Editor’s Desk

Guest Editor In Chief

Dear Colleagues,

I graduated from my graduate implantology residency program almost 18 years ago and I have been practicing metal free implant dentistry for the last 10 years. This would not have been possible without some pioneers such as the late Sami Sandhaus who back in the early seventies believed that ceramic implants could be an alternative to titanium and titanium alloy implants. The original ceramic implants were made of seashells and were found to have successfully integrated in mandibles of Mayan skeletons dating back to 600 AD.

In 1965 Brånemark who coined the term “osseointegration” placed his first pure titanium dental implant into a human jaw and for the next fifty years titanium implants revolutionized dentistry, evolved significantly and have enjoyed great success both for fixed and removable dental prostheses. Despite the undisputable success of titanium and titanium alloy implants, their use has come with problems ranging from cosmetic challenges, to loss of bone, to degradation of the implants to the systemic effects on the recipient. Interestingly enough the demand for ceramic implants even after a decade in North America remain patient-driven. Furthermore, there has been a rise in reports of metal sensitivities to implant alloys and the United States FDA has begun to turn its attention to the effects of metal implants on their recipient’s health.

The first ceramic implants were monocrystalline and made of 100% Alumina (Al2O3) or Zirconia (ZrO2). They were not successful because of the physical properties of these materials. Fast forward to the early nineties, ceramic im-plants evolved to become polycrystalline, made of ceramic composite capable of withstanding the rigors of the oral environment. Since then there has been a very rapid evolu-tion in the chemical composition, macro and micro design of ceramic implants. In less than ten years we have witnessed ceramic implants evolve from being exclusively one-piece to two-piece like their metal counterparts. In the last 5 years we have witnessed the largest manufacturers of dental implants adding or seeking to add ceramic implants to their portfolios. Today we have ceramic implants with healing screws, straight and angled abutments and in some cases with metal free prosthetic screws. This evolution has made ceramic implants more versatile and fit to be used in a broad range of teeth replacement situations.

The latest development we are observing is digital dentistry workflows now incorporating ceramic implants. The once difficult to plan and place one-piece implants are remaining relevant thanks to guided surgery. Superior and predictable aesthetics can now be achieved especially since the implants are white in color. With technological advances, zirconia has become one of the materials of choice in implant dentistry, prosthodontics and even orthopedics. A lot has changed in the last decade, patients request less invasive procedures and materials, manufacturers have responded and thankfully dentists in rapidly growing numbers are embracing metal free implant dentistry.

The future is here!


Sammy Noumbissi, DDS, MS

Now available in the Bookstore! - DDHK Magazine Issue 1, Spring 2020

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