Incidental finding of a degrading zirconia dental implant 29 months after implantation: Histological and histomorphometrical analysis

Abstract

With the emerging development and improvement of biomaterials, the application of ceramics in restorative medicine has experienced a renaissance. New production processes have reportedly helped to overcome unfavorable biomechanical characteristics of these materials, which lead to a wide application of zirconia as ground material for dental implants. Zirconia-based implants are biocompatible, demonstrate ability to osseointegrate and have a teeth-like color, rendering them to be an ideal replacement for titanium-based implant systems, which represent the current gold standard in implantology. However, there is a lack of standardized guidelines on production of zirconia-based implants and long-term studies on the stability of this material in vivo are missing. In this study we demonstrate for the first time the accumulation of degradation products of a commercially available one-piece zirconia-based dental implant 29 months after implantation, which was recovered following a traumatic accident. Biopsy specimens from the implant and the surrounding tissue attached to it were processed for histological and histomorphometrical analysis. Although the implant was well integrated into the anchoring bone, degradation particles were observed in tissues adjacent to lower aspects of the implant. The observed implant degradation might seriously compromise implant stability several years after implantation. This incidental finding highlights the requirement of further research on zirconia-based ceramics before they can be advertised as safe alternative to titanium-based implant systems. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2919-2923, 2018.

Sind Zirkonoxidimplantate eine gute biologische Alternative zu Titanimplantaten?

“…Die Entwicklung von neuen funktionalisierten Titanoberflächen, die in der Lage sind, mögliche Probleme im Zusammenhang mit Korrosion/Biotribokorrosion zu minimieren, und/oder von neuen nichtmetallischen Implantatmaterialien ist von größter Bedeutung, um nachteilige Gewebeeffekte zukünftig zu vermeiden. Mit der Entwicklung und Verbesserung von Biomaterialien hat die Anwendung von Keramik in der restaurativen Zahnmedizin eine Renaissance erlebt [41]. In diesem Zusammenhang hat sich die Verwendung von dentalen Implantaten aus Zirkonoxid zu einer Alternative von Titanimplantaten entwickelt [42,43].…”

“…Zirkondioxid hat außerdem eine Reihe vielversprechender physikalischer und mechanischer Eigenschaften, darunter eine niedrige Wärmeleitfähigkeit, eine hohe Biegefestigkeit (900-1200 MPa), eine angemessene Bruchfestigkeit sowie eine hohe Verschleiß-und Korrosionsbeständigkeit [45,47]. Trotz der vielversprechenden und günstigen Eigenschaften dieses Biomaterials ist jedoch weitere Grundlagen-und klinische Forschung erfor-derlich, um Langzeitergebnisse zu generieren sowie technische und biologische Komplikationen im Zusammenhang mit ihrer Verwendung zu bewerten [41,43,45].…”

Biomimetic Aspects of Oral and Dentofacial Regeneration

“…Zirconium implants are not as predictable as titanium implants. One study found degradation products of a zirconia-based implant only 29 months postoperatively [ 309 ]. Additional alternatives focusing on aesthetics include using a different system whereby the titanium implant’s external colouring is pink, which reduces the potential of soft tissues appearing grey while maintaining the predictability of a titanium implant [ 306 ].…”

Identification of Zirconia Particle Uptake in Human Osteoblasts by ToF-SIMS Analysis and Particle-Size Effects on Cell Metabolism

“…In this context, numerous studies from the fields of orthopedics and oral implantology point to a nano/microparticle-mediated tissue inflammation with subsequent bone loss [ 4 , 5 ]. In case of oral implants, an accumulation of nano/microparticles has been observed in the peri-implant hard and soft tissues around zirconia oral implants [ 5 , 6 , 7 , 8 ]. The assumed mechanisms of particle release are the formation of debris during implant insertion and/or the aging process of zirconia ceramics during their functional period [ 8 ].…”