Despite decades of titanium as the gold standard in oral implantology, the search for alternatives has been growing. High esthetic standards and increasing incidence of titanium allergies, along with a rising demand for metal‐free reconstructions, have led to the proposal of ceramics as potential surrogates. Following numerous experimental studies, zirconium dioxide (zirconia) has earned its place as a potential substitute for titanium in implantology. Yet, despite zirconia's excellent biocompatibility and tissue integration, low affinity to plaque and favorable biomechanical properties, early failures were significantly higher for zirconia implants than for titanium implants. Technical failure as a result of fracture of the material is also a major concern. So far, zirconia implants have been mainly manufactured as one‐piece implant systems because of the material's limitations. Nevertheless, various two‐piece systems have been progressively emerging with promising results. Screw‐retained abutments are desirable but present a major technical challenge. Innovation and technical advances will undoubtedly lead to further improvement in the reliability and strength of zirconia implants, allowing for novel designs, connections and reconstructions. Additional clinical studies are required to identify all relevant technical and biological factors affecting implant success and patients’ satisfaction. However, the evidence for a final verdict is, at present, still incomplete.

Systemic metronidazole and amoxicillin significantly improved the 6-month clinical outcomes of full-mouth non-surgical periodontal debridement, thus significantly reducing the need for additional therapy.

Levels of several cytokines and acute-phase proteins significantly changed after treatment regardless of treatment modality. There was no evidence for a specific DSL- or PDT-enhanced expression of inflammatory mediators.

ObjectivesThe 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.Material and methodsThirty-two partially edentulous, systemically healthy patients were treated with 49 two-piece zirconia implants (ZERAMEX® T Implant System). Zirconia abutments were connected with adhesive resin cement. Single-unit full-ceramic crowns were cemented. The cases have been followed for 588±174 days after loading (range 369–889 days). All patients have been re-evaluated 1 year after loading.ResultsThe cumulative survival rate 1 year after loading was 87% implants. All failures were the result of aseptic loosening, and no implants were lost after the first year. The results of the other cases were good, and the patients were very satisfied. The cumulative soft tissue complication rate was 0%, the cumulative technical complication rate was 4% implants, the cumulative complication rate for bone loss >2 mm was 0%, and the cumulative esthetic complication rate was 0%. Including the data from 20 patients treated with an earlier version of the system, an over-all 2-year cumulative survival rate of 86% was calculated for a total of 76 two-piece zirconia implants supporting all-ceramic crowns in 52 patients.ConclusionsReplacement of single teeth in the posterior area was possible with this new full-ceramic implant system. Failures were due to aseptic loosening.

Excellent clinical results in the antibiotics group were obtained regardless of the presence or absence of six classic periodontal periopathogens prior to treatment.

ObjectivesThe aim of this review was to evaluate the clinical success and survival rates of zirconia ceramic implants after at least 1 year of function and to assess if there is sufficient evidence to justify using them as alternatives to titanium implants.Materials and methodsAn electronic search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Clinical Trials (CENTRAL) databases was performed in April 2015 by two independent examiners to retrieve clinical studies focusing on the survival rate of zirconia implants after at least 1 year of function. Implant survival was estimated using the overall proportion reported in the studies with a Clopper-Pearson 95 % confidence interval (random effect model with a Der-Simonian Laird estimate).ResultsFourteen articles were selected out of the 1519 titles initially screened. The overall survival rate of zirconia one- and two-piece implants was calculated at 92 % (95 % CI 87–95) after 1 year of function. The survival of implants at 1 year for the selected studies revealed considerable heterogeneity.ConclusionsIn spite of the unavailability of sufficient long-term evidence to justify using zirconia oral implants, zirconia ceramics could potentially be the alternative to titanium for a non-metallic implant solution. However, further clinical studies are required to establish long-term results, and to determine the risk of technical and biological complications. Additional randomized controlled clinical trials examining two-piece zirconia implant systems are also required to assess their survival and success rates in comparison with titanium as well as one-piece zirconia implants.Clinical relevanceZirconia implants provide a potential alternative to titanium ones. However, clinicians must be aware of the lack of knowledge regarding long-term outcomes and specific reasons for failure.

The objective of this work was to compare the effects of antimicrobial photodynamic therapy (PDT), diode soft laser therapy (DSL), and thorough deep scaling and root planing (SRP) for treatment of residual pockets. Thirty-two subjects with a history of non-surgical treatment for chronic periodontitis were included. Residual pockets >4 mm and bleeding upon probing were debrided with an ultrasonic device and then subjected to either PDT, DSL, or SRP. Pocket probing depth (PPD), bleeding on probing (BOP), and gingival recession were monitored over 6 months. Counts of four microorganisms were determined by direct hybridization with RNA probes. PPD decreased from 5.6±1.0 to 3.8±1.1 in 6 months (p<0.001), and BOP decreased from 100% to 52% (p<0.01). The risk for a site to remain >4 mm with BOP depended on initial PPD (p=0.036) and was higher if treated with DSL (p=0.034). Frequencies of three microorganisms were significantly lower in PDT-and SRP-treated than in DSL-treated quadrants (p=0.02) after 14 days, but not at months 2 and 6. All three treatments resulted in a significant clinical improvement. PDT and SRP suppressed Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola stronger, and resulted in fewer persisting pockets after 6 months, than DSL application.

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