Do we really need a zirconium implant or abutment?

373 Rating(s).


Posted on By Maurice Salama In Anterior/Esthetic

Implant and bone graft performed on #8. GBR and CTG added for tissue thickness. Do we still need zirconium? See 4 year post-op. Thoughts? Zirconium Implants?

Titanium abutment
Ti abutment occlusal

Tissue Color
4 yr post op titanium


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20 Comments

I think this is a great case, what type of crown is this?


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Rami; Thanks for the post. The abutment was titanium and the crown was all-ceramic. The final image was 4 yrs. post op. I believe that thickening of the labial tissues with CTG was a significant factor in the long term esthetic result, color and gingival marginal stability.
Dr. Salama


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I think tha is a wonderfull case and the results for four years are a succes for the funcion and the esthetic, really we don´t need zircon abutment for all anterior cases, only we need is an excelent lab and excelent clinical technics, thanks for present of this case. Dr. Arturo Meijueiro, Titaniumfix Mexico


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We do when the tissue biotype is thin, less than 2mm. Your soft tissue grafting in this case is excellent! Maurice when you say all ceramic crown that is a little vague today with the number of options available. That being said I bet it is an opaque core with pressed, cutback and layered ceramic on top-beautiful incisal effects!


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Wonderfull case. A result of complete understanding of the esthetic anterior implant.

Just a question: how do you mask the abutment so you can cement above an all ceramic crown?
¿maybe a telescopic opaque crown?

Thanks a lot!


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We won't Need Zironium Implants! If you worry about athetetics, use costumized zirkonabutment with titanium Base!


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It's my feeling that zirconium implants still have some questions regarding fracture resistance, costs and sensitivity of the technique. We have a lot of lab and technical options in esthetic region with conventional titanium implants, with at least four decades of clinical success. Otherwise, Zirconia abutments are a reality in selected cases.
Regards,
Sormani.


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Espectacular Mauricio


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It couldn't be better ,beautiful job


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Thank you for sharing this beautiful case...


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Wonderful result..Thank you DS


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Hello dr Salama
I love the "one abutment one time" concept.
When it's combine with friction fit connection and snap on components is a piece art.
But, to hide the abutment color behind thick tissue, we need to place the margin subgingival. How do you manage the cement exes. Thank you. Vinc


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Thanks Dr Salama for sharing this beautiful case... very nice soft tissue contour, volume, texture and colour ..... as they say " Soft Tissue is The Issue " :)


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Great case Maurice.
The CTG thickened up the tissue but even still I can see a darker hue to the tissue above #11 compared to #21. The result is stable at 4 years. Fantastic.

I am big on Ceramic Implants. My reason for choosing a ceramic implant in this case is simplifying the procedure. Using a one-piece aesthetic implant is more predictable long term. Even thought we have 4 decades of literature on titanium (different materials and configurations than what we actually use today) we have all seen the average case after 5-10 years? What do those cases looks like, even thought the implant likely "survived"? We know what happens long term with the two piece design.

Fracture resistance of zirconia is a non-issue in the literature as long as we have the right size implant to take the occusal load. A one piece zirconia implant is stronger than the two piece titanium. I would be more concerned over the fracture of a narrow titanium implant or abutment screws.


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Magnificent. Yes, slight darker hue on 8. But if with an intra-oral photo the difference is so little I guess it won't show. May be the use of a zirconium abutment could potentiate the reflection of a lighter light after the transmited light through the crown reflects on the abutment. However having a whiter light reflected from such an abutment might increase the "kind of umbrella effect" at the cervical. Filipe Lopes.


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Maurice,
Beautiful surgery & a fantastic restorative result …..That being said, this is extremely challenging from a restorative point of view, especially in practices that don't have a ceramist in the office or one close by willing to make house calls. Matching a single central crown to a natural central is difficult to begin with, now throw in a titanium abutment to mask and you have a very challenging situation. You can mask the titanium abutment first with opaque porcelain to match a dentin shade and then fabricate an E-Max crown, which can have beautiful translucency. The porcelain on the abutment can be etched at the lab and then the E-Max crown can be bonded to the abutment if so desired. Also, the opaque porcelain on the abutment can help with blocking out the greyish hue at the marginal tissue. Just another technique to use instead of a zirconia abutment . The key to this case though was the meticulous way the tissue was handled and how the site was developed….Kudos my friend !
Regards, Jay


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Magnificent Maurcie,

Colleagues...you are seeing the grayish color, only because you know there is implant beneath. I bet you can get this perception if you see the same picture and you are unaware about dental implant beneath.

Omar


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Maurice,

Few questions and comments-

Was this a stock titanium that was prepped?

I am very hesitant to use Zirconia custom abutments- I have seen 3-4 fractures of the abutment in the screw shaft as little as 1 year and as long as 7 years- Intrestingly at our last AAOMS implant meeting- several lectures on the trial and tribulations of zirconia abutments for SINGLE tooth replacement- I have had stock zirconia fracture but different place- supra shaft -

I prefer gold hue abutments for anterior teeth- thoughts from audience on color matching crowns?

Cheers,

Richard

Mo- sorry Giants not in Super Bowl!


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Richard; This was prepped stock titanium CONTOUR HLA abutment. Yes, there seems to be much discussion about gold hue rather than Zirconium Custom in this area. Atlantis makes them. Steve Chu has much on this topic.
Your Cowboys did not make it either Richard.
Enjoy the game.
Mo


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I use gold hue from Atlantis and Biomet-

Mo,

I am a Raiders fan lifelong so I just pray one year I will get a real QB

Cheers,

Richard


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