Title Zirconia Implants May Cause Less Peri-Implant Mucosal Discoloration Than Titanium Implants
Clinical Question In patients receiving dental implants, are there less instances of peri-implant mucosal discoloration using zirconia implants compared to titanium implants?
Clinical Bottom Line Placement of zirconia implants led to less peri-implant mucosal discoloration than titanium implants without soft tissue grafting.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
26697552Thomas/20167 Pig Maxilla Approx. 6 months of ageLaboratory study
Key resultsBoth Titanium and Zirconia implants led to peri-implant mucosal discoloration. However, the discoloration was more pronounced for titanium implants without soft tissue grafting. This animal study using spectrophotometric measurements showed a mean color difference (ΔE) of 8.05 (+/- 2.51) for Titanium compared to that of 4.93 (+/- 3.18) for Zirconia. Colorimetric measurements showed P< 0.001 for Titanium implants before and after placement and P= 0.001 for Zirconia implants before and after placement. Mucosal thickness had a small impact on the color differences as well (P= 0.109).
19486077Zembic/200922 Patients receiving 40 single tooth implants in canine/posterior regionsRandomized Controlled Clinical Trial
Key resultsThis clinical study showed that both Zirconia and Titanium abutments caused similar amount of mucosal discoloration. The spectrophotometric color difference for Zirconia (DeltaE(ZrO(2))) was 9.3 +/- 3.8 and for Titanium (DeltaE(Ti)) was 6.8 +/- 3.8, with this difference not significant when assessed after 3 years.
Evidence Search Zirconia Dental Implants, Titanium Dental Implants, Dental Implant Esthetics, Soft Tissue
Comments on
The Evidence
The first study was an in vivo animal study. There was a small sample size. The animal model was chosen because of its similarity to human models in terms of color, texture, and anatomy of mucosal sites. In the second study, all of the patients completed the study and were treated the same with adequate follow up. Compliance and double-blindness was not reported. The authors did not mention any conflicts of interest. Both studies utilized spectrophotometry to assess changes in color of gingival tissues with underlying titanium or zirconium implants. The differences reported in the first study did show statistical differences, but the clinical relevance of the reported changes were not determined in these studies.
Applicability The primary outcomes for these two studies found differences in the relative effects for each of the materials, with titanium leading to a greater change in one study and to a lesser change in the second study. These studies found other factors such as mucosal/bone thickness, as well as the presence of connective tissue grafting as contributors to changes seen in color for each of these materials. The first study suggests there are multiple factors, including gingival thickness influencing esthetic outcomes. The high variability and lack of significance in the second study reinforces the role for multiple factors influencing these esthetic outcomes. The true clinical importance of the impact of these two materials on esthetic changes in soft tissue coloration remains to be determined.
Specialty (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Zirconia Dental Implants, Titanium Dental Implants, Dental Implant Esthetics, Soft Tissue
ID# 3030
Date of submission 05/06/2016
E-mail harrisdj@livemail.uthscsa.edu
Author Devon Harris
Co-author(s) e-mail
Faculty mentor Thomas Oates, DMD, PhD
Faculty mentor e-mail oates@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available