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Today’s modern day dental implants developed through an accidental discovery in medical research back in 1952. A Swedish doctor by the name of Branemark found that when titanium was placed into contact with bone and left undisturbed, the bone grew right against the surface making the titanium objects unremovable without cutting out the bone around the titanium. This then developed into today’s implants.

History of Dental Implant Materials

Prior to this and even since then, other materials have been tested and tried. Vitreous carbon was one material which worked very well in fusing to bone, but being brittle and having other issues made it impractical for use as a dental implant. Titanium seemed like an ideal material—its properties made it useful, practical and predictable. The initial implants were pure titanium, but they were a bit too soft so an alloy was developed to overcome the negative properties.

Today, well over 95% of the dental implants placed are titanium alloys. There are literally hundreds of implant companies and systems worldwide and when scientific and surgical protocols are followed, the success of these implants are all well over 98% even after 10 years.

Since titanium dental implants have been in use, there has not been one report of an allergy or reaction to the metal itself. Nevertheless,there are some people who have either an allergy or sensitivity to other metals (e.g. prevalence of nickel allergy is about 5%) and/or simply have concerns about any metals within the body.

Zirconium—The Metal-Free Option?

In order to allay these concerns and have an implant option for these people, several companies have conducted further research and development into “metal-free” implants. This has led to the use of another metal called zirconium, which is just one row below titanium in the chemical periodic table.. Zirconium first became popular in its crystalline cubic zirconia form due to its resemblance to a flawless diamond. For dental use, it is used in the form of zirconium oxide ZrO2. It is not pure ZrO2—there are trace amounts of another metal called hafnium (Hf) and the oxide is combined with yttrium (another metal) to improve its properties. The result is a white opaque-looking product and in this form, labeled as a ceramic, although there are metal atoms within the material.

The material is very strong and hard and has also been used for making crowns and bridges. With the search for alternative implant materials, it was discovered that zirconia also fused to bone (osseointegrated) much like titanium. It first became approved for use in Europe in 2008 and in Canada in 2013.

Titanium and Zirconia—Pros and Cons

Both materials can integrate with bone with equal success provided certain protocols are  followed. We do, however, have a much longer history with titanium. Some of my patients have titanium that is still functioning after 20-35 years. We may find the same success with zirconia, but until the material has been tested for the same amount of time as titanium, we simply will not know.titanium dental implant

Titanium implants are much more versatile than zirconia because they can be made as one piece or two-piece systems. In two-piece systems, the implant replaces the root and is generally placed at the level of the underlying bone. Attached to this is a post or abutment—the part that sticks through the gums and is used to support or attach the teeth.

Two piece systems are a lot more versatile and offer many more options prosthetically. They can be used for overdentures (removable teeth) that snap into place as well as permanent teeth that are cemented or screwed onto the implants. Additionally, the implant can even be placed slightly off-angle and an angled or customized post can be fitted to correct it. Zirconium implants can also be modified if they are slightly off but are not as prosthetically ideal as what can be done with a separate post.

In some cases, placing an implant slightly off-angle is not a surgical error, but rather a necessity due to the volume and location of bone in the implant site. I could go on for pages, but basically titanium implants offer much more versatility with the final teeth and flexibility with their surgical placement.

Zirconium implants (the implant body and the post or abutment) on the other hand, are made as one piece. Therefore, the only option for the prosthetics is to cement the teeth into place. Secondly, there is very little room for error—one has to be very careful not to place an implant at an improper location or angle. Therefore surgical placement and volume of bone is absolutely critical.

In some cases, I have placed implants to find the bone is less than ideal. With titanium implants, I am often able to place the implant, leave it buried under the gums and graft the area simultaneously. If it had been a zirconium implant which sticks above the gums, the ability to graft would be reduced or risky, and may need to do a separate procedure first to ensure the bone is 100%.

Both types of implants require several months for the bone to fuse or grow against the implant before we can place the final teeth. With one-piece zirconia implants, this healing phase can be a little more tricky as we cannot bury the implant under the gum tissue. if there is pressure or movement of the implant, it will not osseointegrate.

Another concern is the long-term strength. We no longer see fracture of titanium implants since the alloys were introduced, but zirconia implants have been known to fracture. If this occurs, usually the only option is to remove them and that can create a large defect in the bone. The smaller diameter implants (3.25 mm) are at the greatest risk. I have had patients come in with fractured zirconia crowns or bridges but fortunately I have not had to remove a fractured zirconia implant (yet). Therefore anyone with heavy function (clenching or grinding) probably would not be an ideal candidate for zirconia.

Advantages of Zirconia Dental Implants

Advocates of zirconia state several advantages of the material:

  1. No dark colour of the metal showing through the gums
  2. No corrosion of the zirconia as with titanium
  3. No piezo-electric currents between dissimilar metal in the mouth
  4. It is thermally non-conductive

According to CeraRoot, a manufacturer of zirconia implants: “The gradual degradation of materials by electrochemical attack is a concern particularly when a metallic implant is placed in the hostile electrolytic environment provided by the human body.” On the other hand, while zirconia has its perks, much less is known about the role played by surface modifications on the osseointegration of zirconia dental implants, according to a study by the Faculty of Dentistry at the University of Toronto. So who is right?

How To Make Sense Of All This

In general, I am a little cynical about many things and am a bit of a contrarian. I take a holistic and conservative approach to my patients, my practice philosophy and my life. Hence, I do not use mercury fillings, I have concerns regarding root canals, cavitations etc. and try to provide alternative treatments that have a scientific basis behind them.

On the other hand, I still mostly place titanium implants. Some sources will quote those same negative qualities of titanium as I listed above because you will have all these issues.  But in reality, we just do not see it. Gray colour show-through is very rare and easily overcome by other methods. Corrosion and piezo-electric currents occur when two very dissimilar metals are placed in close proximity and are bathed in an electrolytic solution. Saliva can act as a electrolyte, but even in patients with old mercury fillings, I have not seen evidence of piezo currents or corrosion.  Thermal conductivity whereby a person can feel it just does not occur.

I have two titanium implants in my mouth and will need a third one within a couple of months. I personally became very ill 17 years ago with extremely high levels of mercury, cadmium and lead in my body and had to go through a long process of chelation (treatment used in conventional medicine for removing heavy metals) to remove it. If I had concerns about the metal, I definitely would not even consider using it, let alone placing one in my body.

I become cynical when I see the only ones that are promoting a product are the ones that benefit from it. I see the same things with other products beyond dentistry whereby they only show the studies illustrating their product in a positive light, and/or the studies are biased in their favour. I also question the excerpt I quoted above about the degradation by electrochemical attack—what studies and what results are they basing those opinions on? Do those studies truly reflect the conditions and materials within the mouth? At this point, the comment is just an opinion, or at most, a limited observation but it is stated as if it were an irrefutable fact leading to health risks.

Nevertheless, I do have patients that either have multiple sensitivities or just do not want to take any risks or chances with metals and want to have zirconium implants only. I do not try to change people’s minds other than to explain any limitations or alterations they may need to their treatment plan. I will place zirconium implants for them once they understand these limitations.

Forgive me if I seem too critical of zirconia-advocates (like CeraRoot). I believe they are a good company with a good product that works reasonably well, but there is nothing quite like our natural teeth and we need to truly understand and accept the limitations of any material we use. I am just against exaggeration or fear-mongering for the sake of selling a product or idea.

About Dr. Balogh:

Dr. Balogh - Expert in Cosmetic Dentistry and Dental Implants

Dr. Balogh (DDS) is a dentist for Vancouver Centre for Cosmetic Implant Dentistry. He specializes in Dental Implantology and Cosmetic Dentistry. He has been providing dental implant services in the Greater Vancouver area since 1992. You can follow him on Google+.

58 thoughts on “Types of Dental Implant Materials — Titanium vs Zirconia

  1. Thank you for what is a clear, concise and balanced overview of titanium
    implants and ceramic implants. it was most helpful as sooner or later I will
    need implant based dentures.
    F.O’Toole,
    Nanaimo.

    Reply
  2. Hello Dr. Balogh:: My name is Theresa I came accross your artical while surfing the internet for information on zirconium implants. I lost the majority of my teeth due to esophageal reflux and crohns disease. I had a complete set of titanium implants which rejected six months later. Shortly after I was in an accident and fractured my righht anklle, right 5th metacarpal, and 5th finger at the dip joint titanium pins were placed in all broken bones. I rejected the pin in the finger and developed ostomylitis and ended up having to have ithe dip joint amputated. A few months later the pins in my ankle and hand started to protrude laterally and had to be removed. I really do not want dentures but I think the risk is to high there is an alloid present in zirconium. Anyway, I really appreciate your artical it really helped I think I will keep it simple and go with the best dentures money can buy and keep the $19,000 and take my sister on a cruise. Do you have any recomendations on dentures that are durable and cosmetically appealing ? I heard that there is a denture out that adheres to the gumline without using paste?

    Reply
    • Hi Theresa,

      Unfortunately, how well a denture fits depends largely on the size and shape of the ridge remaining after the teeth have been removed, the fit (adaptation) of the denture to the tissues and how the teeth are set up. The material choice will not make much difference other than in some situations whereby a soft liner can be used (or in some cases a flexible acrylic like flexite) that can take advantages of small undercuts to help hold the dentures in place.

      Sincerely,
      Dr Balogh

      Reply
      • Dr. Balogh, I do have a question. I am in the final stages of replacing my front 6 teeth. I have been wearing the temps since September of 2016, and it is May 2017. The ? is the temps feel like they are foreign the feeling is not only the thicker temps but the way the taste buds pick up they are not real. Will my crowns feel different. I have a bridge that will take care of the front and individual crown on my incisors. So a total of 4 titanium implants. The temps just don’t feel right, there is no pain it just doesn’t feel right. Some nights I will take ibuprofen to help. Thanks Greg

        Reply
        • Hello Greg,

          Thank you, for your question. I’m assuming your temps are made out of some type of acrylic… in that case, they are probably a lot thicker than the final teeth will be.

          Acrylic often has to be made thicker or else it will break. Acrylic is also a bit porous so it can affect the taste of foods…that could also be caused by any areas that are trapping food or plaque. Nevertheless, the teeth should be comfortable with the exception of feeling thicker or maybe not as smooth and polished as the final teeth.

          There are many different ways your dentist may approach making the final teeth, but in my opinion a wise thing would be to make any modifications possible to the temps before the final teeth are made…that way the ceramist/lab tech will have a guide as to the size and shape of teeth that are aesthetic and comfortable. The temps don’t have to be perfect but a good approximation will make getting a good final result a lot easier.

          Reply
    • Hi ‘Skyblue’

      Unfortunately no… however you can check on the following sites and to find dentist with a holistic background/approach and one who offers zirconia implants respectively. Hopefully this will get you in the right direction.

      Sincerely,
      Dr Balogh

      Reply
  3. I had an implant.the first time when they were going to take the impresions the screw broke.they took it out put bone wait a few months they put me another one and this time the bone didnt grap the bone.my question is why the first time was ok and the second not.please explain me.thank you

    Reply
    • Hi Ramon,

      Very difficult to say without more information about how the site looked after the implant was removed, what and how the graft material was put in place, and how the area healed. Broken screws do occur but they can be removed…usually fairly easy to do. So I am wondering if there were other issues with the implant that required its removal? Sorry this may not be very helpful but I have more questions than answers myself.

      Sincerely,
      Dr Balogh

      Reply
  4. I have no quality of life due to six dental implants, I have a list of symptoms. I need advice regarding resources. Can we communicate by email? I can provide additional I formation if so. Thank you. If you are not available I would greatly appreciate a referral .

    Reply
    • Christine,

      Are these zirconia or titanium? If you had it to do over with, what would you do? I’m about to embark on my first IF I feel I can be safe but immune system (and autoimmune) issues, I’m just not sure that is wise.

      Thanks!
      Rebecca

      Reply
    • Hi Christine,

      The first thing to identify is whether the problems you are having is due to an issue with your body and the material, or is it related to the actual dental work. If it appears as though it may be a reaction to one of the materials, a melisa test http://www.melisa.org can determine if you have a body burden of metals, and a Cliffords test http://www.ccrlab.com can tell you if you have sensitivities to any of the dental materials used as well as all the other materials that are currently available. You can email our office directly at info@vccid.com if I can be of further help.

      Sincerely,
      Dr Balogh

      Reply
    • Hi Christine,
      I read your comment to Dr. Balogh and I was curious. I don’t want to be nosy, but you might be able to help my husband who is getting ready to find a dentist who will do implants. He is 57 and will probably need 4 to 5 implants on his front teeth. I would like to know what your experience has been, so that he can avoid any future troubles. Thank you so much

      Reply
      • Hi Annette,

        Great idea – Speaking to other people that have had similar treatment is a good way to find out what is involved. Many times in the past I have had patients who not only want to see some of my past work, they want to speak to patients directly to find out what they experienced, are they still happy, was it uncomfortable etc. In my opinion this is not an unreasonable request.

        So if you need to speak to past patients to feel more comfortable with the treatment that has been proposed, ask your dentist about providing a list. I have found my past patients more than willing to speak very openly and frankly to others about their experience.

        Sincerely,
        Dr Balogh

        Reply
  5. Thanks for your info,I need a full mouth of implants and I’m going to do it in Tijuana (since is close to LA where I live and is way cheaper since I I have a dental insurance but doesn’t cover any of this)with a prominent dentist who’s doing implants for over 20-30 years,when I mentioned Zirconia implants he was not too excited,we are in the process of cleaning my mouth now and proceed to install the new implants,I have a little time to decide which in I going to choose,your article gives me the idea to get Titinium ones (like my doctor said),next month he’s going to a Conference and will bring more info about new treatments with Zirconia,wish me luck and I thank you again for this article and your comments!!

    Reply
    • Hi Carlos,
      I’m glad you enjoyed the article and found the information useful. You may consider getting tested for titanium sensitivity with a Melisa test (www.melisa.org)…at least you will have peace of mind that you don’t have any sensitivities to the metal.

      Sincerely,
      Dr Balogh

      Reply
  6. I was wondering if I could get dental implants. I was told that I have bones left in my gums. I told by one dentist I could get the implants but one other dentist told me I could not get the implants and was refer to oral surgery. Which I have not health issues or any medical conditions.

    Reply
    • Hi Hootie,

      Unless you have some serious medical condition which would affect your bone healing you most likely can have implants. Although implant dentistry has been around for over 50 years, there is a very wide range of training, knowledge and experience among implant dentists, so some dentists may feel that implants are not possible because they don’t see a solution. I have had patients whereby they have been previously told they don’t have enough bone for implants and yet with some minor modification in treatment plan and technique we were able to provide implants. Some dentists either do not perform the surgical procedures or their surgical skill may be limited so they will refer you to an oral surgeon or another implant dentist with greater surgical experience. Most importantly, make sure to get more than one opinion and ask questions.

      Sincerely,
      Dr. Balogh

      Reply
  7. Dr. Balogh,
    I have recently had two titanium implants, and now I am waiting to get the crowns on them. I am very concerned that I made the wrong choice. Thank you for your article, I am considering going to test for Titanium allergy, since there doesn’t seem to be an obvious reaction.
    In your practice, is the exposure of the metal through the gum usual? I really trusted the dentist I went to, and did not do much research prior, but want to be sure before I proceed.
    Also, what is your opinion on gum grafting? I had two done, and now the newly crowns are showing the metal.
    Thank you

    Reply
    • Hi Maria,

      By all means if you have any concerns go ahead and get tested. Although titanium sensitivity is still very rare, at least you will have peace of mind with your dental treatment. As far as the metal showing it can happen, (and is not related to sensitivity issues) but without seeing how and where it is difficult to comment on what caused it. (I’m assuming when you say the metal is showing that it is the actual implant and not a post or healing collar attached to the implant.)

      Some implants have a smooth surface at the top which is meant to stick above the gum tissue, so it could even be perfectly normal and correct. If it is the body of the implant showing through (this is the part that is meant to be buried and covered by bone) then that may lead to plaque accumulation on the rough surface of the body which would not be healthy in the long term. However, even this can be remedied and the implant saved and maintained. Sorry if this is not a very exact answer but without knowing or seeing more about your situation it is difficult to comment at the risk of making incorrect assumptions.

      Sincerely,
      Dr. Balogh

      Reply
  8. Hello,

    read your article. It was very informative. Thank you. I am now in my 30’s. I started to grind my teeth, at approximately 13 years of age. I now have great damage and sensitivity on my teeth. Is it OK for those with prior bruxism problems to get implants?

    In addition, would a night guard be enough protection, while undergoing the healing process after the surgery?

    I look forward, to hearing from you. Thank you for your time.

    Reply
    • Hello Jeremiah:

      You can still have implants even though you have bruxism issues, however some alteration in treatment plan may be required…for example it may require more implants to support the additional load on the implants; splinting the teeth can help lessen the load on individual implants; selecting the most durable type of material for the final teeth will be important; looking carefully at your bite and eliminating any bite issues that might be contributing to your bruxism; fabricating a night guard to wear while sleeping will help to protect the teeth and implants….these are just a few of the things that we can do to ensure the long term success of your teeth and implants.
      Sincerely,
      Dr Balogh

      Reply
  9. Greetings Dr Balogh,

    Appreciate your desire to help sort out our issues on your own time. When have an extraction of molar with no root canal but an tooth infection is it important to remove the Periodontal ligament and or Lamina Dura before having an implant?

    Thanks .. Wayne

    Reply
    • Hi Wayne,

      It is always wise to thoroughly clean the socket whenever a tooth is removed…we do not need to remove all the bone surrounding the socket but a thorough cleaning of all soft tissue is important. If infection has been present some bone removal in the area will help to remove any bacteria in the bone, and will stimulate bleeding which will help the body get rid of bacteria and promote healing. (As far as I know this concept of removing some bone around the infected area is not taught in dental schools nor is considered a standard of care…however if done carefully there is no harm)

      As far as implant success, most implants will still integrate even if the sockets were not cleaned out as thoroughly as I described.

      Sincerely,
      Dr. Balogh

      Reply
  10. Dear Dr. Balogh,
    Thank you for your very informative writing. You may be interested in my story. I have been sick for 7 years and always have known it had something to do with my root canal and then implant but no one would listen to me or believe me until this year. 7 years ago after having a root canal I began having dizzy spells and then passing out occasionally. 1 1/2 years later it absessed. I had the tooth extracted and then an implant (titanium). Everything went well and I recovered easily but the dizzy spells increased, then severe a-fib which no medication would stop. The symptoms kept increasing, I would often get pain in the tooth area, down my neck and shoulder and arm (sometimes excruciating pain). I had all the symptoms of a heart attack frequently but without having a heart attack. I have not been able to work for 5 years, and have been on the couch more than on my feet. My doctors have only been concerned with the a-fib and would not believe it was connected to my tooth. This year I found a holistic dentist who believed me, tested me and found that I was a conductor of electrical currents. I had metal in 3 places in my mouth hidden under crowns and a bridge that I didn’t know about. My wonderful dentist gave me my life back by removing and replacing everything with porcelain. Everything but the implant, we were hoping that wouldn’t have to be removed. Although I am so much better, it’s been like a miracle to be able to function normally again. Still I am having some issues yet. One night I woke up in terrible pain on the right side of my body and discovered that my husband had left his cell phone next to me on the table, when I got rid of it the pain stopped. Sometimes when in a car and passing a cell phone tower I get a huge zap of dizziness, sometimes it will go away shortly other times I’m down for 24 hrs. with pain and a-fib. So you see I’m afraid I’m going to have to have the implant removed and I am really scared, I no longer trust modern dentistry (I was very sick 20 years ago due to mercury fillings) and my angel dentist doesn’t do surgery so I will have to go to someone who is not holistic minded. After reading your info on zirconia I think I may be better off with a bridge instead of another implant. I just wonder how many other sick people are suffering from this kind of thing and don’t know that it is their teeth causing it. My biological dentist says that 80% of people are ok with metal in their mouths but then there are those of us that are super sensitive to it. I am grateful that I somehow knew that it was my tooth and didn’t give up in finding someone who believed me. My cardiologist can hardly believe the difference in my health.
    I am 71 years young and a certified nutritional consultant who takes very good care of herself and I know my body.

    Reply
  11. Dr. Balogh
    I just had a conciliation today with a orthodontist regarding implants. I had did a lot of reach for the past 5 months. Maybe sometimes reading too much is not got good. He did a ct scan and everything looked good. His treatment plan was all on 4 on the bottom arch and trim the bone to even from one side to the other. On upper arch 6 implants also he said to trim the bone not because of not uneven but said I had a big smile. His suggestion was to do the lower arch first – placing implants, trimming bone then immediate load with temporary bridge. While fabercating the teeth to make a new set of upper dentures to match the lower teeth then after a month when I was ready to place implants on upper arch and taking the denture and making it a permanent bridge load. He said doing it in two different periods would not be so stressing for the patient in recovering. I was not sure on the type of implant he was talking about using so I just now was researching between the two materials and ran across your article. Which one do you prefer? Is the price different on the two was more of my question. He uses also a prettau bridge. What do you think of that material used? One thing I liked of chocked on was the price!! Reason for me reaching now is the cost of materials. I want a nice natural looking smile but omg does 56k sound accurate? I was expecting 30k at the extreme most 40k. Your advice would be appreciated. Thank you.

    Reply
    • Hello Alean:

      As far as difference in costs between the two materials, typically Zirconium is more expensive in most places. With us, however, the price is essentially the same. Although the implant cost is higher, we do not have to fabricate a separate post/abutment so the cost of the final teeth is less. If you are comparing a single implant, post and crown in our office the difference in total cost is only $100.

      Regarding preference of material, in my opinion it is more dependent on patient needs, sensitivities and health. The all-on-four system does not work with zirconium implants, as two of the implants are placed on a steep angle and “realigned” using a separate abutment that attaches to the implant. That is just not possible with zirconia. I also don’t know your age, what has happened to your teeth in the past, your bite and so many other things that are important for the diagnosis and treatment plan. All-on-four systems can work, but at the same time if any one implant fails the entire set of teeth will fail, often along with the other implants. So patient selection and case selection is very important in my opinion.

      Prettau is a brand name for an all-zirconia bridge. The material itself is very good. There are other “brands” for full zirconia bridges and I really couldn’t say whether one is truly better than the other. Maintenance with these types of prosthetics can be difficult as they are made of one solid piece and you really can’t clean under them very well. Buy a waterpik and clean the area daily with hot salt water.

      As far as what you have been quoted the cost is certainly average considering they are doing both arches. I don’t know if you are in the US or Canada as currently there is a big difference in our currency and hence apparent costs. Based on four implants on the lower and six on the upper, here in Vancouver I would say the average price is probably ~60K Canadian, although the range among different dentists is huge as the low would be ~55K and the high ~100K! It does sound like your dentist has provided you with some good advice. Just take your time to do your due diligence so that you are comfortable with your decisions.

      Sincerely,
      Dr. Balogh

      Reply
  12. Hi, Dr. Balogh. Thank you for this very interesting article. I had two titanium screws implanted in my upper jaw today by Dr. Shalaby in Santa Ana, California. I can’t say enough about what a skilled and knowledgeable dentist Dr. Shalaby is! When I got home, I was fascinated by the process, and started researching everything I could find about the implant procedure online. I learned about oseointegration and different implant materials, surfaces, and coatings. I came across the Ceraroot website, and at first, wondered if it actually was better than titanium. I’m no dentist, but I’ve been around long enough to have a pretty well-developed BS detector, and I was a bit suspicious and cynical about some of what I was reading there, including the carefully-worded implication that 4% of the population is allergic to titanium, and that titanium implants will corrode and further degrade due to electrolysis… yet titanium has shown to be quite capable of oseointegration with bone, so how could that possibly be a concern?

    After reading your article, I’m even more convinced that my dentist knows best. I don’t appreciate companies who stoop to using scare tactics and innuendos to sell their products, especially when it comes to my health.

    Reply
  13. Thank you very much for your article Dr. Balogh. I have been in search of a dentist since mine passed away, knowing that I needed some implants done. I have found one that has introduced me to the zirconia, which I thought he said zirconium which some what concerns me. He said nothing about the titanium. Money is tight with me though I don’t believe regular Dentures will work for me. So I’m thinking of going with the zirconia full implant. The new dentist I found is fairly young and new and may have only done one or two of these before. I checked with Aspen Dental as a second opinion and they completely tried to redirect me away from these, to normal Dentures which I do not believe will work for me. I have been told it depends on the amount of implants needed to be successful. The dentist I have chosen seems to be willing to work with my many quarks. I asked if he would be able to do just the tops at first and then do the bottoms at a later date and he said yes. In your opinion is that possible the second opinion from the dentist that were directing me away from the implant, said that I should not do it that way, I should get them top and bottom at the same time. Would you give me a rough idea of the cost of zirconium full implant vs. titanium full implants both together and separate upper and lower individually? Any additional information I can acquire would be greatly appreciated, thank you for being Who You Are. You seem like my old dentist doing it to help people, not just in it to make money. The dentists I’ve been running across seem more like used car salesman than doctors. Thank you very much in advance.

    Reply
    • Hello Doug:

      Sorry, I didn’t get to reply to your question before the holidays. December was very busy for me.

      There can be some advantages to doing both upper and lower together, but it is not always feasible, especially from a cost point of view. However, it certainly is possible to do one arch only for now and do the other at a later date. Regardless of which one you start with, it is important to know where the final teeth are going to be for both arches before any work is done. For the top, aesthetics, speech and function are very important. Your dentist should have a plan for both so that when all is said and done, the teeth not only look good, but they fit, are functional and ideal for speech etc.

      As far as which one to start with depends on many factors such as the condition of the teeth that are remaining. Regarding titanium vs zirconia, both will work well but there are differences. Whether we recommend one or the other is too difficult to say at this point without more information.

      Regarding costs, there is a huge range and it depends on several factors: The type of teeth being made, which may determine the number of implants and in turn will/may determine the location of the implants, which will/may also determine whiter one not bone grafting is required….so it is difficult to give you exact numbers without seeing you in person, seeing some x-rays and knowing what the final result is going to be.

      Nevertheless, to give you some rough ideas, assuming you are looking at fixed permeant teeth, I would not recommend using fewer than 6 implants on the lower and 7-8 implants on the upper. Technically you can use less, and there are those who advocate an “all-on-four” approach which is four implants to secure a full arch of teeth. In my opinion, this is under-engineered and prone to problems, except for certain patients/situations.

      Then there is the type of teeth: acrylic(plastic)/porcelain and gold/zirconia – big difference in costs.

      With the above parameters in mind roughly lower costs ~28-35,000 and uppers ~37-44,000. Keep in mind there are less expensive options, but I assumed we are doing permanent teeth. This also does not take into account any bone grafting other than a minor amount.

      Keep in mind there is also a big range in prices from office to office. Here in Vancouver the range is about 100%. For example, a single implant and crown in our office is ~4500, whereas I have had patients come in with estimates for the exact procedure with prices ranging from $3800 to $8000

      I hope this gives you some answers and doesn’t deter you from moving forward. Implant dentistry is probably the most expensive dental procedure a person will have. So just like any major decision/purchase, it is in your best interest to do your due diligence, ask questions and get second opinions. If this is too expensive a proposition, there are less expensive options and it may also be possible to do individual arches in stages as well.

      Sincerely,
      Dr. Balogh

      Reply
  14. Hello Dr. Balogh,
    In preparation for double jaw surgery, (to correct an overbite and misalignment of teeth as well as TMJ deterioration in the left side) I went through bicuspid extractions (all 4) while in braces, only to experience collapsing of my lips and face. Long story short I switched orthodontists and he and my surgeon hoped that bringing my jaws forward would help to resolve the situation, my orthodontist has been pulling my molars forward to fill the spaces. I am now 7 months post surgery and the spaces are almost closed, but I’m having so much pain and feel unbalanced with bringing my back molars forward. I feel like I lack support in the back of my mouth, which is causing pressure and headaches, as well as neck pain. I am interested in reverse extraction treatment and implants where the bicuspids were pulled, however I have suffered some bone loss in the sites as well. In your opinion, would implants be an option for me ? Possibly in conjunction with bone grafting where needed? Any insight or advice would be greatly appreciated!
    Thank you 🙂

    Joy H.

    Reply
    • Hello Joy:

      Sorry for this late reply. December was terribly busy and I fell behind in some things. I can understand what you are going through. The traditional treatment of bicuspid extraction and bringing teeth forward to close the spaces may look good aesthetically but for some people, it creates functional problems such as pain etc particularly in the TMJ and muscles. I have other patients who have had issues very similar to yours.

      Implants may be an option, and if there is bone loss the sites could be grafted. However, before going through further orthodontic treatment, my recommendation would be to look at your bite and find out where you jaws truly need to be to be comfortable. It may not be necessary to move your teeth back, and it is also possible that if you did you may still have some issues. And after moving the teeth forward, then moving them back to where they were could create other issues with either the teeth or the bone.

      I would suggest making an appliance that will allow your jaws to move to a comfortable position. From there it can be determined if further orthodontics can achieve this position and whether implants will be needed. In some cases the teeth can be built up with selective fillings to relieve the bite. Often times, this is a more conservative approach at least in the short term.

      There may be other factors – you said you had jaw surgery and that there was some TMJ deterioration preexisting.

      Hopefully this helps.

      Sincerely,
      Dr. Balogh

      Reply
  15. Dr. Balogh,

    You stated,
    “I also question the excerpt I quoted above about the degradation by electrochemical attack—what studies and what results are they basing those opinions on? Do those studies truly reflect the conditions and materials within the mouth?”

    There are numerous articles discussing your very concern.

    Google: electrochemical degradation of titanium dental implants

    Many “hits” will come up.

    This phenomenon is well-documented.

    It occurs in the mouth.

    I am a physician.

    If you email me directly, I will be happy to discuss the matter.

    Reply
  16. Dr. Balogh,

    I am a diabetic and have periodontal disease. I have a loose front tooth and another tooth near it that is cracked to the root. I have been told that I will need those teeth replaced with implants; however, I need bone graphing first because of my degree of bone lost. Because of my sense of fear and my being a diabetic, is there some words of encouragement or comfort you can share with me regarding this procedure and the best material to use?

    Thanking you in advance.

    Jacqueline

    Reply
    • Hello Jacqueline:

      Certainly being diabetic means your immune system and healing could be compromised. However, the main factor is how well your diabetes and blood sugar is being controlled.

      I have not seen any issues with my patients who are diabetic, and I have done both bone grafting and placed implants. One of my first diabetic patients that I treated came in just before Christmas. She has two implants in the upper molar areas. These sites were grafted before the implants could be placed and everything has been good since it was completed (implants, bone and crowns)….over 20 years ago (~1995)

      Most diabetics have elevated blood sugars. As long as it is reasonably controlled, in other words not dropping down to 3 and then jumping up to 10-13+ I have not seen a significant difference in results. We may alter treatment slightly in approaching things a little slower or doing larger procedures in phases but overall I don’t think you have to worry as long as you are careful with your sugars.

      Your periodontal disease, depending on how severe it is, how well it is controlled etc will likely be a bigger factor for the long-term prognosis of your existing teeth and even the approach to your implant treatment.

      As far as materials used, that would be based more on what is going to work best for the area ion particular, rather than your diabetes.

      I hope this helps to relieve some of your concerns. Without seeing the details of your particular situation, it is difficult to tell you much more.

      Sincerely,
      Dr. Balogh

      Reply
  17. Dr. Balogh,

    I lack two maxillary lateral incisors (never even had a primordium). Therefore, on the left side, it goes: maxillary central incisor, maxillary canine, premolars etc. On the right side: maxillary central incisor, maxillary canine and one primary tooth – canine (then, again, permanent teeth – premolars etc.).
    My primary canine needs to be replaced (it’s a bit fractured and has a very weak root). My dentist told me the bone is in a good shape and there’s enough space for an implant.
    I have some concerns regarding this procedure – I have sensitive nerves (I had endodontic therapy three times, using a microscope – both me and my dentist still remember this nightmare) and I’m not really sure if I want to have titanium under my soft and (I guess) thin gum (let’s call it an inner resistance). I started reading about zirconia implants and I realised that most of disadvantages mentioned by dentists are related either to their fracturing features or, even more often, to the fact that they are mostly one-piece implants. When it comes to one-piece argument – I read about two-piece zirconia implants (such as Zirkolith) – what is your opinion about such implants?

    Thank you in advance,
    Sue

    Reply
  18. Hello dr Balogh
    Im thankful for your time here with us.I had a titanium implant in my upper front right jaw few years ago.Now there’s a gum infection.plus bone loss.I’ve been told to remove the implant.I’m really concerned seeing this is my front tooth.I had a specialist suggests to do bone graft and get a new implant..What will u suggest be best..I’m in my late twenties,Wouldn’t like d idea of dentures..Yet again I’m so skeptical of implants.seeing ur post,not so sure if Zirconium implant will be a better option.
    Thank you doctor
    Ruke

    Reply
    • Hello Liz,

      Thank you for your question.

      The cost difference between zirconia and titanium implants will really depend on which office you go to.

      Zirconia implants are more challenging to place and the implant itself tends to be more expensive, so the surgery costs are typically higher.

      However, you do not need an abutment so the prosthetic fees could be less.

      I really don’t know what other dentists out there are charging, but if we do both the prosthetics as well as the surgery the difference currently is only ~$200 since the lack of need for an abutment offsets most of the higher surgery costs.

      Sincerely,

      Dr. Balogh

      Reply
  19. Hi Dr. Balogh,

    Thank you for this article. I’ve had two titanium implants since May 2010, with my crowns finally placed in December ’10. The two teeth are adjacent and I lost the first tooth root in ’00 and had no prosthetic until after losing the 2nd tooth. I underwent two bone grafts, the first alone and then additional grafting the day of the implantation, due to the amount of bone loss from the first tooth through the years (I’d had an abscess in that tooth since age 11 in ’86, so bad tooth/broken tooth/root canal but no crown/no tooth for 26 years). I’ve had sensitivity on the roof of my mouth/upper gum ever since. I learned Listerine Whitening causes open sores over my implants so I stopped using it years ago. Well for the last few days I’ve had little spotted sores in this area. I know I need to see the dentist, but I’m wondering , does this sound like a titanium allergy? I will get tested, but I’m wondering if zirconium implants would even be possible for someone like me?

    I’m still paying for the first set. Grrrrr.

    Reply
    • Hello Liz,

      Thank you for your question.

      It is hard to say whether what you are describing is truly an allergy or sensitivity.

      Definitely, my personal recommendation is to be cautious with all commercial mouthwash…there is often a number of compounds in them and any one of them could be problematic in itself.

      The small sores could be canker sores (which are considered to be autoimmune and often related to stress, though certain foods can also cause cankers), it could be viral or even simply a traumatic irritation from foods etc.

      If it is any of the above they should go away on their own within 10-14 days. I suggest using warm salt water rinses until they go away.

      If they are still there after 2 weeks without any improvement then they should be checked.

      Sincerely,

      Dr. Balogh

      Reply
  20. Good morning Dr. Balogh. I am in the process of implants. I’ve had titanium posts inserted. 6 on the top and 4 on the bottom. A misunderstanding of the cost between my Dentist and I has myself looking at different options. My dentist said one option is Zirconia dentures that could be screwed in. More permanent. One piece for the top, one for the bottom. Total cost would be 24k instead of 40k. On the surface, is this a good plan?

    Reply
    • Hello Gary,

      Thank you for your comment.

      Certainly, a treatment plan like the one that has been proposed to you is a good and viable choice.
      Monolithic zirconia (made/milled out of one piece) is becoming really popular because of its strength and aesthetics. It has been around for ~7 years.

      The one thing that may become an issue is if anything breaks in the future, you may not be able to repair it. Unfortunately, we sometimes don’t find out these things until we have done many ourselves and have seen the long-term results after 10+ years.
      Certainly, the studies and lab tests show the material is very strong but in my experience what is done in a laboratory setting is not always equivocal to what happens in real life.

      There are a lot of other factors that may make this treatment choice good or not so good for you besides costs and repair.
      You need to ask about ease of cleaning, maintenance, any clenching habits, aesthetics, your age and how long you hope this to last etc and how this compares to other options.

      Sincerely,

      Dr. Balogh

      Reply
  21. I had a rash and pain reaction after a titanium rod was in my body. It was taken out and I took the melisa test and have a allergy reaction to titanium dioxide tio2. The other alloys tested came back negative. Do all titanium dental implants have coated on them or create over time titanium dioxide/oxide in the implant site? Knowing my allergy I’m trying to find a titanium implant that does not have or produce the type of titanium I’m allergic to. There is no one in my state that does zirconium implants so that’s not an option.

    Reply
    • Hello Sophie,

      Thank you for your comment.

      All titanium implants form a titanium oxide layer on the surface.

      Titanium will oxidize once exposed to the air. Essentially all implants, whether they are pure titanium or an alloy (as in most implants today) will have this oxide layer.

      If you do have a sensitivity you will have to consider an alternative material such as Zirconium.

      Keep in mind titanium is also present in many cosmetics, suntan lotions, and certain foods etc. In order to develop a sensitivity or allergy to any compound, you will have had to have previous exposure of some sort.

      Sincerely,

      Dr. Balogh

      Reply
  22. Hi Dr. Balough,
    I appreciate the article you wrote providing valuable information.
    I had to have 3 teeth removed due to cracking and infection.
    #3, #14, and # 19. I am trying to decide between titanium and zirconium implants. What is the risk of gum infection with the titanium implant? I was told that one benefit with the zirconium implants is that the gums adhere to the implant and would thus reduce the risk of gum infection. My dentist changes $1000 more per tooth for the zirconium
    implant. Plus I need a sinus lift and bone graft on # 3 due to bone loss.
    I would value your Input.
    Thank you,
    Sharon Castillo

    Reply
    • Hello Sharon,

      Thank you for your comment.

      Both titanium and zirconia implants can be placed with minimal to no gum inflammation.

      The key is to have good “attached” gum tissue around the implant and no pulling of the area from muscle attachments (in dentistry we call it a frenum pull),

      as well as a contour that is readily cleanable and does not impact food or plaque.

      I would agree that zirconia has its advantages, in that the tissue response seems to be better and you don’t have any connections of posts/abutments underneath the gum tissue – where a micro gap of the two components can lead to some inflammation.

      However there are also one piece titanium implants. I don’t think your decision whether to use titanium or zirconia should not be affected by your concern about tissue health.

      In my opinion, we can achieve really good tissue health around titanium and I have many patients with titanium implants in place for over 15 years with excellent tissue health.

      Sincerely,

      Dr. Balogh

      Reply
  23. Hello Dr Balogh
    Four yrs ago I had 4 molars on my left lower side removed, and one on my right lower side, they were root canals that were abscessed. I have used a partial denture that is very uncomfortable. I have tori on the inside of my lower jaw that I am going to have removed, I believe this will make a partial more tolerable. My question is, Should I consider using the bone from the tori removal to graft on to the bone where the molars were removed? I have considerable bone loss in this area, and am thinking this may make a partial more comfortable too? I will not do implants because I clench my teeth a lot. I would only consider zirconia implants and I just don’t trust that they would stand up to my clenching. Can you recommend any companies for flexible partials, that are BPA free? ~ Thanks you

    Reply
    • I was told today by both the endodentist and my holsitic dentist that I need a tooth extracted and implant done. My holistic dentist is recommending a zirconia implant. And, much to my surprise I have only found 1 in my area (Los Angeles) that does zirconia. I have read the above and still don’t know what to do. How do I make a decision?

      Reply
      • Hello,

        Thank you for your comment.

        You could get tested to see if your system has any sensitives to titanium, and if there are none then your could consider using a titanium implant. I did have someone else come see me from the L.A. area about one year ago. I tried to find her someone who did zirconia implants in California or one of the adjoining states but at the time I could not find anyone.

        You can also try contacting the people at http://www.Ceraroot.com as they sell and distribute zirconia implants to Canada and all over the USA… they would be able to give you a list of some of the doctors that use their implants.

        Sincerely,

        Dr. Balogh

        Reply
    • Hello Marley,

      Thank you for your comment.

      If you are definitely not considering implants, I don’t see much value in grafting the bone. And if you are, you certainly could use this bone but I just wish to inform you that a few studies that have been done using bone from this site and they seem to indicate that it does not grow bone very well… possibly because it is too dense. However, I would not rule out using it if you are having the surgery anyways. I agree that if you clench your teeth you may put excessive stress on implants, however, a lot of that can be mitigated by making a good guard wear at night. During the daytime, you can make yourself aware of clenching and consciously stop it. I say this not truly knowing how severe your clenching is so it could be that my comments/suggestions are not 100% accurate. Regarding partials, you may want to consider using a material called Flexible…it is a nylon type of material and although it has some drawbacks in regards to ease of adjustments it is probably better for someone who has issues or concerns with the traditional acrylics (methacrylates).

      Sincerely,

      Dr Balogh

      Reply
  24. Hi Dr. Balogh,

    Thank you so much for the great article. It’s very helpful and informative. I am glad my dentist used titanium for my two implants (No. 30 and No. 19) about 5 months ago.

    I am more conservative when choosing some material for the medical reason. I’d rather have some material which has been long tested by patients. Now for me it’s about time to have abutment and crown ready. I read some info online, it seems that there is no doubt about safety on gold crown, but I am afraid people could still see them since No. 30 and No. 19 are not the ones far all the way back in the mouth. What do you think? Any type crown would you recommend from long-lasting, low-maintainance perspective? Do you think titanium abutment would be an ideal choice too? Another question is how the abutment and crown bond together. Which way is better in a long run between screw and cement?

    Thank so much and looking forward to hearing from you,
    Rachel

    Reply
    • Hello Rachel,

      Thank you for your comment.

      For the materials, titanium custom abutment will work very well and would be my first choice. For the crown, you could have a zirconia crown or a porcelain bonded to metal crown. Both can be equally aesthetic. However, the strength of the zirconia is much better in the long term.

      My preference regarding screws is to cement/bond the crowns to the abutments but to have a screw access if possible for long term maintenance. There is a long discussion regarding the pros and cons of screwed in versus cemented. It is too long to go into detail here, but the above method takes the best of both methods.

      Sincerely,

      Dr. Balogh

      Reply
  25. Good afternoon, doctor, very good article, I was also diagnosed with mercury poisoning and I’m doing the chelation. In me the first molar was removed and I want to draw the second molar to the first molar and thus avoid implants. Do you think this can work? Will the second molar support the traction?

    Reply
    • Hello Vinicius,

      Thank you for your comment.

      Yes, this can be done. It will require fixed braces for over a period of 6-12 months. Speak to an orthodontist, as they will be able to give you a better diagnosis and timeline.

      It is certainly possible.

      Sincerely,

      Dr. Balogh

      Reply
  26. This is been so helpful as I was considering getting Ceraroot implants and now I realize there’s really nothing for me to be afraid of with titanium as I’ve also had pins and a plate in my ankle without issues 20 years ago. And as I like the look of gold crowns because I had one on a tooth that had a root canal -which is one of the teeth that had to be extracted because of failed root canal or infection never went away and I was in pain with for years (and I would never have a root canal ever again, if anyone ever tells me I need a root canal ever again I’m just getting my tooth extracted from the get-go) and I have a crown on the opposite side same tooth lower molar which needs to be replaced because it’s cracked so my question is are zircona crowns that go on your implants better than having gold for any reason? Thank you!

    Reply
    • Hello, Michelle

      Thank you for your comment.

      There is no problem with placing a zirconia crown on a titanium implant. It is done quite often and will work very well.

      The most important factor is to make sure the abutment, which holds the crown, is made out of either titanium or gold. In the past, some abutments or their connections were made out of zirconia and because the zirconia is narrow and thin in this area these zirconia abutments have been known to fracture.

      I hope that helped to answer your question.

      Sincerely,

      Dr Balogh

      Reply

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