Zirconium Dental Implants

Zarcilla, Molo, Curato, Corado,

Rojas, Culang, Montes, Wang,
Villaroman, Ignacio, Morillo,
Opeda
 Introduction
Healthy teeth form the foundation of
an attractive face and can be crucial
to overall good health.
Over the years, dentists have
evaluated many practical,
comfortable, functional, and
affordable ways to replace missing
teeth.
 What is a Dental Implant?
A dental implant is a surgical component that
interfaces with the bone of the jaw or skull to support
a dental prosthesis such as a crown, bridge, denture,
facial prosthesis or to act as an orthodontic anchor.
 The Problem with
Titanium Implants

Calcium/titanium
Allergic reactions Temperature conduction
interactions
Galvanic and electrical
Titanium and fluorine Gum aesthetics
activity
Metallosis Electromagnetic antennae Cytotoxicity
Formation of titanium Lymphocyte
DNA damage
oxides transformation
 Advantages of Zirconia Implants

No allergic reactions
Bio-inert
Esthetics
Hygienic
Electrically and galvanically neutral
No temperature conduction
Promotes bone growth
Promotes gingival health
Zirconia VS Titanium
 Disadvantages/Considerations

Cost
Cytotoxicity
Radioactivity
 Indications and Contraindications
Indications:
1. All esthetic zone cases, especially in those with
scalloped, thin biotype gingival architecture and in
critical gingival papilla build-up cases
2. Patients with metal allergies and chronic diseases
resulting from them
3. As an alternative to Titanium dental implants in
any intraoral location
Contraindications:
1. Patients that exhibit a lack of compliance to post-
operative instructions.
2. A lack of operator clinical and technical knowledge
about implant surgery and prosthetic restorations
3. Any other general contraindications to implant
rehabilitation with one or two-piece titanium
implants, such as bruxism.
 Intraoral Adjustments

Implant Selection
Minimum height required for one-pc Zirconia is
thought to be 7mm
All Zirconia one-piece implants should be
surrounded by at least 1.5 mm of bone, with 3
mm of bone between two implants
The minimum distance of the implant shoulder
to the adjacent teeth is 0.5 mm - measured
from the greatest curvature of the neighboring
teeth
Abutment Preparation
Inserting the implant and increasing the
Bone to Implant Contact (BIC)
 Biologic Width

Biologic widthis the natural

distance between the gingival sulcus
and the height of the alveolar bone.
The gingival sulcus is a little crevice
that lies between the enamel of the
tooth crown and the sulcular
epithelium.
The maintenance of this biologic
width is essential for the
preservation of periodontal health
 Treatment
Planning!
Abutment selection
Measuring
Try-in abutments
Clinical planning

Model planning
CeraRoot Implant System
Outline

Modification

Final restoration

Abutment installation

Final tightening

Cementation
Post Operative Instructions
after Dental Implant
Surgery
 Post-Operative Instructions

Do not disturb the wound.

Avoid rinsing, spitting, or touching
the wound on the day of surgery.
There will be a metal healing
abutment protruding through the
gingival (gum) tissue.
 Bleeding

Some bleeding or redness in the

saliva is normal for 24 hours.
Excessive bleeding can be controlled
by biting on a gauze pad placed
directly on thebleeding wound for 30
minutes.
If bleeding continues please call for
further instructions.
 Swelling

Swelling is a normal occurrence after

surgery.
To minimize swelling, apply an ice
bag, or a plastic bag, or towel filled
with ice on the cheek in the area of
surgery.
Apply the ice continuously, as much
as possible, for the first 36 hours
 Diet

Drink plenty of fluids.

Avoid hot liquids or food.
Soft food and liquids should be eaten
on the day of surgery.
Return to a normal diet as soon as
possible unless otherwise directed.
 Pain
You should begin taking pain medication as
soon as you feel the local anesthetic wearing
off.
For moderate pain, 1 or 2 Tylenol or Extra
Strength Tylenol may be taken every 3-4
hours.
Ibuprofen (Advil or Motrin) may be taken
instead of Tylenol.
Ibuprofen, bought over the counter comes in
200 mg tablets:
2-3 tablets may be taken every 3-4 hours as
needed for pain.
 Antibiotics

Be sure to take the prescribed

antibiotics as directed to help
prevent infection.
 Oral Hygiene
Good oral hygiene is essential to good healing.
The night of surgery, use the prescribed Peridex Oral
Rinse before bed.
The day after surgery, the Peridex should be used
twice daily, after breakfast and before bed. Be sure to
rinse for at least 30 seconds then spit it out.
Warm salt water rinses (teaspoon of salt in a cup of
warm water) should be used at least 4-5 times a day,
as well, especially after meals.
Brushing your teeth and the healing abutments is no
problem. Be gentle initially with brushing the surgical
areas.
 Activity

Keep physical activities to a minimum

immediately following surgery.
If you are considering exercise, throbbing or
bleeding may occur.
If this occurs, you should discontinue
exercising.
Keep in mind that you are probably not
taking normal nourishment.
This may weaken you and further limit your
ability to exercise.
 Wearing your Prosthesis
Partial dentures, flippers, or full
dentures should not be used
immediately after surgery and for at
least 10 days.
This was discussed in the pre-
operative consultation.
COMPLICATIONS!
 Case Presentation
The patient, a 67-year-old female non-smoker
in good general health, presented with a
missing tooth #36 and a fractured crown on
tooth #35.
History revealed that tooth #36 was extracted
due to failed endodontic treatment and that the
fracture of the #35 post-core and crown
occurred during mastication.
Radiographic and clinical exam revealed that
bone volume was adequate in all dimensions
and soft tissue was thick and keratinized.
Pre-operative radiograph. Pre-operative top view.
Periapical showing the Pre-operative condition.
edentulous site of tooth #36 Adequate mesiadistal and
buccal lingual bone volume
and the endodontically can be visualized as can the
treated root of #35. quality and volume of the well-
keratinized tissue.
 Treatment Plan
Treatment options discussed included:
Endodontic treatment of #35, crown lengthening, post-
core and crown
conventional four unit fixed partial denture
implant-retained crowns
An implant-supported reconstruction was the
preferred treatment option. The possibility of the
use of a zirconia one-piece dental implant was also
discussed.
The Ceramic Tooth Replacement Approach was
followed due to restorative simplicity and patients
desire for the most tooth-like treatment option.
 Treatment Plan
The final treatment would involve the
extraction of #35, immediate
placement of two CeraRoot implants
and provisionalization using an Essex
Retainer.
After the rigid fixation of the implants,
full contour aesthetically layered
zirconia crowns would be used as
final restorations.
 Surgical Treatment
After premedication with an antibiotic to be
continued for 7 days post-op and
anesthetization of the operative area, an
atraumatic extraction of #35 was performed
using surgical elevators and forceps.
The osteotomy was preformed utilizing ceramic
drills at maximum speed of 300 RPM.
The site of #36 was prepared using a tissue
punch and a slow drilling protocol. The final
preparation of the osteotomy was done with
countersink drills.
 Surgical Treament
Careful attention was paid to preparing the
implant site to accommodate the wide diameter
of the prosthetic emergence. The shoulder of the
implant was placed at the desired tissue level.
The CeraRoot 16 implant at the #36 site was
threaded into place and achieved excellent stability
at over 50Nm with the buccal restorative margin
placed where desired, about 0.5mm below the
gingival margin.
The CeraRoot 14 implant was press fit and tapped
into final position again with the restorative platform
just apical to that of the original tooth
 Surgery buccal-view
Placement of the restorative
margins is equigingival or
Surgery top-view
slightly sub gingival. This
Ideal location of the two makes the prosthetic steps very
implants mesiodistally and easy to accomplish as tissue
angulation. The restorative can be retracted with cord or
result can be easily ablated using radio-surgery or
visualized laser.
Surgery lingual-view
View of placement from the
lingual showing the shape of Radiograph day of surgery
the restorative abutment. This Apex of the anterior implant is
abutment was designed to near the apex of tooth #34. No
mimic an ideal tooth contact is evident and the PDL is
preparation. The taper and size preserved. The inter-proximal
margin of the prosthetic table
of the abutment can be seems like it is at osseous level
modified if needed to account due to the angulation of the X-ray
to different clinical situations. and the radio-opaque bone graft.
 Surgical Treatment

The facial of the extraction site, and the

circumferential gap between the implant and the
bone, was grafted with the autogenous bone
chips.
The radiographic image showed good
placement, the apical portion of the anterior
implant was very close to the apex of tooth #34
as a result of overcorrection of the angulation on
the implant. Clearly visible is the fact that the
PDL of the first bicuspid was not violated and
tooth #34 remained vital and asymptomatic.
No sutures were needed as no flap was raised.
 After 12 weeks

Healed Buccal-view
Interproximal tissue is maintained
and soft tissue in general is
healthy and maintained its form
Healed top-view and texture. The soft tissue
Soft tissue maturation is apparent. around the implants is identical to
Visible is the restorative margin. that around the natural teeth
The prosthetic rehabilitation can
now proceed as if this were a tooth
 Prosthetic Treatment

No preparation of the restorative margin was

required as the margins were very well placed.
Retraction was accomplished using #00 cord
and a digital scan utilizing the iTero scanner was
taken.
Two Prettau zirconia crowns were fabricated with
zirconia in all functional areas and porcelain
added on the buccal of the crown for aesthetics.
This assured that the functional areas would be
resistant to chipping and wear. The crowns were
tried in and inserted with a Glass Ionomer
cement.
Prosthetic Treatment
 One Year Follow-up

Upper view is immediately

Upper view is at the end
after cementation. Lower of healing, lower at 12
is at 12 months. months.
 Discussion

From the onset of treatment to the cementation of

the crowns 14 weeks elapsed. This demonstrated
the restorative simplicity gained by precise
placement of the implants and the capacity of the
soft tissues to heal in a most natural manner.
 Discussion

When treating the completely edentulous

patient, the application of the metal two-piece
implants is appropriate.
However, the use of two-piece metal implants
in treating the partially edentulous patients
presents some clinical complications that in the
authors opinion have been ignored for some
time.
The complexity of creating and maintaining
tissue contours and health around the implant
abutment complex is an ever-elusive aspect of
modern implantology.
 Conclusion

A very high degree of clinical success has been

achieved in this case using an all-ceramic
Zirconia, one-piece dental implant. With the
emergence profile being designed as part of a
white, tissue level implant, we see less peri-
implantitis and less mechanical and aesthetic
soft tissue complications.
The great aesthetic potential and restorative
simplicity make the CeraRoot implant system
ideal for tooth replacement. Periodontal health
is amplified by the absence of a connection and
micro-gap, and the affinity of the gingival
complex to the zirconium oxide surface.