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Table of Contents   
REVIEW ARTICLE  
Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 643-649
A systematic review of zirconia as an implant material


Department of Prosthodontics, Government Dental College and Research Institute, Victoria Hospital Campus, Fort, Bangalore, Karnataka, India

Click here for correspondence address and email

Date of Submission22-Apr-2011
Date of Decision19-Oct-2011
Date of Acceptance26-Feb-2012
Date of Web Publication19-Feb-2013
 

   Abstract 

The purpose of this systematic review was to assess the published data concerning zirconia dental implants from various aspects.
To identify relevant literature an electronic search was performed of PubMed. Titles and abstracts were screened and articles that fulfilled the inclusion criteria were selected for a full-text reading. Articles were divided into four groups: 1) studies evaluating the mechanical properties of zirconia implants, 2) studies on osseointegration of zirconia, 3) studies on peri-implant tissue response to zirconia implant, and 4) studies on plaque accumulation with zirconia.
Review of the selected articles showed that zirconia implants are reliable for placement in the jaw bone. Furthermore, zirconia implants present a material surface that is compatible with the peri-implant tissue and relatively less attractive to plaque.
Based on the reviewed literature, it appears that zirconia has the potential to become the dental implant material of choice, especially for aesthetic restorations; however, some issues need to be studied further.

Keywords: Zirconia ceramic, zirconia implant, zirconia and osseointegration, zirconia and plaque, zirconia and soft tissue

How to cite this article:
Prithviraj D R, Deeksha S, Regish K M, Anoop N. A systematic review of zirconia as an implant material. Indian J Dent Res 2012;23:643-9

How to cite this URL:
Prithviraj D R, Deeksha S, Regish K M, Anoop N. A systematic review of zirconia as an implant material. Indian J Dent Res [serial online] 2012 [cited 2020 Aug 9];23:643-9. Available from: http://www.ijdr.in/text.asp?2012/23/5/643/107383
In recent years the treatment options and modalities for achieving optimal functional and aesthetic outcomes with implant restorations have clearly changed. [1] The material of choice for manufacturing dental implants has for long been commercially pure titanium because of its excellent biocompatibilty and mechanical properties. [2],[3] However, the gray color of titanium can give rise to aesthetic problems. [3],[4] In some situations, there may be a paucity of soft tissue height above the implant level at the time of definitive restoration or, alternatively, this can occur following marginal bone loss and soft tissue recession; in such situations there is an unaesthetic display of the metal components. [5]

Therefore, implant research has focused on discovering tooth-colored implant material that improves the aesthetic appearance of dental implants and, at the same time, is highly biocompatible and able to withstand the forces present in the oral cavity. One ceramic material that has been used for dental implants is aluminium oxide (Al 2 O 3 ). [6],[7],[8],[9] It osseointegrated well but was withdrawn from the market because of its poor survival rate. [9],[10],[11],[12]

Zirconia-based ceramics are the latest exceptionally high-strength materials to be introduced into dentistry. [13],[14],[15] The strength and toughness of zirconia can be accounted for by its toughening mechanisms, such as crack deflection, zone shielding, contact shielding, and crack bridging. [15] Prevention of crack propagation [16] is of critical importance in high-fatigue situations, such as those encountered in mastication and parafunction. [5] This combination of favorable mechanical properties makes zirconia a unique and stable material for use in high-load situations. [5],[17],[18],[19],[20]

Zirconia exists in three major phases. [21] At room temperature and atmospheric pressure, the thermodynamic phase of pure zirconia is the monoclinic phase, [21],[22] which changes to the intermediate tetragonal phase at higher temperatures. The metastable tetragonal phase easily transforms to the monoclinic phase, which forms the basis for the toughening mechanism of the ceramic material. [23],[24],[25],[26]

The osseointegration of zirconia as well as possible clinical outcomes have been demonstrated in various studies. In studies that used titanium implants as a control, yttria-stabilized tetragonal zirconia implants were comparable [3],[27],[28],[29] to, or even better than, titanium implants. [30] Zirconia, like titanium, is a biocompatible material and promotes the health of the surrounding soft tissues. [31],[32],[33],[34],[35] Zirconia is radiopaque and clearly visible on radiographs. Its ivory color is similar to the color of natural teeth. [36],[37] This is especially critical in the aesthetic zone [38],[39],[40] and especially with high lip line smiles as it allows for light transmission [39] at the critical interface between marginal gingival tissue and prosthetic components. [1] Furthermore, with the development of dental CAD/CAM systems, [41],[42] this high-strength ceramic is becoming the first choice in treating aesthetic implant cases. [1] Besides these favorable properties, zirconia is proposed to accumulate dental plaque to a lesser extent than titanium. [31],[41] Further, in a short-term clinical study, it was observed that the biologic, aesthetic, and mechanical properties of zirconia were favorable, and the material could be used in various prosthetic indications on teeth or in implants. [41]

Accumulation of titanium particles has been reported in tissues close to implant surfaces, [43] local lymph nodes, [44] and elsewhere [45],[46] in the body. On the other hand, there is general agreement on the absence of local or systemic toxic effects after the implantation of zirconia ceramics into muscles or bones of different animals. [47],[48],[49],[50]

Despite the fact that ceramics have been in use in implant dentistry for many years, only a few systematic reviews of zirconia as an implant material have been published. The purpose of this paper was to assess its potential to become the material of choice for dental implants.


   Materials and Methods Top


A literature search was performed of the PubMed database using the following key words: 'zirconia,' 'zirconia implant,' 'zirconia and biocompatibility,' 'zirconia and osseointegration,' and 'zirconia and plaque.' The searches were limited to articles in English and those with an associated abstract. Studies on materials coated with zirconium compounds were excluded.

Literature was reviewed under the following groups:

  • In vitro studies on the mechanical properties of zirconia implants
  • In vivo and in vitro studies on osseointegration of zirconia implants
  • In vivo studies on peri-implant/soft tissue response around zirconia implants
  • In vivo studies on plaque accumulation around zirconia implants

   Mechanical Properties Top


Biaxial flexural strength

Among the studies reviewed, there were three studies [17],[51] that assessed the biaxial flexural strength (piston-on-three-ball) of zirconia ceramics. The results achieved by Chai [15] et al. [Table 1] were the same as that by Yilmaz. [17] Yilmaz et al. observed that the strength of zirconia was higher than that of alumina. Qeblawi [51] subjected zirconia bars to various mechanical treatments [Table 1] and observed a higher flexural strength with airborne particle-abraded zirconia and hand-ground zirconia.
Table 1: Mechanical properties of zirconia

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Uniaxial flexural strength

Chai [15] et al. compared various ceramic materials and found that yttrium-stabilized zirconia had the highest uniaxial flexural strength of 899 ± 109 MPa.

Fracture toughness

Yilmaz et al.[17] studied fracture toughness of different materials by measuring indentation strength and indentation fracture and concluded that the highest fracture toughness values (MPa) were obtained with the zirconia-based ceramic materials.

Shear bond strength

Qeblawi [51] et al. subjected the mechanically-treated zirconia specimens (airborne particle-abraded, silicoated, and hand-ground) to three chemical treatments. The highest shear bond strength values were achieved for the silicoated + silanated group and the least by the airborne particle-abraded + zirconia primer group. In the In vivo study by Isabella [40] et al. in rabbits, no statistically significant difference was observed between chemically-modified implants and topographically-modified zirconia implant.

Stress distribution

Kohal [52] et al. did a three-dimensional finite element analysis to analyze stress distribution patterns in implants (re-implant system) made of commercially pure titanium and yttrium-partially stabilized zirconia implants. It was found that yttrium-partially stabilized zirconia implants had very similar stress distribution to commercially pure titanium implants.

Osseointegration

Zirconia-based implants were introduced into dental implantology as an alternative to titanium implants. A number of studies have been done to compare the osseointegration of zirconia implants with that of titanium implants. Most of the studies [30],[39],[53] have revealed no significant difference between the osseointegration of zirconia implants and that of titanium implants. Depprich et al.[54] found similar attachment of both implants to bone, with similar features ultrastructurally. An increased proliferation of osteoblasts was found around zirconia implants as compared to titanium implants, though the attachment and adhesion strength of primary cells was more with titanium. Mosgau et al.[55] and Dubruille et al.[56] reported higher bone-to-implant contact (BIC) with zirconia than with titanium. Peri-implant bone volume density was superior with submerged zirconia implants as compared to titanium implants according to Gahlert et al.[53] [Table 2]
Table 2: Osseointegration of zirconia (In vivo studies)

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Peri-implant tissue compatibility

Two studies evaluated the periodontal parameters with zirconia implants vs that with titanium implants. Bleeding on probing remained around 50% for zirconia throughout the study period, while in titanium it was initially 75% but later reduced to 50%. The mean probing depth declined more in zirconia implant as compared to titanium as per Brakel et al.[57] Tete et al.[58] observed comparable collagen orientation to both zirconia and titanium implants.

Further, lower values of distance from peri-implant mucosa to the apical termination of the barrier epithelium were obtained for zirconia implants according to Wellander et al.[59]

Spectrophotometer analysis were also done by two groups of authors [37],[59] and both found much lesser mucosa color changes with zirconia implants than with titanium implants [Table 3].
Table 3: Peri-implant tissue compatibility with zirconia implants

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Plaque/bacterial accumulation

We found five studies that assessed the bacterial accumulation around zirconia implants. Brakel et al.[57] found more bacterial accumulation around titanium implants than around zirconia implants. Wellender et al.[37] found the least number of leukocytes residing around zirconia implants. Rimondini et al.[32] compared bacterial adhesion to as-fired and rectified YTZP and titanium using both in vitro and in vivo studies. Streptococcus mutans was found the least with rectified YTZP, comparable to titanium, and maximum with as-fired. Streptococcus sanguis showed much less adhesion to both zirconia than to titanium. The study by Rimondini et al. [32] also showed significantly lesser cocci and rods in relation to zirconia than titanium. Wellander et al. [37] found lesser leukocytes around zirconia implants than around titanium [Table 4].
Table 4: Plaque accumulation with zirconia

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   Discussion Top


Systematic reviews are useful for evaluating potential materials that may be used for various applications in dentistry. Very few materials have been advocated for use as implants. Zirconia, because of its mechanical strength [2],[3] and ivory-like color, [36],[37] has been used for many applications in aesthetic zones in dentistry. Following reports of its successful osseointegration in orthopedic cases, [27],[47] the osseointegration of zirconia has been studied in the jaws of various experimental animals.

Owing to the ceramic's favorable aesthetic properties and acceptable mechanical properties, we wanted to evaluate zirconia as an implant material. To the best of our knowledge, there have been only few reviews published in literature in this regard. In the present systematic review of literature, most of the parameters have been compared with that of titanium, presently the most commonly used implant material.

The biaxial flexural strength of zirconia implant ranges between 900 and 1100 MPa, [17],[21] while the Weibull modulus [17] ranges from 10 to 13. Surface treatments such as airborne particle abrasion and hand-grinding have been found to improve the flexural strength [51] of zirconia implant. The uniaxial flexural strength of zirconia has been found to be 409-899 MPa. [15] Along with strength, the fracture toughness is one of the first parameters to evaluate performance of a dental ceramic. For zirconia implants fracture toughness has been found to be 4-6.2 MPa. [17],[21] Also the stress distribution for yttrium-partially stabilized zirconia was similar to that of titanium. In some studies, however, zirconia implant groups have shown irreparable implant head fractures at relatively low fracture loads. [60]

Surface topography and mechanical and chemical treatment of zirconia affect the shear bond strength of zirconia implants. Chemical treatments such as silanation of silicoated zirconia and application of zirconia primer on zirconia have been found to increase the shear bond strength significantly. [51]

An endosseous implant is described as osseointegrated when it is immobile in function. Objective measures of stability testing have been described. The Periotest ® is a commercially available device that is used for this purpose. [61] A good number of studies confirm the osseointegration of zirconia to be similar to or even better than that of titanium. Despite the better attachment and adhesion strength of osteoblasts on titanium surface, relatively more proliferation of osteoblasts has been found on zirconia surface. [52] According to literature there is no significant difference in the synthesis of bone-specific proteins on the surfaces of either of these two materials. Similar bone-to-implant contact in zirconia and titanium was seen in many studies. [27],[30] It has been further observed that surface roughness on zirconia enhances the bone-to-implant contact. [62],[63] The peri-implant bone volume density of submerged zirconia has also been found to be higher than that of titanium. [53] However, further clinical studies need to be carried out to confirm the results from in vivo animal studies.

Adequate literature is available on the soft tissue compatibility of zirconia implants and favorable peri-implant response. Soft tissue adhesion with the implant material or an early, long-standing, effective barrier [62] will protect the bone more efficiently from the external environment (i.e., oral cavity) and result in decreased marginal bone resorption. [1] Average probing depth with zirconia implants was 0-3 mm and bleeding on probing [57] was comparable to that seen with titanium implants. Also, the two implant materials show similar thickness of fibrous capsule around the implants, [34] and similar orientation of parallel, parallel oblique, and oblique collagen fibers. [57] Lesser gingival recession was seen after placement of zirconia implants. [58] The aesthetic favorability is also confirmed by studies that show that zirconia induces the least color change under thin mucosa. [64]

Another important parameter to be considered in the selection of an implant material is its affinity towards bacteria/plaque. Lesser plaque accumulation has been reported with zirconia implants. [58] Bacteria such as S sanguis, Porphyromonas gingivalis, short rods, and cocci have shown lesser adherence to zirconia than to titanium surface. [32] The adhesion of Streptococcus to zirconia has also been shown to similar to that to glass ceramics. [65] There seems to be no difference between polished and glazed zirconia as far as adherence of bacteria is concerned. [66]


   Conclusion Top


There is sufficient significant data on various parameters to conclude that zirconia is an aesthetic alternative to titanium implants. As for mechanical properties, zirconia possesses sufficient strength and fracture strength to withstand masticatory forces. However, more studies are needed to evaluate the modulus of elasticity and tensile strength of zirconia as an implant material. The aspect of osseointegration has been adequately covered in literature and it can be concluded that zirconia has as good potential as titanium to osseointegrate with bone. The various in vivo studies have shown good peri-implant results, enough to suggest good biocompatibility of zirconia implants with surrounding tissues. Any substantial accumulation of bacteria is also not reported with zirconia implants.

Despite the significant amount of literature supporting the use of zirconia as an implant material, there is need for long-term clinical studies on the subject. Presently, the studies pertain to zirconia's use only as a single-piece implant, hence the nonavailability of zirconia as a multiple piece implant is an added limitation. Because of the lack of clinical reports on the long-term success rates with zirconia implants, the authors suggest caution with regard to certain aspects of zirconia implants, such as tensile strength and modulus of elasticity. Nevertheless, the authors support its clinical use in view of its good osseointegration, aesthetics, and biocompatibility.

 
   References Top

1.Dooren EV. Using zirconia in esthetic implant restorations. QDT 2007;30:119-28.  Back to cited text no. 1
    
2.Smith DC. Dental implant: Materials & design considerations. Int J Prosthodont 1993;6:106-17.  Back to cited text no. 2
[PUBMED]    
3.Depprich R, Zipprich H, Ommerborn M, Naujoks C, Wiesmann HP, Kiattavorncharoen S, et al. Osseointegration of zirconia implants compared with titanium: An in-vivo study. Head Face Med 2008;4:30.  Back to cited text no. 3
    
4.Kohal RJ, Weng D, Bachle M, Strub J. Loaded custom made zirconia & titanium implants show similar osseintegration: An animal experiment. J Periodontol 2004;75:1262-8.  Back to cited text no. 4
    
5.Dunn DB. The use of a zirconia custom implant supported FPD prosthesis to treat implant failure in anterior maxilla: A clinical report. J Prosthet Dent 2008;100:415-21.  Back to cited text no. 5
    
6.Oliva X, Oliva J, Oliva JD. Replacement of congenitally missing maxillary permanent canine with a zirconium oxide dental implant & crown. A case report from an ongoing study. J Oral Maxillofac Surg 2008;1:140-4.  Back to cited text no. 6
    
7.Wijs FD. Front tooth replacement with Tubingen implants. J Oral Rehabil 1994;21:11-26.  Back to cited text no. 7
    
8.Schulte W. The intraosseous Al 2 O 3 (Frialit) Tubingen implant. Developmental status after eight years(I-III). Quintessence Int 1984;15:1-39.  Back to cited text no. 8
    
9.Oliva J, Oliva X, Oliva JD. One year follow up of first consecutive 100 Zirconia Dental Implants in humans: A Comparison of two different rough surfaces. Int J Oral Maxillofac Implants 2007;3:430-5.  Back to cited text no. 9
    
10.Oliva J, Oliva X, Oliva JD. Ovoid Zirconia Implants: Anatomic Design for Premlar Replacement. Int J Periodontics Restorative Dent 2008;28:609-15.  Back to cited text no. 10
    
11.Steflik DE, Lake FT, Sisk AL, Parr GR, Hanes PJ, Davis HC, et al. A comparative investigation in dogs: 2 year morphometric results of the dental implant bone-interface. Int J Oral Maxillofac Implants 1996;11:15-25.  Back to cited text no. 11
    
12.Burge TI, Gronningsaeter AG. Survival of single crystal sapphire implants supporting mandibular overdentures. Clin Oral Impl Res 2000;11:154-62.  Back to cited text no. 12
    
13.Swain MV. Toughening mechanisms for ceramics. Mater Forum 1989;13:237-53.  Back to cited text no. 13
    
14.Guazzato M, Albakry M, Ringer SP, Swain MV. Strength, fracture toughness & microstructure of a selection of all-ceramic materials. Part 1. Pressable and alumina glass-infiltrated ceramics. Dent Mater 2004;20:441-8.  Back to cited text no. 14
    
15.Chai J, Chu FC, Chow TW, Liang BM. Chemical solubility &b Flexural strength of Zirconia- based ceramics. Int J Proshodont 2007;20:587-95.  Back to cited text no. 15
    
16.Garvie RC, Hannink RH, Pascoe RT. Ceramic steel? Nature 1975;258:703-4.  Back to cited text no. 16
    
17.Yilmaz H, Aydin C, Gul BE. Flexural strength & fracture toughness of dental core ceramics. J Prosthet Dent 2007;98:120-8.  Back to cited text no. 17
    
18.Zirconia SR, Xeramics Z. An introduction to Zirconia, 2 nd ed. Twickenham, UK: Litho 2000;1986:1-5.  Back to cited text no. 18
    
19.Quinn JB, Sundar V, Llyod IK. Influence of microstructure & chemistry on the fracture toughness of dental ceramics. Dent Mater 2003;19:603-11.  Back to cited text no. 19
    
20.Sundh A, Molin M, Sjogren G. Fracture resistance of yttrium oxide partially stabilized zirconia all-ceramic after veneering & mechanical fatigue testing. Dent Mater 2005;21:476-82.  Back to cited text no. 20
    
21.Guazzato M, Albakry M, Swain MV, Ironside J. Mechanical Properties of In-Ceram Alumina & In-Ceram Zirconia. Int J Prosthodont 2002;15:339-46.  Back to cited text no. 21
    
22.Denry I, Kelly JR. State of the art of zirconia for dental applications. Dent Mater 2008;24:299-307.  Back to cited text no. 22
    
23.Nakamura K, Kanno T, Milleding P, Ortengren UL. Zirconia as a Dental Implant Abutment Material: A Systematic Review. Int J Prosthodont 2010;23:299-309.  Back to cited text no. 23
    
24.Subbarao EC, Maiti HS, Srivastava KK. Martensitic transformation in zirconia. Phys Status Solidi Series A 1974;21:9-40.  Back to cited text no. 24
    
25.Evans AG, Marshall DB, Burlingame NH. Transformation toughening in ceramics. In: Heuer AH, Hobbs LW, editors. Science & technology of Zirconia. Columbus, Oh: American Ceramic Society; 1981 p. 202-16.  Back to cited text no. 25
    
26.Garvie RC, Nicholson PS. Phase analysis in zirconia systems. J Am Ceram Soc 1972;55:303-5.  Back to cited text no. 26
    
27.Depprich R, Zipprich H, Ommerborn M. Osseointegration of zirconia implants: An SEM observation of the bone-implant interface. Head Face Med 2008;4:25.  Back to cited text no. 27
    
28.Heuer AH, Lange FF, Swain MV, Wvans AG. Transformation toughening: An overview. J Am Ceram Soc 1986;69:i-iv.  Back to cited text no. 28
    
29.Gahlert M, Rohling S, Wieland M. Osseointegration of zirconia & titanium dental implants: A ahistological and histomorphometric study in the maxilla of pigs. Clin Oral Impl Res 2009;20:1247-53.  Back to cited text no. 29
    
30.Hoffmann O, Angelov N, Gallez F. The Zirconia Implant-Bone Interface: A Preliminary Histologic Evaluation in Rabbits. Int J Oral Maxillofac Implants 2008;23:691-5.  Back to cited text no. 30
    
31.Stadlinger B, Hennig M, Echelt U. Comparison of zirconia & titanium implants after a short healing period. A pilot study in minipigs. Int J Oral Maxillofac Surg 2010;39:585-92.  Back to cited text no. 31
    
32.Josset Y, Oum' Hamed Z, Zarrinpom A, Lorenzato M. In vitro reactions of human osteoblasts in culture with zirconia & alumina ceramics. J Biomed Mater Res 1999;47:481-93.  Back to cited text no. 32
    
33.Rimondini L, Cerroni L, Carrassi A, Toricelli P. Bacterial Colonization of Zirconia Ceramic Surfaces: An In Vitro and In Vivo Study. Int J Oral Maxillofac Implants 2002;17:793-8.  Back to cited text no. 33
    
34.Degidi M, Artese L, Scarano A. Inflammatory infiltrate, microvessel density, nitric oxide synthase expression, vascular endothelial growth factor expression, and proliferative activity in peri-implant soft tissues around Ti & Zr oxide healing caps. J Periodontol 2006;77:73-80.  Back to cited text no. 34
    
35.Ichikawa Y, Akagawa Y, Nikai H, Tsuru H. Tissue compatibility & stability of a new zirconia ceramic in vivo. J Prosthet Dent 1992;68:322-6.  Back to cited text no. 35
    
36.Caglar A, Bal T, Aydin C, Yilmaz H, Ozkan S. Evaluation of stresses occurring on three different Zirconia Dental Implants: Three-Dimensional finite element analysis. Int J Oral Maxillofac Implants 2010;25:95-103.  Back to cited text no. 36
    
37.Welander M, Abrahamsson I, Berglundh T. The mucosal barrier at implant abutments of different materials. Clin Oral Implants Res 2008;635-41.  Back to cited text no. 37
    
38.Covacci V, Bruzzese N, Maccauro G, Andreassi C, Ricci GA, Piconi C, et al. In vitro evaluation of the mutagenic & carcinogenic power of high purity zirconia ceramic. Biomaterials 1999;20:371-6.  Back to cited text no. 38
    
39.Ahmad I. Yttrium- partially stabilized zirconium dioxide posts: An approach to restoring coronally compromised nonvital teeth. Int J Periodontics Restorative Dent 1998;18:454-65.  Back to cited text no. 39
    
40.Rocchietta I, Fontana F, Addis A, Schupbach P, Simion M. Surface modified zirconia implants: Tissue response in rabbits. Clin Oral Implants Res 2009;20:844-50.  Back to cited text no. 40
    
41.Kollar A, Huber S, Mericske E, Stern RM. Zirconia for teeth & implants: A case series. Int J Periodontics Restorative Dent 2008;28:479-87.  Back to cited text no. 41
    
42.Gamborena I, Blatz MB. Comprehensive esthetic & functional rehabilitation with a CAD/CAM All-ceramic system.  Back to cited text no. 42
    
43.Meyer U, Buhner M, Buchter A, Kruse-Losler B, Stamm T, Wiesann FI. Fast element mapping of titanium wear around implants of different surface structures. Clin Oral Implants Res 2006;17:206-11.  Back to cited text no. 43
    
44.Weingart D, Steinemann S, Schilli W. Titanium deposition in regional lymph nodes after insertion of titanium screw implants in maxillofacial region. Int J Oral Maxillofac Surg 1994;23:450-2.  Back to cited text no. 44
    
45.Frisken KW, Dandle GW, Lugowski S, Jordan G. A study of titanium release into body organs following the insertion of single threaded screw iplants ino the mandibles of sheep. Aust Dent J 2002;47:214-7.  Back to cited text no. 45
    
46.Schliephake H, Reiss G, Urban R, Neukam FW, Guckel S. Metal release from titanium fixtures during placement in the mandible: An experimental study. Int J Oral Maxillofac Implants 1993;8:502-11.  Back to cited text no. 46
    
47.Piconi C, Maccauro G, Muratori F, Prever BD. Alumina & zirconia ceramics in joint replacements. J Appl Biomater Biomech 2003;1:19-32.  Back to cited text no. 47
    
48.Griss P, Von Adrian-Werburg HV. Biological activity & histocompatibility of dense Al 2 O 3 -MgO ceramic implants in rats. J Biomed Mater Res 1973;7:453-62.  Back to cited text no. 48
    
49.Harms J, Mausle E. Tissue reaction to ceramic implant material. J Biomed Mater Res 1979;13:67-87.  Back to cited text no. 49
    
50.Garvie RC, Urbani C, Kennedy DR, Mcheuer JC. Biocompatibility of magnesia-partially stabilized zirconia ceramics. J Mater Sci 1984;19:3224-8.  Back to cited text no. 50
    
51.Qeblawi DM, Muñoz CA, Brewer JD, Monaco EA. The effect of zirconia surface treatment on flexural strength and shear bond strength to a resin cement. J Prosthet Dent 2010;103:210-20.  Back to cited text no. 51
    
52.Kohal RJ, Papavasiliou G, Kamposiora P, Tripodoakis A, Strub JR. Three-Dimensional Computerized Stress Analysis of Commercially Pure Titanium and Yttrium-Partially Stabilized Zirconia Implants. Int J Prosthodont 2002;15:189-94.  Back to cited text no. 52
    
53.Gahlert M, Rohling S, Wieland M, Sprecher CM, Kniha H, Milz S. Osseointegration of zirconia and titanium dental implants: A histological & histomorphometrical study in the maxilla of pigs. Clin Oral Implants Res 2009;20:1247-53.  Back to cited text no. 53
    
54.Depprich R, Ommerborn M, Zipprich H, Naujoks C, Handschel J, Wiesmann HP, et al. Behavior of osteoblastic cells cultured on titanium and structure zirconia surfaces. Head Face Med 2008;4:29.  Back to cited text no. 54
    
55.Schultze-Mosgau S, Schliephake H, Radespiel-Troger M, Neukam FW. Osseointegration of endodontic endosseous cones: Zirconium oxide vs titanium. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:91-8.  Back to cited text no. 55
    
56.Dubruille JH, Viguier E, Le Naour G, Dubruille MT, Auriol M, Le Charpentier Y. Evaluation of combinations of titanium, zirconia, and alumina implants with 2 bone fillers in the dog. Int J Oral Maxillofac Implants 1999;14:271-7.  Back to cited text no. 56
    
57.van Brakel R, Cune MS, van Winkelhoff AJ, de Putter C, Verhoeven JW, van der Reijden W. Early bacterial colonization and soft tissue health around zirconia and titanium abutments: An In vivo study in man. Clin Oral Impl Res 2011;22:571-7.  Back to cited text no. 57
    
58.Tete S, Mastrengelo F, Bianchi A, Zizzari V, Scarano A. Collagen fiber orientation around machined titanium and zirconia dental implant necks: An animal study. Int J Oral Maxillofac Implants 2009;24:52-8.  Back to cited text no. 58
    
59.Piconi C, Burger W, Richter HG, Cittadini A, Maccauro G, Covacci V, et al. Y-TZP ceramics for artificial joint replacements. Biomaterials 1998;19:1489-94.  Back to cited text no. 59
    
60.Kohal RJ, Finke HC, Klaus G. Stability of prototype two-piece zirconia and titanium implants after artificial aging an in vitro pilot study. Clin Implant Dent Relat Res 2009;11:323-9.  Back to cited text no. 60
    
61.Simunek A, Vokurkova J, Kopecka D, Celko M, Mounajjed R, Krulichova I, et al. Evaluation of stability of titanium and hydroxyapatite coated osseointegrated dental implants: A pilot study. Clin Oral Implants Res 2002;13:75-9.  Back to cited text no. 61
    
62.Pirker W, Kocher A. Immediate, non-submerged, root-analogue zirconia implant placed into single-rooted extraction sockets: 2-year follow-up of a clinical study. J Oral Maxillofac Surg 2009;38:1127-32.  Back to cited text no. 62
    
63.Sennerby L, Dasmah A, Larsson B, Iverhed M. Bone tissue responses to surface-modified zirconia implants: A Histomorphometric and removal torque study in the rabbit. Clin Implant Dent Relat Res 2005;7(suppl 1):13-20.  Back to cited text no. 63
    
64.Zembic A, Sailer I, Jung RE, Franz CH, Hammerle CH. Randomized-controlled clinical trial of customized controlled zirconia and titanium implant abutments for single tooth implants in canine and posterior regions: 3-year results. Clin Oral Implants Res 2009;20:802-8.  Back to cited text no. 64
    
65.Rosentritt M, Behr M, Bürgers R, Feilzer AJ, Hahnel S. In vitro adherence of oral streptococci to zirconia core and veneering glass-ceramics. J Biomed Mater Res B Appl Biomater 2009;91:257-63.  Back to cited text no. 65
    
66.Scotti R, Kantorski KZ, Monaco C, Valandro LF, Ciocca L, Bottino MA. SEM evaluation of an in-situ early bacterial colonization on a Y-TZP ceramic: A pilot study. Int J Prosthodont 2007;20:419-22.  Back to cited text no. 66
    

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Correspondence Address:
S Deeksha
Department of Prosthodontics, Government Dental College and Research Institute, Victoria Hospital Campus, Fort, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.107383

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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