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Is a Zirconia Dental Implant Safe When It Is Available on the Market?

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Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, \Charité – Universitätsmedizin Berlin, D-14197 Berlin, Germany
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Université de Lyon, INSA-Lyon, MATEIS UMR CNRS 5510, 69621 Villeurbanne, CEDEX, France
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Department of Oral Health Sciences & Department of Materials Engineering, BIOMAT -Biomaterials Research group & UZ Leuven (University Hospitals Leuven), Dentistry, KU Leuven (University of Leuven), B-3000 Leuven, Belgium
*
Author to whom correspondence should be addressed.
Ceramics 2019, 2(4), 568-577; https://doi.org/10.3390/ceramics2040044
Received: 22 July 2019 / Revised: 29 September 2019 / Accepted: 10 October 2019 / Published: 12 October 2019
(This article belongs to the Special Issue Ceramics for Biomedical Applications)
The market share of zirconia (ZrO2) dental implants is steadily increasing. This material comprises a polymorphous character with three temperature-dependent crystalline structures, namely monoclinic (m), tetragonal (t) and cubic (c) phases. Special attention is given to the tetragonal phase when maintained in a metastable state at room temperature. Metastable tetragonal grains allow for the beneficial phenomenon of Phase Transformation Toughening (PTT), resulting in a high fracture resistance, but may lead to an undesired surface transformation to the monoclinic phase in a humid environment (low-temperature degradation, LTD, often referred to as ‘ageing’). Today, the clinical safety of zirconia dental implants by means of long-term stability is being addressed by two international ISO standards. These standards impose different experimental setups concerning the dynamic fatigue resistance of the final product (ISO 14801) or the ageing behavior of a standardized sample (ISO 13356) separately. However, when evaluating zirconia dental implants pre-clinically, oral environmental conditions should be simulated to the extent possible by combining a hydrothermal treatment and dynamic fatigue. For failure analysis, phase transformation might be quantified by non-destructive techniques, such as X-Ray Diffraction (XRD) or Raman spectroscopy, whereas Scanning Electron Microscopy (SEM) of cross-sections or Focused Ion Beam (FIB) sections might be used for visualization of the monoclinic layer growth in depth. Finally, a minimum load should be defined for static loading to fracture. The purpose of this communication is to contribute to the current discussion on how to optimize the aforementioned standards in order to guarantee clinical safety for the patients.
Keywords: zirconia; ceramics; dental implants zirconia; ceramics; dental implants
MDPI and ACS Style

Frigan, K.; Chevalier, J.; Zhang, F.; Spies, B.C. Is a Zirconia Dental Implant Safe When It Is Available on the Market? Ceramics 2019, 2, 568-577.

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