Surface Structure of Zirconia Implants: An Integrative Review Comparing Clinical Results with Preclinical and In Vitro Data

Abstract

Background: The purpose of this review was to analyze and correlate the findings for zirconia implants in clinical, preclinical and in vitro cell studies in relation to surface structure. Methods: Electronic searches were conducted to identify clinical, preclinical and in vitro cell studies on zirconia implant surfaces. The primary outcomes were mean bone loss (MBL) for clinical studies, bone-to-implant contact (BIC) and removal torque (RT) for preclinical studies and cell spreading, cell proliferation and gene expression for cell studies. The secondary outcomes included comparisons of data found for those surfaces that were investigated in all three study types. Results: From 986 screened titles, 40 studies were included for data extraction. In clinical studies, only micro-structured surfaces were investigated. The lowest MBL was reported for sandblasted and subsequently etched surfaces, followed by a sinter and slurry treatment and sandblasted surfaces. For BIC, no clear preference of one surface structure was observable, while RT was slightly higher for micro-structured than smooth surfaces. All cell studies showed that cell spreading and cytoskeletal formation were enhanced on smooth compared with micro-structured surfaces. Conclusions: No correlation was observed for the effect of surface structure of zirconia implants within the results of clinical, preclinical and in vitro cell studies, underlining the need for standardized procedures for human, animal and in vitro studies.

Influence of loading and aging on the fracture strength of an injection‐molded two‐piece zirconia implant restored with a zirconia abutment

“…Zirconia implants are commonly manufactured in a subtractive manner by grinding in a pre‐sintered or fully sintered and hipped state (Roehling et al, 2018). This technique requires post‐processing such as sintered zirconia slurry coating, sandblasting, or laser treatment to achieve a micro‐roughened surface, which allows for higher and faster bone apposition compared to machined surfaces (Altmann et al, 2017; Chopra et al, 2022; Gahlert et al, 2007; Rohr et al, 2022; Sennerby et al, 2005). On the other hand, ceramic injection molding (CIM) constitutes an alternative method to create zirconia implants by injecting the ceramic feedstock into a mold (Preis et al, 2016; Sanon et al, 2015; Spies et al, 2017; Zhang et al, 2020).…”

Comparison of Zirconia Implant Surface Modifications for Optimal Osseointegration

“…SE surfaces, and SE vs. laser-treated surfaces could not be acquired. Using only BIC values, it was hypothesized that the osseointegration capability is highest in laser-modified > SE-H > SE > blasted ~SA > machined surfaces [25,26].…”

Zirconia versus Titanium Implants: 8-Year Follow-Up in a Patient Cohort Contrasted with Histological Evidence from a Preclinical Animal Model

“…An older study in primates with sandblasted custom-made one-piece implants, integrated for three months and then loaded with cemented crowns for five months, found a mean BIC% of 67% for ZC versus 73% for Ti implants [ 51 ]. It is notable, however, that a recent review did not find that the surface structure of ZC implants influenced BIC% but did find that the chosen animal model had a significant influence on outcomes [ 52 ].…”