“The Zirconia implant: an alternative to titanium?” by Dr Giancarlo BIANCA

Moderated by :

  • Dr Fabrice Baudot, EACim scientific leader and ceramic implantology practitioner since 2013
  • Dr Pascal Valentini, Program Director Post Graduate of Oral Implantology, University of Corsica (France)


Titanium implants have undergone a tremendous technological acceleration in recent years. Innovation has taken place in surface finishes, design, implant connections and immediate protocols. In addition, the advent of digital Cad/Cam zirconia prosthesis and guided surgery has made it possible to treat our patients faster, with better aesthetic results. However, the prevalence of peri-implantitis (PI) around titanium implants(1), should be a daily clinical concern due to their high incidence. Recent studies report the presence of titanium particles around implants with IP compared to a healthy peri-implant environment(2,3). (2,3) A relationship between biocorrosion, metal particles and biological complications is reported to exist (4). This theme occupies most of our congresses and raises the question of the reliability of our implant treatments in the long term(5).

The qualities of zirconia ceramics as a prosthetic restorative material show us in daily use an extremely low bacterial colonization(6), and soft tissue which is then a barrier to the underlying infection. Zirconium is a metal which, once oxidized, becomes a ceramic, zirconium oxide. This then loses all the properties of a metal, thermal and electrical conductivity. This contributes greatly to its high biocompatibility observed with periodontal cells(7).

Zirconia implants may appear as a real alternative to titanium in our patients, especially those with allergic conditions, autoimmune diseases, periodontal risk factors and metal intolerance (8). We must also take into account the current trend in dentistry towards non-metallic restorations and the long-term aesthetic appearance of our restorations. The absence of oxidation reaction around zirconia implants and the reduction of bacterial plaque are real assets for their long-term stability in the oral sphere. Looking back 20 years, the latest generation of zirconia implants, which are monobloc and now in 2 parts, offer mechanical and biological qualities closer to the natural root. The objective of my presentation will be to share my 14 years of experience.


1- Daubert DM, Weinstein BF, Bordin S, Leroux BG, Flemming TF.
Prevalence and predictive factors for peri-implant disease and implant failure: a cross-sectional analysis. J Periodontol. 2015 Mar;86(3):337-4

2- T.G. Wilson, Jr.,P.Valderrama, M.Burbano, J.Blansett, R.Levine, H.Kessler,       and D.C. Rodrigues. Foreign Bodies Associated With Peri-Implantitis Human Biopsies. J Periodontol • January 2015

3- Safioti LM, Kotsakis GA, Pozhitkov AE, Chung WO, Daubert DM. Increased Levels of Dissolved Titanium Are Associated With Peri-Implantitis – A Cross-Sectional Study.J Periodontol. 2017 May;88(5):436-442.

4- Mombelli A, Hashim D, Cionca N. What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review. Clin Oral Implants Res 2018;29 (suppl18):s53

5- CHARALAMPAKIS G, RABE P,LEONHARDT A, DAHLEN G .Clinical and microbiological characteristic of peri-implantitis cases : a retrospective multicenter study. Clinical Oral Implants Research 2012 ;23,issue9 ;1045-1054.

6- Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A. Bacterial adhesion on commercially Pure titanium and zirconium oxide disks: an in vivo human study. J Periodontol 2004; 75 (2): 292-6.

7- Sterner T, Schütze N, Saxler G, Jakob F, Rader CP. Effects of clinically relevant alumina ceramic, zirconia ceramic and titanium particles of different sizes and concentrations on TNF-alpha release in a human macrophage cell line. Biomed Tech (Berl). 2004 Dec;49(12):340-4.

8- Stejskal V, Reynolds T, Bjørklund G . Increased frequency of delayed type hypersensitivity to metals in patients with connective tissue disease. J Trace Elem Med Biol. 2015; 31: 230–236.