Zirconia vs. Titanium
The first dental implants were made of titanium alloy. Both the post and the abutment (connector) were titanium. This material is hard and a grayish silver color. It’s known for being strong, but also light and resistant to corrosion.
In the year 2000, zirconia was introduced to the market. It’s a ceramic material that looks more like that natural tooth. It began its use as an abutment only and is widely considered to be more compatible with gum tissue.
Five years later in 2005, the first full ceramic implant was introduced in Europe by a company called CeraRoot. In 2011, this technology was approved by the FDA (Food & Drug Administration) for use in the US.
If the name zirconia sounds familiar, it’s because this is the material that fake (but realistic-looking) diamonds are made of. The zirconia is treated with other components to give it an opaque white color that closely resembles a natural tooth. When the compound is changed to zirconium dioxide, the material shifts from ceramic to the synthetic diamond that’s found in costume jewelry.
Today, more than 95% of dental implants still utilize titanium, despite the introduction of this new material. In this article, we’ll discuss the pros and cons of each so that you can make the best decision when it comes to choosing a dental implant.
First, let’s define a dental implant and dispel a couple of myths about them.
Contrary to popular belief, a dental implant is more than just “dentures.” The implant refers to the structure that connects the bone or jaw to a dental prosthetic, like a crown, bridge or denture. Dental implants are also referred to as tooth implants. They’re made to act like a tooth’s root and can be fashioned out titanium, zirconia or ceramic.
It looks like a post, and the crown, bridge or denture is fitted on top of it, rather than affixing directly to the gum line, which is the case with dentures.
Conventional dentures fit over the jaw, and though they’ve come a long way since their invention all the way back in 700 B.C., they still have some disadvantages compared to a tooth implant.
For example, many denture-wearing patients report the following issues:
- Reduced chewing function
- Lack of food enjoyment
- Suboptimal digestion and constipation
- Acid reflux
- Reduced levels of B12, folic acid, and albumin
- Discomfort because of their bulk and movement
- Inconvenience and mess from denture adhesive
- Thinning jaw bones and sunk-in facial features
- Embarrassment from dentures falling out while eating or talking
A dental implant, on the other hand, has none of these challenges. Patients have a natural-looking smile with no impediment to chewing function or food enjoyment. Implants restore 80 to 100 percent of mouth and chewing function, making them increasingly popular.
Which is Better? Titanium or Zirconia?
Both materials are considered safe and have high patient satisfaction rates. However, these two compounds are vastly different in their look, feel, and even placement. The following is a discussion that outlines the difference and evaluates which solution is better depending on the individual patient’s needs.
Risk and Dangers of Corrosion
Because titanium is a metal, it is subject to corrosion. This means that it can lose stability and oxidize over time. Titanium is relatively resistant to corrosion, but it still happens, especially because the environment in the mouth can accelerate the process. Bacteria, constant exposure to moisture, stress impacts, and electric conductivity all cause wear and tear on the implant.
As the implant breaks down, patients also face the dangers associated with metal entering the body and bloodstream. Common side effects include Chronic Fatigue Syndrome and muscle soreness.
Zirconia, on the other hand, faces none of these challenges because it is ceramic.
The concept of corrosion is nothing new. Many people have had to get metal fillings replaced over time due to this natural occurrence. However, this isn’t the case with a ceramic filling.
The metal that’s present in a titanium implant means that it can be electrically and thermally conductive. In extreme cases, this means that a patient may either feel an electric charge or heat through their implant and into their nervous system. However, there have been no reported cases of this occurring, but it’s mentioned here as it has been raised as a point of concern among patients considering titanium.
In most cases, the posts and abutments of implants can’t be seen. However, patients who have higher and thinner gum lines or gaps in their teeth may feel self-conscious that people around them can see the gray metallic color of the titanium.
Since zirconia is a neutral color that looks similar to natural teeth, insecure patients feel more confident with zirconia as opposed to titanium.
The Depth of the Implant & Gum Health
Because of the unsightly color of the titanium, the implants are burrowed deeper into the mouth, more at the bone level. However, bacteria can grow more easily that way, making this type of implant more prone to infection.
The single piece structure of zirconia is beneficial for two reasons. First, the implant is placed at the gum line instead, which makes it easier to maintain and keep clean. Second, this type of implant combines the post and the abutment all in one piece, negating the gap of space where bacteria can grow.
Not only does this compromise the integrity and the structure of the implant, but it can also negatively affect oral health, and even cause bad breath.
Another thing to consider is that the risk of infection is highest in the immediate days following a dental procedure. The two-piece titanium implant construction makes this inherently riskier. However, with proper placement of the structure and careful hygienic habits by the patient, this risk is minimal.
Because of the body’s reaction to the metal in a titanium implant, patients who have implants for several years may report bone loss, inflammation, and bleeding at the gums. None of these effects are reported with zirconia implants because this material is bio-compatible.
It should be noted that the FDA also classifies as bio-compatible, though their definition of bio-compatibility is loose. According to the FDA, to meet this requirement, the material must be non-toxic and “interact favorably with the human body.”
It’s a wonder that more people haven’t expressed concern about the metal in titanium fillings and the effect it can have on the body.
The first thing to note is that to strengthen the titanium, it’s combined with a metal alloy like nickel. According to the CDC (Centers for Disease Control), ten to twenty percent of Americans are allergic to nickel. Further, about four percent of patients tested in a recent study showed an allergy to titanium itself.
Concerns about Metal
It’s not just allergies that raise some concerns about the use of titanium. While zirconia is a bio-compatible material that doesn’t react to a body’s chemistry, this isn’t necessarily the case with titanium. The overwhelming majority of patients have zero issues with the metal material, but those with auto-immune conditions may want to proceed with caution.
People with autoimmune disorders like Hashimoto’s, Crohn’s Disease, Graves’ Disease, Rheumatoid Arthritis, Lupus, and more are prone to their body rejecting or attacking the implant. An autoimmune condition is an imbalance in the immune system that causes it to attack benign objects, and even its own organs and tissues.
Therefore, if a patient has one of these conditions, they should speak with their doctor before considering a titanium implant.
Both zirconia and titanium perform equally well in this category. They are both shown to integrate seamlessly with a patient’s bone structure.
Titanium is undoubtedly an incredibly strong and durable material. It’s not uncommon to find patients with implants close to forty years old that have stood the test of time and are perfectly intact.
Unfortunately, the same cannot be said about zirconia implants simply because they haven’t been in use for as many years. Some dentists who are strict proponents of titanium claim that this type of implant will never break, whereas they’ve seen zirconia material break within a few years of implantation.
The patients most at risk for having a zirconia implant break are those that have a smaller diameter tooth, and especially those that grind or clench their teeth incessantly. In those situations, most dentists are likely to recommend titanium.
It was mentioned earlier that titanium implants are made up of two pieces: the post and the abutment. Their zirconia counterparts are only one piece. While there are advantages to a single piece in terms of hygiene and inhibiting bacteria growth, there is something to be said for the flexibility of having a two-piece system.
For example, they can be used for both snap on solutions like overdentures and removable teeth. Plus, minor adjustments can be made to them, and they can be customized and more easily refitted to accommodate bone movement. While zirconia implants can withstand some slight adjustments, the options are more restricted.
Again, because there’s a limited option for movement and flexibility with a zirconia implant, proper initial placement is even more important than it is for the titanium version. A slightly off angle can be easily fixed with titanium, but not so with zirconia.
This might seem like a dental error if an angle is slightly off, but the reality of the situation is that sometimes the underlying bone is not in the shape the doctor anticipated. A titanium implant allows for more burrowing since it’s already placed deeper into the bone. However, with zirconia’s more surface-area placement, bone that’s not in the best of shape may require a graft for the implant to hold. In some cases, an entirely new (and expensive) procedure may be necessary.
This is often one of the most important considerations. While the price of an implant and its placement will vary depending on the dentist and the location of the office, bear in mind that a zirconia implant will be pricier than a titanium one. Most of the other factors are equal but be prepared for a significant price difference.
As long as your dentist follows proper procedure and protocols, dental implants are completely safe. Neither one is more or less or painful than the other, despite the fact that titanium is implanted more deeply.
The speed of recovery is the same for both materials. Also, in both procedures, the patient will be fully sedated and feel no pain during the implantation. Afterward, there may be bruising, but it disappears relatively quickly. Many patients are able to resume their routines and even return to work the day after the procedure.
Following the Trends
Some dentists have spoken out about the fear mongering inherent with titanium. They claim that titanium is harmless, and they argue that it’s a more durable and versatile solution. Logically, they’re able to point to companies that manufacture zirconia implants as being the ones behind this fear mongering as a way to profit off of people’s health concerns.
It’s undeniable that there’s a trend to dentistry that not only looks more natural but also uses materials that more closely match our body’s innate biological systems. Metal is unsightly (in cases where it’s visible), and there’s no doubt that it can corrode over time.
A thorough discussion with your dentist will help you make the right decision for you. Here are a couple of talking points to get you started, and these are topics we recommend you bring up during your consult.
You may prefer titanium if:
- You want to ensure the longevity of the implant
- You grind or clench your teeth regularly
- You have concerns about the dentist’s ability to properly place an implant (titanium allows for more margin of error)
- You’re on a tighter budget
- You need a full set of teeth replaced
You may prefer zirconia if:
- You are prone to gum disease or worried about developing it
- You have a gum line that would should the gray color metal
- You have an auto-immune condition or a documented allergy to metal