Crestal bone response to loaded zirconia and titanium implants: a radiographic and histometric analysis in canines
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ORIGINAL ARTICLE
Crestal bone response to loaded zirconia and titanium implants: a radiographic and histometric analysis in canines Corinne E. Oeschger 1,2 & Dieter D. Bosshardt 3 & Stefan Roehling 4,5,6 & Michael Gahlert 6,7,8 & David L. Cochran 5 & Simone F. M. Janner 1,5 Received: 14 November 2019 / Accepted: 29 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To evaluate the crestal bone response to a two-piece zirconia implant compared with a control titanium implant using periapical radiographs (PAs) and histometry. Materials and methods Thirty zirconia and 30 titanium implants were placed in healed posterior mandibles of five canines. Full-ceramic single-tooth restorations were cemented after 6 weeks of healing. Three observers measured the distance between the implant shoulder and the crestal bone (DIB) at placement, loading, and harvesting after 4 or 16 weeks in function. The influence of implant material and loading time on DIB as well as the inter-observer agreement were analyzed. Additionally, histometric distance between implant shoulder and most coronal bone-to-implant contact (IS-cBIC) was compared with DIB. Results Mean DIB values increased between 4 and 16 weeks of loading for both zirconia (from 1.66 to 2.25 mm; P < 0.0001) and titanium (from 1.81 to 1.95 mm; P = 0.06). Zirconia yielded mean IS-cBIC values of 2.18 mm and 2.48 mm (P < 0.001) and titanium 2.23 mm and 2.34 mm (P = 0.27) after 4 and 16 weeks, respectively. The raters reached an excellent intraclass correlation coefficient. PAs underestimated the bone loss on average by 0.39 mm. Conclusions Zirconia implants showed a greater increase of DIB during early healing and function than titanium. Clinical relevance Crestal peri-implant tissue dimensions may show more pronounced changes around two-piece zirconia implants during early healing. PAs may underestimate peri-implant bone loss. Keywords Crestal bone . Dental implants . Osseointegration . Radiographic analysis . Zirconia implants
Introduction Titanium implants have been successfully used for the replacement of teeth for over 40 years, since the first reports by Brånemark 1969 and Schroeder 1978 [1, 2]. Mechanical and biological stability and excellent long-term results make
titanium the gold standard as an implant material [3, 4]. Demand for metal-free implant materials has recently increased, partially due to more or less founded criticism towards titanium [5, 6] and the potential of optimal esthetic outcomes of white ceramic materials [7]. Among these, recent reports hypothesize a limited impact of bacteria from zirconia
* Simone F. M. Janner [email protected]
5
Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
1
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland
6
Private Dental Clinic Prof. Gahlert and Dr. Röhling, Munich, Germany
2
Private Practice, Solothurn, Switzerland
7
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