Hardly any reservation persists as stubbornly in implantology as the one about the fracture-prone ceramic implant. In episode 129 of the Queens & Sons of Dentistry podcast, the development engineer Thorsten Buurlage, who heads the manufacture of the Neodent ceramic implants, and the dentist Dr Maximilian Fuhrmann explain where this reputation comes from – and why, in their assessment, it no longer applies to modern zirconia systems.
Where the reputation for fracture susceptibility comes from
Buurlage describes himself as comparatively new to the dental sector – and sees an advantage in this: he does not carry the “rucksack of the past” with him and can judge the fracture debate neutrally. The causes of the early failures are known: on the one hand design-related weaknesses, on the other – and above all – entirely unsuitable materials that were never intended for load-bearing applications; he cites aluminium as an example. Today’s high-strength zirconia materials simply no longer have this problem. He describes the strength tests of the current implants as “more than excellent” – in most cases the values are even far above titanium.
Dr Fuhrmann confirms this development from a clinical point of view: the data situation has changed markedly in studies over five to ten years, and the materials have improved. Fractures used to occur above all when implants were not placed in accordance with the protocol or were subjected to unfavourable extra-axial loading. In his own practice he has not yet experienced an implant fracture.
Design: deliberately a copy of the titanium implant
Buurlage speaks remarkably openly about the design philosophy: seen from the outside, the ceramic implant is “a copy of the titanium implant” – and that is precisely the intention. Titanium implants bring with them decades of experience during which optimal protocols have emerged. The aim was to align with these routines rather than reinvent the world of implantology – because “nobody is a professional without a certain amount of routine”. The two-piece implant distributes the forces evenly across the implant body via six lugs, similar to its titanium counterpart; the drilling protocol also contributes to primary stability. The only new elements are the white aesthetics and the biocompatibility of the material. In the conversation the presenter compares the concept to an electric car: familiar on the outside, a different technology at its core.
The learning curve from the practitioner’s point of view
Dr Fuhrmann started out conventionally with titanium and familiarised himself with ceramic implantology around seven years ago – partly in order to offer patients who were concerned about potential intolerances a scientifically sound alternative. There was definitely a learning curve: “titanium is not ceramic.” The drilling protocols differ from system to system, and certain things that are possible with titanium require particular attention with ceramic. Over the years the practice has nonetheless ventured into more difficult borderline implantological situations in which ceramic was regarded as barely suitable – with consistently positive results: “ceramic can certainly take quite a lot”.
Prosthetics: screw-retained rather than cemented
In the prosthetic workflow, Fuhrmann particularly appreciates the screw-retained solution of the system he uses. With systems whose components are joined using special adhesives, adhesive can slip into the tissue; without strong magnification, residues are difficult to check reliably – “if something is left behind, it is always awkward”. The screw-retained design, by contrast, mirrors the familiar workflow from the titanium world with similar components. The dentist sees room for improvement in the range on offer: thicker, longer or individual abutments would open up even more cases; in such situations the practice currently still falls back on titanium.
Conclusion: an upgrade rather than a reinvention
The overall picture painted by both interviewees is that of an upgrade: proven techniques and routines combined with a material that offers higher strength values and better biocompatibility. Ideally, according to Buurlage, the practitioner notices none of this – “if there is no fracture, the strength values go unnoticed”. At the same time, the learning curve described by Fuhrmann shows that success depends on consistent adherence to the system-specific protocols – but then, in the account of both guests, the material is in no way inferior to established titanium in terms of load-bearing capacity.