A growing number of people are consciously considering which materials enter their bodies – and sooner or later they face the question of the right dental restoration. In episode 129 of the Queens & Sons of Dentistry podcast, the dentist Dr Maximilian Fuhrmann, who has been practising for more than 14 years with a focus on prosthetics, periodontology and implantology, and the mechanical engineer Thorsten Buurlage, who is responsible for the high-tech manufacture of the Neodent ceramic implants, discuss the role zirconia will play in future alongside titanium, a material that has proved itself over decades.
Biocompatibility as the central argument
For Thorsten Buurlage, who has worked in ceramic development for around ten years, ceramic implants are “the answer to the requirement that patients actually make” – namely health. Ceramic, he says, is the most biocompatible material currently known; nobody can know what the future will bring, but as things stand today zirconia sets the benchmark here. Dr Fuhrmann confirms this observation from clinical practice: more and more patients are actively asking for an alternative to titanium. The reasons range from the wish for a metal-free restoration through highly aesthetic demands to a more holistically oriented dentistry, in which a solution that is as “interference-free” as possible takes centre stage.
Strength: zirconia need not shy away from the comparison
The fact that in everyday life ceramic brings coffee cups to mind rather than highly loaded components is something Buurlage dispels with his background in drive technology. On the data sheet, zirconia is the only material that matches the elasticity and strength of steel – with considerably higher wear resistance. For a direct comparison he cites flexural strength values of around 800 newtons for titanium against roughly 1,200 for ceramic. With an appropriate design, ceramic components can therefore achieve the same or even higher strength values than titanium. As evidence of the material’s potential he points to prosthetics: ceramic has long become established for bridges as well – ten years ago anyone using ceramic there would have been declared mad, whereas today it is common practice.
Dr Fuhrmann adds the clinical perspective: the body of evidence has changed markedly over the past five to ten years, and the materials have improved. Fractures used to occur above all when implants were not placed in accordance with the protocol or were subjected to unfavourable extra-axial loading. In his own practice he has not yet experienced a fracture – even though over the years the team has certainly ventured into borderline implantological territory.
Aesthetics: the white colour as a visible difference
Alongside biocompatibility, Buurlage sees aesthetics as the second major argument: the white colour corresponds exactly to what is expected of teeth and dental products. How relevant this can become clinically is illustrated by Fuhrmann with a case from the aesthetic zone: in a patient with a thin biotype, an anterior tooth was extracted and an implant placed immediately – without immediate loading. It is precisely in such situations, where a dark implant body could shine through in the event of bone loss, that the colour of the ceramic implant plays out “its appeal”.
Costs and subjective perception
According to Fuhrmann, costs depend heavily on the system. Compared with the ceramic system the practice used previously, the current one is even cheaper; against titanium implants the additional price is roughly 150 to 200 euros gross. These material costs are passed on to the patient one to one as a pass-through item – similar to prosthetics from an external laboratory, since storage costs may not be added on. As regards subjective perception, Fuhrmann sees no demonstrable difference between the materials: some patients report a foreign-body sensation after implant placement because the proprioception of the natural tooth with its fibre apparatus is missing – but this applies to every implant and depends heavily on individual perception.
Assessment: the better as the enemy of the good
In the podcast Buurlage offers a thought experiment: had implantology started with ceramic, nobody would switch back to grey titanium implants – that would amount to a step backwards. Better technologies with genuine added value establish themselves on the market sooner or later, even if this sometimes takes decades; he draws parallels with the move from the carriage to the car, with the computer and with the smartphone. How seriously Fuhrmann takes the material is shown by his answer to the question of what he would recommend to his own parents: where the bone supply is sufficient and no major augmentation is required, a ceramic implant. The conclusion of the discussion: ceramic is not categorically “better” than titanium – but for many practitioners and patients it is the next logical step in development.