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Chappuis V, Cavusoglu Y, Gruber R, Kuchler U, Buser D, Bosshardt DD.
Osseointegration of Zirconia in the Presence of Multinucleated Giant Cells. 2016

Aug;18(4):686-98. doi: 10.1111/cid.12375. Epub 2015 Sep 17.


Current strategies to reduce medical device-associated infections propose zirconia as a potential implant material which may limit bacterial adhesion. link




Derks J, Håkansson J, Wennström JL, Tomasi C, Larsson M, Berglundh T.
Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss. 2015 Mar;94(3 Suppl):44S-51S. doi: 10.1177/0022034514563077. Epub 2014 Dec 11.


Treatment outcomes in implant dentistry have been assessed mainly as implant survival rates in small, selected patient groups of specialist or university clinical settings. This study reports on loss of dental implants assessed in a large and randomly selected patient sample. link



Derks J, Schaller D, Håkansson J, Wennström JL, Tomasi C, Berglundh T.
Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis.

2016 Jan;95(1):43-9. doi: 10.1177/0022034515608832.


Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. link



Jank S, Hochgatterer G.
Success Rate of Two-Piece Zirconia Implants: A Retrospective Statistical Analysis. 2016

Apr;25(2):193-8. doi: 10.1097/ID.0000000000000365.


About 10 years ago, one-piece zirconia implants were introduced to dentistry. The aim of the study was to evaluate the clinical success of two-piece zirconia implants regarding osseointegration using the manufacturers' warranty data. link


R Cosgarea, C Gasparik, D Dudea, B Culic, B Dannewitz, A Sculean.
Peri-implant soft tissue color around titanium and zirconia abutments: a prospective randomized controlled clinical study. 2015 May;26(5):537-44. doi: 10.1111/clr.12440. Epub 2014 Jun 24.


To objectively determine the difference in color between the peri-implant soft tissue at titanium and zirconia abutments. link


N Kajiwara, C Masaki, T Mukaibo, Y Kondo, T Nakamoto, R Hosokawa.
Soft tissue biological response to zirconia and metal implant abutments compared with natural tooth: microcirculation monitoring as a novel bioindicator. 2015 Feb;24(1):37-41. doi: 10.1097/ID.0000000000000167.


Zirconia is often used for implant abutments for esthetics. The aim of this clinical study was to compare the effects of zirconia and metal abutments on periimplant soft tissue. link


Wachi T, Shuto T, Shinohara Y, Matono Y, Makihira S.
Release of titanium ions from an implant surface and their effect on cytokine production related to alveolar bone resorption. 2015 Jan 2;327:1-9. doi: 10.1016/j.tox.2014.10.016. Epub 2014 Nov 3.


Although interest in peri-implant mucositis and peri-implantitis has recently been increasing, the mechanisms driving these diseases remain unknown. link


Addison O, Davenport AJ, Newport RJ, Kalra S, Monir M, Mosselmans JF, Proops D, Martin RA.
Do 'passive' medical titanium surfaces deteriorate in service in the absence of wear? 2012 Nov 7;9(76):3161-4. Epub 2012 Jul 25.


Globally, more than 1000 tonnes of titanium (Ti) is implanted into patients in the form of biomedical devices on an annual basis. link


Oliva J, Oliva X, Oliva JD.
Five-year success rate of 831 consecutively placed zirconia dental implants in humans: a comparison of three different rough surfaces. 2010 Mar-Apr;25(2):336-44.


The aim of this study was to evaluate the 5-year success rate of zirconia (ZrO2) implants with three different kinds of surfaces. link


Manzano G, Herrero LR, Montero J.
Comparison of clinical performance of zirconia implants and titanium implants in animal models: a systematic review. 2014 Mar-Apr;29(2):311-20. doi: 10.11607/jomi.2817.


This study aimed to compare the values of removal torque (RT) and bone-implant contact (BIC) reported in different animal studies for zirconia and titanium implants. link


Cionca N, Müller N, Mombelli A.
Two-piece zirconia implants supporting all-ceramic crowns: a prospective clinical study. 2015 Apr;26(4):413-8. doi: 10.1111/clr.12370. Epub 2014 Mar 26


The aim of this prospective clinical study is to evaluate the safety and efficacy of a new all-ceramic implant system to replace missing teeth in partially edentulous patients. link


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


Little is known about the mechanisms of bacterial interaction with implant materials in the oral cavity. A correlation between plaque accumulation and progressive bone loss around implants has been reported. link


Sridhar S, Wilson TG Jr, Palmer KL, Valderrama P, Mathew MT, Prasad S, Jacobs M, Gindri IM, Rodrigues DC.
In Vitro Investigation of the Effect of Oral Bacteria in the Surface Oxidation of Dental Implants. 2015 Oct;17 Suppl 2:e562-75. doi: 10.1111/cid.12285. Epub 2015 Jan 27.


Bacteria are major contributors to the rising number of dental implant failures. Inflammation secondary to bacterial colonization and bacterial biofilm is a major etiological factor associated with early and late implant failure (peri-implantitis). link


Monzavi M, Noumbissi S, Nowzari H.
The Impact of In Vitro Accelerated Aging, Approximating 30 and 60 Years In Vivo, on Commercially Available Zirconia Dental Implants. 2017 Apr;19(2):245-252. doi: 10.1111/cid.12462. Epub 2016 Nov 9.


Despite increased popularity of Zirconia dental implants, concerns have been raised regarding low temperature degradation (LTD) and its effect on micro-structural integrity. link


Canullo L, Tallarico M, Radovanovic S, Delibasic B, Covani U, Rakic M.
Distinguishing predictive profiles for patient-based risk assessment and diagnostics of plaque induced, surgically and prosthetically triggered peri-implantitis. 2016 Oct;27(10):1243-1250. doi: 10.1111/clr.12738. Epub 2015 Nov 20.


To investigate whether specific predictive profiles for patient-based risk assessment/diagnostics can be applied in different subtypes of peri-implantitis. link


Kohal R, Klaus G, Strub JR. Zirconia implant supported all ceramic crowns withstand long term load: a pilot investigation. Clin Oral Implants Res. 2006;17(5):565-571.


TZP, study shows that implants fulfill biomechanical requirements for anterior teeth (tested with 1.2 million cycles) link


Kohal R, 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(4):323-329.


Study with prototype abutments showing that the biomechanical stability for this prototype is borderline for possible occlusal forces link 


Andreiotelli M, Kohal R. Fracture strength of zirconia implants after artificial aging. Clin Implant Dent Relat Res. 2009;11(2):158-166.


TZP, study shows that fracture strength values are within clinical acceptance level, aging in the artificial mouth with 1.2 million cycles link


Kohal R, Wolkewitz M, Mueller C. Alumina‐reinforced zirconia implants: survival rate and fracture strength in a masticatory simulation trial. Clin Oral Implants Res. 2010;21(12):1345-1352.


Comparison ATZ / TZP, showing that ATZ can withstand functional loading over an estimated period of 20 years (5 million simulated loading cycles link


Kohal RJ, Wolkewitz M, Tsakona A.
The effects of cyclic loading and preparation on the fracture strength of zirconium dioxide implants: an in vitro investigation. Clin Oral Implants Res. 2011;22(8):808-8


TZP, showing that the implants are able to withstand occlusal forces even after an extended interval of artificial loading (5 million cycles / roughly 20 years) link


Akagawa Y, Hosokawa R, Sato Y, Kamayama K. Comparison between freestanding and tooth-connected partially stabilized zirconia implants after two years' function in monkeys: a clinical and histologic study. J Prosthet Dent. 1998;80(5):551-558.


In vivo animal study, primate model, partially stabilized zirconia implants placed with a 1-stage procedure achieve long-term stability of osseointegration link


Scarano A, Di Carlo F, Quaranta M, Piattelli A.
Bone response to zirconia ceramic implants: an experimental study in rabbits. J Oral Implantol. 2003;29(1):8-12.


In vivo animal study, zirconia implants, This study concluded that these implants are highly biocompatible and osteoconductive link


Kohal RJ, Weng D, Bächle M, Strub JR.
Loaded custom-made zirconia and titanium implants show similar osseointegration: an animal experiment.
J Periodontol. 2004;75(9):1262-1268.


In vivo animal study, custom-made zirconia implants osseointegrated to the same extent as custom-made titanium control implants link


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(s1):s13-s20.


In vivo animal study, The findings suggest that surface-modified zirconia implants can reach firm stability in bone link


Gahlert M, Gudehus T, Eichhorn S, Steinhauser E, Kniha H, Erhardt W.
Biomechanical and histomorphometric comparison between zirconia implants with varying surface textures and a titanium implant in the maxilla of miniature pigs. Clin Oral Implants Res. 2007;18(5):662-668.


In vivo animal study, ZrO2r implants can achieve a higher stability in bone than ZrO2m implants. Roughening enhances bone apposition link


Depprich R, Zipprich H, Ommerborn M, et al. Osseointegration of zirconia implants compared with titanium: an in vivo study. Head Face Med. 2008;4(1):30.


In vivo animal study, zirconia implants with modified surfaces result in an osseointegration which is comparable with that of titanium implants link


Tetè S, Mastrangelo 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. 2008;24(1):52-58.


Zirconia showed connective tissue adhesion that was similar to that seen on the machined titanium surface, but demonstrated limited plaque formation link


Langhoff JD, Voelter K, Scharnweber D, et al. Comparison of chemically and pharmaceutically modified titanium and zirconia implant surfaces in dentistry: a study in sheep. Int J Oral Maxillofac Surg. 2008;37(12):1125-1132.


In vivo animal study, comparison between titanium and zirconia, There were no significant differences in BIC at 2 - 8 weeks link


Rocchietta I, Fontana F, Addis A, Schupbach P, Simion M.
Surface‐modified zirconia implants: tissue response in rabbits. Clin Oral Implants Res. 2009;20(8):844-850.


In vivo animal study, additional specific chemical modifications of the topographically modified zirconia implants do not seem to enhance the BIC link


Yamashita D, Machigashira M, Miyamoto M, et al. Effect of surface roughness on initial responses of osteoblast-like cells on two types of zirconia. Dent Mater J. 2009;28(4):461.


In vitro, the overall results demonstrated that NANOZR and 3Y-TZP with rough surface could provide good initial cell responses, adequate for future implant usage link


Kohal RJ, Wolkewitz M, Hinze M, Han J, Bächle M, Butz F.
Biomechanical and histological behavior of zirconia implants: an experiment in the rat. Clin Oral Implants Res. 2009;20(4):333-339.


In vivo animal study, all tested zirconia and titanium implant surfaces were biocompatible and osseoconductive link


Koch FP, Weng D, Kramer S, Biesterfeld S, Jahn-Elmermacher A, Wagner W.
Osseointegration of one‐piece zirconia implants compared with a titanium implant of identical design: a histomorphometric study in the dog. Clin Oral Implants Res. 2010;21(3):350-356.


In vivo animal study, zirconia implants are capable of establishing close BIC rates similar to what is known from the osseointegration behavior of titanium implants link


Schliephake H, Hefti T, Schlottig F, Gédet P, Staedt H. Mechanical anchorage and peri‐implant bone formation of surface‐modified zirconia in minipigs. J Clin Periodontol. 2010;37(9):818-828.


In vivo animal study, all implants achieved osseointegration with similar degrees of BIC and BVD; however, titanium implants showed a higher resistance to removal torque, probably due to higher surface roughness link


Stadlinger B, Hennig M, Eckelt U, Kuhlisch E, Mai R. Comparison of zirconia and titanium implants after a short healing period. A pilot study in minipigs. Int J Oral Maxillofac Surg. 2010;39(6):585-592.


In vivo animal study, The results suggest that unloaded zirconia and titanium implants osseointegrate comparably, within the healing period studied link


Hoffmann O, Angelov N, Zafiropoulos GG, Andreana S.
Osseointegration of zirconia implants with different surface characteristics: an evaluation in rabbits. Int J Oral Maxillofac Implants. 2011;27(2):352-358.


In vivo animal study, comparable rates of bone apposition in the zirconia and titanium implant surfaces at 6 and 12 weeks link


Bormann KH, Gellrich NC, Kniha H, Dard M, Wieland M, Gahlert M.
Biomechanical evaluation of a microstructured zirconia implant by a removal torque comparison with a standard Ti-SLA implant. Clin Oral Implants Res. 2012;23(10):1210-1216. doi:10.1111/j.1600-0501.2011.02291.x.


In vivo study, 4 - 12 weeks, biomechanical bone- tissue response of the investigated zirconia implants is non-inferior to that of the well- documented, roughened titanium surface link


Möller B, Terheyden H, Açil Y, et al.
A comparison of biocompatibility and osseointegration of ceramic and titanium implants: an in vivo and in vitro study. Int J Oral Maxillofac Surg. 2012;41(5):638-645.


In vivo comparison of titanium and zirconia, the results indicated similar biocompatibility and osseointegration for zirconium compared to titanium implants. link


Gahlert M, Roehling S, Sprecher CM, Kniha H, Milz S, Bormann K.
In vivo performance of zirconia and titanium implants: a histomorphometric study in mini pig maxillae. Clin Oral Implants Res. 2012;23(3):281-286.


In vivo animal study, The results indicate that there was no difference in osseointegration between ZrO2 implants and Ti-SLA controls regarding peri- implant bone density and BIC ratio link


Mai R, Kunert-Keil C, Grafe A, et al.
Histological behavior of zirconia implants: An experiment in rats. Ann Anat - Anat Scoreboard. 2012;194(6):561-566. doi:


In vivo animal study, osseointegration of zirconia implants after 28 and 56 days, conclusion that surface osseointegrates and is osseoconductive link


Aboushelib MN, Salem NA, Taleb ALA, El Moniem NMA.
Influence of surface nano-roughness on osseointegration of zirconia implants in rabbit femur heads using selective infiltration etching technique. J Oral Implantol. 2013;39(5):583-590.


In vivo animal study, osseous healing of selective infiltration-etched (SIE) zirconia implants compared to as-sintered zirconia and titanium implants, anhanced osseointegration link


Saulacic N, Erdösi R, Bosshardt DD, Gruber R, Buser D.
Acid and alkaline etching of sandblasted zirconia implants: a histomorphometric study in miniature pigs. Clin Implant Dent Relat Res. 2014;16(3):313-322.


In vivo animal study, Zeramex T implants with the proprietary surface treatment, osseointegration is confirmed with high BIC link


Prosthodontics R. Experimental zirconia abutments for implant-supported single-tooth restorations in aesthetically demanding regions: 4-year results of a prospective clinical study. 2004


Zirconia abutments offered sufficient stability to support implant-supported single-tooth reconstructions in anterior and premolar regions. The soft and hard tissue reaction toward zirconia was favorable link


Sailer I, Philipp A, Zembic A, Pjetursson BE, Hämmerle CHF, Zwahlen M.
A systematic review of the performance of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin Oral Implants Res. 2009;20(s4):4-31.


The 5-year survival rates estimated from annual failure rates appeared to be similar for ceramic and metal abutments. No provision of evidence for differences of the technical and biological outcomes of ceramic and metal abutments link


Ekfeldt A, Fürst B, Carlsson GE.
Zirconia abutments for single-tooth implant restorations: a retrospective and clinical follow-up study. Clin Oral Implants Res. 2011;22(11):1308-1314. doi:10.1111/j.1600-0501.2010.02114.x.


Zirconia abutments for single-implant crowns seem to demonstrate good short-term technical and biological results (> 3 years) link


Vanlıoglu BA, Özkan Y, Evren B, Özkan YK. Experimental custom-made zirconia abutments for narrow implants in aesthetically demanding regions: a 5-year follow-up. Int J Oral Maxillofac Implants. 2011;27(5):1239-1242.


Custom-made zirconia abutments offered sufficient stability to support all-ceramic restorations over narrow implants in anterior regions over a 5-year period. The soft and hard tissue reactions to zirconia were favorable. link


Kim SS, Yeo IS, Lee SJ, et al.
Clinical use of alumina-toughened zirconia abutments for implant-supported restoration: prospective cohort study of survival analysis. Clin Oral Implants Res. 2013;24(5):517-522. doi:10.1111/j.1600-0501.2011.02413.x.


Alumina-toughened zirconia abutments are likely to exhibit excellent long-term survival in clinical use for fixed restorations. Single tooth replacement at the molar region may require special care link


Hosseini M, Worsaae N, Schiødt M, Gotfredsen K.
A 3-year prospective study of implant-supported, single-tooth restorations of all-ceramic and metal-ceramic materials in patients with tooth agenesis. Clin Oral Implants Res. 2013;24(10):1078-1087. doi:10.1111/j.1600-0501.2012.02514.x.


The biological outcomes at the zirconia and metal abutments were comparable. All-ceramic crowns demonstrated better color match, but higher frequency of marginal discrepancy compared to metal-ceramic crowns link


Zembic A, Bösch A, Jung RE, Hämmerle CHF, Sailer I. Five-year results of a randomized controlled clinical trial comparing zirconia and titanium abutments supporting single-implant crowns in canine and posterior regions. Clin Oral Implants Res. 2013;24(4):384-390. doi:10.1111/clr.12044.


No statistically or clinically relevant differences between the 5-year survival rates, and the technical and biological complication rates of zirconia and titanium abutments in posterior regions link


Zembic A, Philipp AOH, Hämmerle CHF, Wohlwend A, Sailer I.
Eleven-Year Follow-Up of a Prospective Study of Zirconia Implant Abutments Supporting Single All-Ceramic Crowns in Anterior and Premolar Regions. Clin Implant Dent Relat Res. 2014:n/a - n/a. doi:10.1111/cid.12263.


Customized zirconia single implant abutments exhibited excellent long-term outcomes in anterior and premolar regions. (> 11 y) link


ISO14801 fatigue testing; Report No. 16010106-D-CS dated March 31, 2016 and Report No. 14070102-D-CS dated April 21, 2015; Spineserv GmbH & Co. KG, Söflinger Strasse 100, DE-89077 Ulm link


Locator® is a registered trademark of  Zest IP Holdings LLC, USA link


Information PEEK-OPTIMA® Ultra Reinforced
Invibio T-PB-PUR-E-0031-A (3/2013) link


Boyer R et al., Materials Properties Handbook: Titanium Alloys, ASM International, 1994 link

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