the front of the mouth, where appearance and esthetics are critical. The combination of the ceramic and porcelain will be biologically safe, very strong and extremely natural looking. Never allow a dentist to make the false tooth or teeth with a metal base, especially stainless steel.
For teeth in the back of the mouth, where resistance to breakage from ordinary chewing is more important, or for people who grind their teeth (called bruxism), a strong, biocompatible alternative is using just zirconia for the teeth attached to the implant. Although zirconia is as strong as steel and highly resistant to breaking, the downside is that zirconia, although white in color, is not as natural looking as real teeth.
Lastly, although not a biocompatibility issue, ceramic implants tend to be more expensive than metal implants, primarily because they are more costly for the dentist to obtain than titanium metal implants.
Should I allow a dentist to replace a missing tooth with a traditional dental bridge, instead of an implant?
Good question. Dental bridges are now considered to be a poorer choice for replacing missing teeth, because dental bridges must be attached to the adjacent teeth, usually with caps. In order for a cap to be fitted on a tooth, that tooth, even if it is perfectly healthy and has no fillings, has to be ground down to make space for the cap.
If you do choose a dental bridge over an implant, make sure it is made entirely with a zirconia based ceramic, so it will be biologically sound and strong enough to resist breaking. In particular, do not allow the bridge to be made the old way with a biologically questionable metal base (often stainless steel) covered with porcelain.
Do you want further help or advice from Dr. Gilbert regarding dental implants or any other dentally related concerns you may have? All you have to do is go to the Dental Advice Consultation page on this website and fill out a simple form to arrange for a consultation.
Dental implants, whether metal or ceramic, are surgically inserted into the jaw where the tooth used to be, and is then allowed a period of healing (osseointegration). Sometimes additional bone is grafted into the jaw bone to provide more bone thickness and support for the implant. The process of osseointegration and healing takes about four to six months to occur. Generally speaking, once the implant has fused to the jaw, a post (called an abutment) is attached to the top of the implant to support the false tooth which is then screwed or cemented on to the abutment.
In summary, the health advantages of ceramic implants compared to metal implants are:
- Bio-compatible (completely tissue-friendly).
- No allergic reactions, no sensitivity to temperature and no impact on taste.
- Bio-inert. Ceramic implants do not cause tissue reactions.
- Plaque does not stick well to implant surface.
- No corrosion and no galvanic side effects.
- Aesthetically pleasing because white color is similar to the color of natural teeth.
So, if a dentist recommends implants for you, make sure they are of the newer, non-metal zirconia type. If your dentist says that they do not use ceramic implants, then find and go to a holistic dentist because a holistic dentist is more likely to be familiar with and offer zirconia implants, than a traditional dentist. Need help with finding a holistic dentist? Look at the Resources and Referrals page on this website.
Do you want further help or advice from Dr. Gilbert regarding dental implants or any other dentally related concerns you may have? All you have to do is go to the Dental Advice Consultation page on this website and fill out a simple form to arrange for a consultation.
Are the false teeth that are attached to implants biocompatible?
To be biocompatible, the tooth or teeth that are attached to the implant(s) should be fabricated with a zirconiia ceramic for the foundation, with a more translucent, natural looking lithium disilicate porcelain on the exterior. This combination of ceramic and porcelain works best for teeth in the front of the mouth, where appearance and esthetics are critical. The combination of the ceramic and porcelain will be biologically safe, very strong and extremely natural looking. Never allow a dentist to make the false tooth or teeth with a metal base, especially stainless steel.
For teeth in the back of the mouth, where resistance to breakage from ordinary chewing is more important, or for people who grind their teeth (called bruxism), a strong, biocompatible alternative is using just zirconia for the teeth attached to the implant. Although zirconia is as strong as steel and highly resistant to breaking, the downside is that zirconia, although white in color, is not as natural looking as real teeth.
Lastly, although not a biocompatibility issue, ceramic implants tend to be more expensive than metal implants, primarily because they are more costly for the dentist to obtain than titanium metal implants.
Should I allow a dentist to replace a missing tooth with a traditional dental bridge, instead of an implant?
Good question. Dental bridges are now considered to be a poorer choice for replacing missing teeth, because dental bridges must be attached to the adjacent teeth, usually with caps. In order for a cap to be fitted on a tooth, that tooth, even if it is perfectly healthy and has no fillings, has to be ground down to make space for the cap.
If you do choose a dental bridge over an implant, make sure it is made entirely with a zirconia based ceramic, so it will be biologically sound and strong enough to resist breaking. In particular, do not allow the bridge to be made the old way with a biologically questionable metal base (often stainless steel) covered with porcelain.
Do you want further help or advice from Dr. Gilbert regarding dental implants or any other dentally related concerns you may have? All you have to do is go to the Dental Advice Consultation page on this website and fill out a simple form to arrange for a consultation.