Rob, a dentist asks,I’ve heard that Nobel BioCare’s new all zirconium one piece dental implant, is supposed to come to the U.S. market sometime in !!". #here are also other zirconium implants $rom other companies onthe market.%hat do the dentists here think o$ these new all zirconium implants& 'o (ou think the( will osseointe)rate as well as titanium, and per$orm as well as the titanium dental implants& 'o (ou think the( will be more prone to $racture& %hat mi)ht some o$ the bene$its o$ an all zirconium implant be *i can see a one+piece all zirconium implant ma(be doin) awa( with the micro)ap bacterial issue seen with some titanium implants& #hanks $or (our thou)hts. -r provides lower levels o$ phosphates+ this will compromise new bone $ormation relative to oidized #i. It is also ver( di$$icult to prep+ and in the end, (ou don’t reall( know how stron) the remainin) material is because there is no wa( to detect the presence o$ micro$ractures. I don’t reall( see an upside to this product, with the possible eception o$ ver( thin mucosa in the anterior. I$ this  product appears stark white like the other /rocera products, as opposed to shaded, then even in thoseinstances it will be easil( detected and o$ little or no bene$it. Stren)th should not be a concern, other than in the case o$ micro$racture caused in the preppin) o$ the material
Ceramic implants are nothing new – so why are zirconium implants offered now?
#he demands o$ patients $or hi)hl( aesthetic restorations have increased tremendousl( durin) the  past $ew (ears so that the( are not willin) to accept the dark shade o$ titanium implants in the so$t tissue 0)in)iva1. whiteS23 meets the demands o$ patients and allows to $abricate aestheticall( appealin) dental restorations. #hese increased demands in the $ield o$ aesthetics can also be observed in the sector o$ conventional  prosthetic restorations in which the zirconium material is about to replace metal brid)es. 4nother ma5or advanta)e o$ the zirconium material is its biocompatibilit(. 4 )rowin) number o$  patients have developed aller)ies to metals6 zirconium implants represent an alternative $or this )roup o$ patients.
How does the whiteSKY implant differ from the Tübingen implant?
 
#he main di$$erence lies in the primar( stabilit( o$ the implant. 7win) to the lacunae, the #8bin)en implant had hi)hl( reduced primar( bone contact6 the result was that a ver( hi)h loss rate was observed durin) the healin) phase. 9oreover the material revealed insu$$iciencies which resulted in an increased tendenc( to $racture a$ter :! (ears. whiteS23 $eatures a modern implant desi)n with a sur)ical protocol matched with the respective bone ;ualit(. #his protocol ensures that primar( stabilit( is )uaranteed b( bone compression. #hanks to its elasticit( and mechanical properties, zirconium is less susceptible to $racture than aluminium oide used $or the #8bin)en implant.
luminium o!ide implants were highly susceptible to fracture? "hat is the fracture beha#iour of zirconium?
#he tendenc( to $racture o$ aluminium oide implants was observed in the "!s < especiall( $or the #8bin)en implants. #he results o$ this observation can be attributed to two $actors6 on the one hand, aluminium oide is a relativel( brittle material and tends to break easil(6 on the other hand the  prosthetic concept which included cemented metal pins even led to an increase in the tendenc( to $racture. #he zirconium material is much more elastic than aluminium oide and hence less susceptible to $racture6 moreover, all measurements that were per$ormed showed that the risk $actor o$ $racture could be eliminated thanks to the one+piece desi)n o$ the whiteS23 implant.
"hy is zirconium a suitable material for implants?
I$ (ou consider all mechanical properties, zirconium is the per$ect material $or dental implants. #he $leural stren)th o$ zirconium is three times above that o$ titanium and two times above that o$ aluminium oide and the modulus o$ elasticit( is between those $or titanium and aluminium oide6 i.e. it has a hi)her dimensional stabilit( than titanium and is less susceptible to $racture than aluminium oide. 4dditionall(, zirconium $eatures a =de$ect blockin) propert(= to avoid the epansion o$ micro$ractures. Conse;uentl(, ecellent lon)+term primar( stabilit( is ensured and )ood results can be achieved in the $ield o$ dental implantolo)(.
$sseointegrated zirconium?
4 series o$ animal eperiments showed that $irm osseointe)ration can be achieved with zirconium. In this contet the sur$ace o$ the implants is hi)hl( relevant. Studies with the brezirkon material that is used $or whiteS23 showed that comparable results o$ bone apposition were achieved $or comparable sur$aces o$ a titanium implant and our zirconium implant. 4s $ar as sur$ace treatment is concerned, we continue the development o$ brezirkon under scienti$ic )uidance to achieve optimal results.
 
re zirconium implants going to replace titanium implants?
7ver the lon) term zirconium will certainl( reach a hi)h market share since there is a )rowin) demand $or these implants $or certain indications amon) dentists and patients as well because o$ the advanta)es o$ the material 0colour, biocompatibilit(1. >owever, we do not believe that < over the medium term < zirconium implants will entirel( replace titanium implants but that both s(stems will  be used $or speci$ic indications.
Can zirconium implant be recommended for all indications?
#he critical phase o$ the sin)le component zirconium implant is the $irst $ew weeks a$ter implant  placement 0durin) the healin) phase1. It is necessar( to protect the implants a)ainst ecessive stress 0loadin)1 durin) this period. #here$ore we recommend to use whiteS23 implants onl( $or sin)le tooth replacement or small )aps in the dentition6 e$$icient protection can be easil( provided $or these indications. In cases o$ )aps in the dentition, each lost tooth should be replaced with
one
implant. Currentl(, zirconium implants should not be used $or $ree+end situations and edentulous rid)es.
"hat type of restorations should be used for zirconium implants during the healing phase?
?enerall(, two di$$erent tendencies can be observed amon) our users and also in the scienti$ic literature. Some users attempt to protect the zirconium implants throu)h the use o$ splints to avoid an( eposure to stress durin) the $irst $ew weeks6 others tr( to protect the implant a)ainst ecessive stress b( appl(in) the rules o$ immediate loadin).
"hat are the ris%s in#ol#ed when using splints for protection?
%hen usin) splints to protect implants it is important to make sure that the patient wears the splints  permanentl(, i.e. durin) da( and ni)ht time since the implant needs to be protected a)ainst ecessive ton)ue and cheek pressure. @re;uentl(, however, splints do not o$$er su$$icient com$ort o$ wearin)6 as a result the patient does not wear them permanentl( contrar( to the dentistAs advice. In such cases there is a risk that onl( so$t+tissue inte)ration will occur. In a ver( limited number o$ cases this could be determined onl( a$ter the insertion o$ the de$initive restoration which caused noticeable increase
 
in the economic dama)e. #here$ore we recommend to $irst place a resin crown onto the implant < $ollowin) splint therap( over si to ei)ht weeks < and thus continuousl( increase the stress 0load1 on the implant.
Can prosthetic restorations immediately be placed&attached on&to the implant after the insertion?
Basicall(, (es. >owever, it must be ensured that crowns and brid)es that are immediatel( luted on implants must have a considerabl( smaller volume than natural teeth and desi)ned in a wa( to o$$er alar)e contact areasur$ace with ad5acent teeth so that these teeth are able to protect the implants and the temporar( restoration. 4dditionall(, Ribbond $ibres can be used to connect the restoration to the ad5acent teeth.
"hat is the current situation in the sector of zirconium implants from the #iew of bredent medical?
4s $ar as zirconium implants are concerned, the market is in a similar situation as in the be)innin) o$ the !s when titanium implants became more and more popular. In our opinion there is still potential$or development as $ar as the desi)n o$ the sur$ace o$ zirconium implants is concerned. In the case o$ titanium, manu$acturers continue to develop new sur$ace desi)ns even a$ter a period o$ thirt( (ears. %e know that a rou)h sur$ace supports osseointe)ration and as a market leader in the sector o$ zirconium implants we are constantl( increasin) our research e$$orts. Initial scienti$ic results such as those obtained b( the Universit( o$ Colo)ne indicate that zirconium implants with sandblasted sur$aces result in osseointe)ration comparable to that o$ titanium implants with sandblasted sur$aces.%e are )oin) to publish correspondin) scienti$ic studies that are bein) conducted in cooperation with our universit( partners.
's bredent medical also going to offer two(piecezirconium implants in the future?
#wo+piece zirconium implants are bein) developed. #he bi))est challen)e is the reliable, durable connection o$ abutment and implant. Basicall(, two options o$ screwed and luted 0adhesive1 connections are possible. Currentl(, however there is no method available $or the zirconium material $or both approaches to ensure reliable lon)+term survival.
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