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Title The Success and the Survival Rates of Titanium-Zirconium (Ti-Zr) Implant are Consistent with Those of Titanium Implants
Clinical Question In Patients receiving small diameter implants, are the success and the survival rates of Ti-Zr implants consistent with those of titanium implants?
Clinical Bottom Line For the patient receiving narrow diameter implants to support a removable dental prosthesis, the success and the survival rates of Zr-Ti (Roxolid) are as good as those for titanium implants. This is based on two spit-mouth randomized multicenter controlled studies.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24713048Quirynen/201475 Patients with edentulous mandiblesRandomized Controlled Trial
Key resultsThis is the continuation of a previous 12-month follow-up study (Al-Nawas et al. 2011). The present 3-year report included 75 out of the original 91 patients who received 2 narrow diameter implants (3.3mm) to support a complete removable mandibular prosthesis. Each site was randomly assigned to receive either a Ti-Zr or a Ti Grad IV implant. Mandibular removable dentures were delivered 6-8 weeks after implant placement. At the three year mark, there were no significant differences between the marginal bone level changes, soft tissue measurements, and the cumulative success and survival rate between Ti-Zr (98.7%) and Ti grade IV (97.3%) implants. These results are consistent with the previously reported 12 month data. Ti-Zr alloy implants can be used successfully to support a removable denture.
#2) No Ref #Muller/201189 patient with edentulous mandiblesRandomized Controlled Trial
Key results89 patients received 178 narrow diameter implants to support lower mandibular removable overdentures. Each patient received 3.3mm bone level Ti implants on one side and equivalent Ti-Zr implants with the same diameter on the other side. Mandibular removable dentures were delivered 8-10 weeks after implant placement. Implant survival, success, and bone level changes were evaluated at 6, 12, and 24 months. The cumulative survival rate at the 24 months was 98.8% for the Ti-Zr group and 97.5 % for the Ti group. There were no significant differences between the survival, success, and bone level changes between the two types of implants.
Evidence Search Roxolid[All] AND (Small-diameter[All Fields] AND ("titanium"[MeSH Terms] OR "titanium"[All Fields]) AND Grade[All Fields] AND IV[All Fields] AND titanium-zirconium[All Fields] AND implants[All Fields])
Comments on
The Evidence
Both studies are split-mouth randomized controlled trials, which allow direct comparison between the two types of implants in one experimental unit and minimize the variability between the comparison groups. In both studies, the implants supported removable mandibular overdentures, therefore, this data cannot be extrapolated to situations with fixed dental prostheses. There is limited data comparing clinical performance of ZrTi to those of Ti implants supporting fixed dental prostheses. More studies with longer follow up comparing these two implants are needed. The longest follow up available is 3 years. The results of these studies suggest that narrow diameter TiZr implants are as good as Grade IV Ti implant for implant supported mandibular overdenture. One limitation included that fact that one of the studies identified (Muller et al. 2011) was not indexed in PubMed and was only available through the manufacturer’s website.
Applicability The results of these studies showed that narrow diameter TiZr implants are as good as Grade IV Ti implants. This will increase the confidence in the placement of Ti-Zr narrow diameter implants. Based on Pre-clinical studies, Ti-Zr implants proved to be up to 40% stronger than Grade IV Ti implants. Based on the available evidence narrow edentulous ridges restored with implant supported overdentures may represent the ideal indication. The successful use of narrow diameter implants may limit the need for adjunctive guided bone regeneration (GBR) when narrow edentulous ridges are present. This advantage may be counterbalanced by the relatively more expensive costs of the Ti-Zr implants.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Roxolid implants, standard-diameter implant, Implant-supported dental prosthesis, clinical, reduced or small diameter implant, TiZr, Titanium Zirconia
ID# 2792
Date of submission: 12/02/2014spacer
E-mail Ghazal@uthscsa.edu
Author Saba Ghazal, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Guy Huynh-Ba, DDS
Faculty mentor/Co-author e-mail HuynhBa@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by KC Esplin (San Antonio, TX) on 10/01/2021
Interestingly, a recent study by Roehling (2019, PMID 30716147) suggests that zirconia implants may be more resistant to peri-implantitis in comparison to titanium implants. Although we are still lacking long-term data demonstrating that zirconia implants have better long-term prognosis, this may suggest increased likelihood that zirconia implants have good long-term survivability.

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