Effect of Zirconia Dental Implant Surfaces on Bone Integration: A Systematic Review and Meta-Analysis

Abstract

Background. The information available about osseointegration and the bone to implant interaction of zirconia implants with various surface modifications is still far from sufficient. Objective. The purpose of this systematic review and meta-analysis was to evaluate and compare zirconia dental implants with different surface topographies, with a focus on bone to implant contact and removal torque. Methods. The systematic review of the extracted publications was performed to compare the bone to implant contact (BIC) with removal torque (RT) values of titanium dental implants and machined and surfaced modified zirconia implants. Results. A total of fifteen articles on BIC and RT values were included in the quantitative analysis. No significant difference in the BIC values was observed between titanium and machined zirconia implants (p = 0.373; 95% CI: −0.166 to 0.443). However, a significantly better BIC values were observed for acid etched zirconia implants compared with those of titanium implants (p = 0.032; 95% CI: 0.068 to 1.461). Unmodified zirconia implants showed favorable BIC values compared to modified-surface zirconia implants (p = 0.021; 95% CI: −0.973 to −0.080). Conclusion. Acid etched zirconia implants may serve as a possible substitute for successful osseointegration.

Zirconia compared to titanium dental implants in preclinical studies—A systematic review and meta‐analysis

“…This lack of information with regard to the implant surface makes a comparison and interpretation of the results between specific experimental investigations hardly possible, since a machined surface in one study could be equivalent with a moderately roughened surface in another. Similar lack of information was reported in previous systematic reviews on the preclinical performance of zirconia implants (Hafezeqoran & Koodaryan, ; Manzano et al.,). Moreover, it must be noted that a comparison of single surface roughness parameters reported in different studies is not reasonable since standards and techniques of the used surface metrology may substantially vary and a successful osseointegration is not exclusively linked to one particular surface feature (Jarmar et al., ; Wennerberg & Albrektsson, ).…”

“…Previously published systematic reviews and meta-analyses on experimental studies did not focus on the comparison between zirconia and titanium implants or included exclusively data on osseous integration (Hafezeqoran & Koodaryan, 2017;Manzano, Herrero & Montero, 2014;Pieralli, Kohal, Hernandez, Doerken & Spies, 2018).…”

“…,Buser, Sennerby and De Bruyn (2017),Chen, Moussi, Drury and Wataha (2016),Depprich et al (2014),Elnayef et al (2017),Hafezeqoran and Koodaryan (2017),Hisbergues, Vendeville and Vendeville (2009), Hobkirk and Wiskott (2009), Kohal et al ( 2008), Kumar, Jain, Jayesh, Parthasaradhi and Venkatakrishnan (2015), Manzano et al (2014), Ozkurt and Kazazoglu (2011), Prithviraj, Deeksha, Regish and Anoop (2012), Van Dooren et al (2012), Wenz et al (2008) In vitro studies 5 Kirsten (2015), Oblak, Verdenik, Swain and Kosmac (2014), Zhu, Yang and Ma (2010), Andreiotelli, Wenz and Kohal (2009a), Delgado-Ruíz et al (2011) Data not clear for evaluation 5 Dubruille et al (1999), Gredes, Kubasiewicz-Ross, Gedrange, Dominiak and Kunert-Keil (2014), Langhoff et al (2008), Lee et al (2013), Sennerby et al (2005) Animal/experimental studies not investigating BIC or RTQ/PI or quantitative soft tissue parameters 4 Delgado-Ruiz et al (2015), Depprich et al (2008a), Kim et al (2016), Thoma et al (2016) Experimental studies investigating titanium implants with a zirconia collar 2 Bianchi et al (2004), Tete, Mastrangelo, Bianchi, Zizzari and Scarano…”

Osseointegration of zirconia and titanium implants in a rabbit tibiae model evaluated by microtomography, histomorphometry and fluorochrome labeling analyses

“…Brushite coating can accelerate osseointegration by dissolution, promoting cell attraction, osteoblast adhesion and bone formation around implants . The absence of surface treatment in zirconia implants may have influenced osseointegration and the statistical results of these implants . In addition, no differences were observed between Ti and machined zirconia implants in this study.…”

Tissue integration of zirconia and titanium implants with and without buccal dehiscence defects—A histologic and radiographic preclinical study

“…Biological properties of zirconia implants were thoroughly investigated on both the hard and soft tissue levels, and also in comparison to titanium implants. Scientific evidence demonstrated no significant differences in the degree of osseointegration with or without bone augmentation procedures between zirconia and titanium implants (Benic et al, ; Hafezeqoran & Koodaryan, ), thereby indicating the suitability of zirconia implants for clinical use. Moreover, even though limited, experimental data demonstrated dimensional and morphologic similarities in the peri‐implant mucosa between zirconia and titanium implants (Tete et al, ; Thoma et al, ; Welander, Abrahamsson, & Berglundh, ).…”