Question

I need to have two teeth replaced with implants. My dentist is now suggesting that I have these implants made entirely of ceramic and not the usual titanium screws. What are the advantages and disadvantages of ceramic and titanium? What are the differences in cost and durability? If I opt for titanium, I will have to find a new dentist: What is the best way to do this? K. L. in B. 

Short answer

The decisive factor with implants is the firm ingrowth of the dental prosthesis in the bone. 99 percent of implants used worldwide are made of titanium. The success rate of titanium implants healing into the bone is very high. The healing of ceramic implants is more risky, takes longer and is therefore significantly more expensive.

The main factor that determines the success of implants is the firm ingrowth of the implants into the bone. Initially, the situation is similar to that of screws that are screwed into wood. However, this purely mechanical hold is completely insufficient for dental success. Implants must completely fuse with the bone in order to guarantee long-term success. Implants made of titanium grow firmly into the bone within two months. Implants made of ceramic take longer, namely four to six months. If implants are subjected to loads that move them more than 0.15 millimetres in the bone during this healing period, healing is at risk. This would lead to loosening and failure. 99 percent of implants used worldwide are made of titanium. The success rate of healing of titanium implants in the bone is very high and amounts to 95 to 98 percent. The healing of ceramic implants is more risky and takes longer. The success rates are correspondingly lower. 

Ceramic implants are more sensitive to the slightest movement during the healing period and must therefore be protected for the entire time. A common method is to wear a plastic sheet over the entire dental arch for 24 hours a day. These additional precautionary measures incur additional costs.

Ceramic implants as an exception 

From today's perspective, ceramic implants only make sense for patients who do not wish to receive titanium implants for personal reasons. The increased additional effort and the increased risk do not yet justify routine use. Implant treatments can be simple, but also very difficult. Implants can be placed by any dentist and "implantologist" is not a protected title. It is therefore all the more advisable to find out about the dentist's qualifications and range of services before undergoing treatment. Ideally, the dentist providing treatment should have additional training in reconstructive dentistry, periodontology or oral surgery. There are also qualified general dentists who have developed specific expertise in implantology. Either the treating dentist can carry out the implant treatment themselves or they can refer you to a colleague who specializes in implantology. You can also find addresses of specialists on the homepage of the Swiss Dental Association (www.sso.ch) of the Implant Foundation (www.implantatstiftung.ch), or at the dental institutes of the universities in Zurich, Basel and Bern. 

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on July 5, 2003