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  1. Hello,
    I am at a loss as to which path to take. I was born with Oligodontia, because of this I had only 19 permanent teeth come in. I had extensive mouth work done as a child and at age 18 had a full set of bridges and crowns put in. I am grateful to my parents for all of this. Fast forward 35 years later and they are beginning to fail. I have healed myself naturally from a Non Hodgkin Lymphoma in the past 16 months so I am super hyper about what is going into this body. Now that that crisis is over and I am in remission, I really need to address my teeth. I need them so I can continue my raw diet. I had to have a bridge removed in the back due to the decay under that molar, lose one lose three. So we are looking at two implants back their as well as on the other side. Bone graft doctor I will be seeing today.
    Since I already have a mouth full of platinum gold and Lord knows what else, I am super concerned about all the variations us metals reacting and causing corrosion. I am only 52 and dentures kinda freak me out. But I also don’t want to tax my immune system and have the cancer return. (Ugh, more stress). I was all excited about the Zirconium, but then read this. Since I will probably have to replace all f the bridges, titanium the s really all we have? I will definitely get the MELISA test done, but I am not sure where to go from here and I am having a challenging time finding a dentist who even does implants as holistically as possible. If you have any suggestions I would greatly appreciate.

    Kindly, Stacy

    • Hi Stacy,

      I think for you a MELISA test would be a nice start for you. At that point, you can make the decision on what you would like to do. I wish you luck in your decision.
      Dr. Kyle Stanley

  2. I have had periodontal disease since I was a teen and I fight hard for my teeth. I encountered an infection on Molar #2 that had a root canal and crown on it. I had it extracted two years ago and a bone graft done at the time of extraction. I have had multiple gum surgeries, etc and have a lot of bone loss, mostly on the top teeth. My top teeth are all totally crowned at this point. My question is, because of the bone loss, would it be foolish to spend the 4000 to get the implant just to maybe have the same problem down the road? I am a candidate for the implant. A cone beam was recently done and I have enough bone but I am hesitant about spending that kind of money on one tooth with my issues. Every time that I have a cleaning I am told about my bone loss and deep pockets. Thank you.

    • Hi Mary,

      This is a great question. The short answer is yes, I would recommend an implant but on a few conditions. Implants must be placed in mouths that are clean and without disease. Therefore if you have ACTIVE periodontal disease, I wouldn’t recommend an implant at this time as it would be more likely to fail, however, if your bone loss is from years ago and you have healthy gums but with previous bone loss, I would say that you would be a candidate for an implant at this time. If your dentist still says you have deep pockets, you may need to get this under control before placing an implant. I wish you all the best in your struggle with your gum disease.
      Dr. Kyle Stanley

    • Thank you Dr. Stanley. You are so kind to answer our questions. I do continue to strive to keep my gum issues under control as I visit the dentist every three months. This damage all happened when I was a child through teen years. My parents were not proactive with our dental care. Therefore, out of seven siblings, I am the only one to still have my teeth. I have invested a lot of money into my teeth along with veneers on my front six top teeth. Thank you again for taking the time to answer all of our questions. If I lived in your area, I would definitely consider your dental services as I can tell how caring you are.

    • Thank you for the kind words! I wish you all the best.
      -Dr. Kyle Stanley

  3. Hello. I had #19 pulled last week (fractured) and a bone graft at that time. I have Hashimotos Disease. Do you have any knowledge of thyroid disease, or any other auto immune disease that has affected patients and their ability to heal from an implant or even their body rejecting it due to their inflammatory disease ? Thank you.

    • Hello Patrice,

      This is a great question as many patients suffer from hypothyroidism. The good news is that there was a study on this that concluded: “This study suggests that medically controlled hypothyroid female patients treated with dental implants are not at higher risk of implant failure when compared with matched controls, and that a history of controlled hypothyroidism does not appear to be a contraindication for implant therapy with endosseous implants.”

      So as long as your hypothyroidism is controlled, you shouldn’t have any increased risk. Just understand that there are always risks with any surgical procedure.
      I hope this helps!
      Dr. Kyle Stanley

  4. Drs. Stanley/Nejad,

    I have a root canal on tooth #19. It has become ?fractured/infected and an implant has been recommended after pulling the tooth and doing a cadaver bone graft. My sister is concerned about the titanium implant as I have amalgam fillings, a gold crown and multiple other crowns. I have a history of atrial fibrillation and have had two ablation procedures for it. She informs me that adding all these different metals can cause battery mouth which can cause atrial fibrillation. She has given me some online links which support negative electrical effects from multiple metals. She has informed me that zirconia implants avoid the battery mouth problem.

    I spoke with my dentist who felt the battery mouth was a rare problem, but told me about a patient who hears the radio through his mouth.

    I would appreciate your advice.

    God bless you!

    Sincerely,

    Daniel Joyce, M.D.

    • Hello Dr Joyce,

      Thank you for the comment. I have heard of “battery mouth” before but there is little, if any, scientific journals supporting this. We have hundreds of patients with old gold crowns, amalgam fillings, and they have titanium dental implants with absolutely no problem. However, if you felt better getting a zirconia-based implant, that would be fine as long as you understand the drawbacks of their design.
      Dr. Kyle Stanley

  5. I’m holding off on having two molars extracted, #3 and #14 and getting implants because I’m undecided on implant type, although my preference is zirconia. I read an article dated 10/2017 on NobelBiocare.com that customers will soon be able to offer their patients the first metal free two piece screw retained implant. 1) Do you have any information on this new implant and when it will be available? 2) I’d like to have my molars extracted now and wait on getting the implants until I decide on the implant type..how long can I wait after having teeth extracted to get implants?

    • Mra,

      We still have no word yet on the new two-piece implant from Nobel Biocare since it all depends on the FDA and nothing goes quickly when the FDA is involved. If you need some teeth extracted, I would recommend getting them removed and have the area grafted to prepare you for your future implants. If you use a well-documented grafting material like xenograft, it will stay for many years so you can wait until they have the implants you like and not worry. Good luck with your treatment.
      -Dr. Stanley

  6. Hi I’m researching getting in Plants right now I’ve went to two places I’m worried about making the wrong choice one offer to tanium and one offer zirconia, I’m going to have my full upper mouth done I would like to anyways is there any recommendations you can give me any places in the California area that you could recommend for me to have a preliminary consult I just don’t want to jump into anything too fast. But it’s very important to me that I have this done for myself. I would love any recommendations.

    • Hello Amy,

      You are smart to have some consultations and make sure you really feel comfortable before you go through with treatment. I would be happy to consult with you about your case to answer any questions you might have. We are in the Beverly Hills area of Los Angeles.

      When you are going through a full arch treatment, it is very important to not only have great surgical components (implants) but also the restorative components (abutments and crowns). Full-arch treatment takes special components known as multi-unit abutments that unfortunately, zirconia implants do not offer due to their one-piece design. Your case must be designed in a digital format to verify you have the correct bone positioning for ideal implant placement and your implants should be placed through “guided implant surgery” for optimal results. This ensures that the teeth on top of the implants are in the correct position to be useful, cleanable, and esthetic. Please give our office a call at 310-278-0440 and we can get you scheduled for a consultation.
      Thanks,
      -Dr. Stanley

  7. Dr Nejad,
    I have an appt. next week with an expert implantologist in Boca Raton here and he will be inserting two in the gum Zirconia screws to attach abutments to later on. The bone is thin in
    the two missing tooth locations. Your blog here had me scared a bit until I researched Nobel Biocare which just announced they will be offering Zirconia to their clients about now in 2018. Good news that you don’t have to shill for titanium anymore or do you still think Zirconia is not a good material for implants? *(People, you need to do all the research and not just trust one or another doctor with such an important medical procedure.)

    • Hello Tom!

      I personally still prefer Titanium due to their long-term success and proven track record unless a patient has a true titanium allergy which is very rare. I am excited to get the new Nobel Biocare two-piece Zirconia implants in my hands to see how I like them with my patients. I hope your surgery goes well and we wish you all the best!
      -Dr. Kyle Stanley

  8. Thanks for all the great information. Following an accident I had only two upper teeth remaining. Since having those removed I now have a full plate and am researching implants. Two clinics have told me I have great bone structure for the “all on 4” implants. Of these two clinics, one does a final teeth of all zirconia and the other does the final on a titanium bar. Are there concerns I should have with either offering? Are they equally appropriate and offer similar endurance? Is there a preference, with good reason, of one over the other?
    Thanks

  9. Hi, I know this forum is for implant; however, the doctors here seems to be very helpful and knowledgeable, so I thought I’d ask some non-implant related questions. Since my RCT in Sept 2017, I’ve been experiencing pain in one of the root canal treated teeth and pain refers to my left nose and eye. A recent CT scan shows bone loss, which was not there before RCT, and I was told I need a re-treatment if it doesn’t resolve on its own. Because of my liver issue I can’t take Ibuprofen for the pain. Can I ask what pain killer isn’t too harmful to the liver and kidney? Thank you.

    • Hi Jen. I’m sorry about your pain. Normally we would use ibuprofen, acetaminophen, or tramadol but I’m not sure which is best for your particular liver condition. I would check with the treating physician to find out what is recommended and the maximum dose which is safe for your liver. Of course, the best treatment would be to take care of the source of the pain with a re-treatment or extraction. All the best- Matt Nejad DDS

    • Hi Jen, Ibuprofen is processed through the kidneys and not the liver. Tylenol, on the other hand is very toxic to the liver and should be avoided if you have liver issues. If your kidney function is fine, ibuprofen should be safe.

  10. Having read your very intelligently written article, I am not clear as to how a zirconia implant is able to osseointegrate since its one-piece design allows it to protrude above the gum line. For example, when replacing a molar, wouldn’t chewing disturb the zirconia implant, making it unstable and thus prevent osseointegration? Or are zirconia implants not used in the replacement of molars? Thanks.

    • Hello Cathy,

      This is a very good and smart question! Implants do not always need to be left under the gums to heal. They only need to be left to heal under the gums if they do not have primary stability during the placement. We have a special way of measuring this at the time of surgery. About 80% of implants have primary stability but the other implants would need to be left undisturbed for a few months to heal under the gums. The one-piece design doesn’t allow for this decision to be made during surgery.

      -Dr. Stanley

    • Dr. Stanley,

      Thank you for your reply. You wrote that 80% of implants have primary stability but that other implants would need to be left undisturbed for a few months to heal under the gums. What would happen in the case of a zirconia implant that did not have primary stability? It seems that its one-piece design would not allow it to heal under the gums.

    • You are exactly right Cathy! This is one of the biggest problems with zirconia-based implants. If we don’t have primary stability and we leave them exposed in the mouth to receive forces from chewing and speaking, they would be more likely to fail.
      Dr. Kyle Stanley

  11. I need to have a #7 tooth replaced and Im trying to figure out the best option. The tooth had a root canal and a crown on it and unfortunately I bit into a piece of hard chocolate and the tooth fracture horizontally across the tooth. My dentist has removed the part of the tooth distal to the fracture and I am using a flipper until I decide how to proceed. Do you know how long one can wait before removing and replacing the tooth? Just wondering how much time I have to get this done or if it should be done immediately.
    I have an existing titanium implant done 12 years ago on a molar and I have always wondered if it was connected to my developing chemical sensitivity. I guess I will never be sure unless I have the implant removed. The main thing is that I don’t want to make it worse. I am trying to decide between the titanium and zirconia and was leaning towards zir because of my sensitivities ; however, I have heard that the zirconia fractures easier and I’m not sure of the longevity on them. Do you know what the fracture rate is on zirconia implants in comparison to titanium and how long zirconia implants last? I also grind my teeth a bit and wonder if a zirconia implant would be more at risk of fracture because of this.

    Just to be safe, I had the Clifford test done and it shows that I would be okay with the Nobel Biocare titanium implant my surgeon would use; however, I have heard that the Clifford test does not take into consideration SLOW/Type 4 allergic reactions to metals whereas the MELISA does. . Do you know which test would be most appropriate for someone like me that has chemical sensitivities to determine titanium allergies? If you had a client with chemical sensitivities would you steer them away from titanium? I noticed with the Nobel Biocare titanium that either the implant or abutment had aluminum oxide in it. I have always heard that aluminum is quite dangerous and it has been associated with Alzheimer’s disease. I was wondering if you have any opinion on aluminum oxide being used in dental implant materials. Finally, do you know any experts in NC or the surrounding states that provide zirconia implants that one could get a consult from ?
    Thank you for your input.
    Chris

    • Hello Chris,
      I’m sorry to hear about your broken tooth. If the tooth has a root canal and isn’t infected, you could possibly leave it for a few months without any problems. I agree with you that Zirconia does fracture easier as it has less flexure to the material. Zirconia implants could last just as long as titanium implants but it depends on many factors that are difficult to measure such as biting force, food that you eat, and the surgery and restorative material. If you grind your teeth as well, in my opinion, the Zr implant is at a higher risk for fracture. I would also recommend that you get the MELISA test to determine if you have a true sensitivity to Titanium. I’m sorry but I do not know any experts in NC. I wish you all the best with your situation.
      Dr. Kyle Stanley

  12. I am skeptical getting implants, but alternative dentists removed all molars upper and lower on the right side. I am extremely allergic to metals. I had two crowns put it and metal was showing on the gum edge and It wasn’t long before I was having a severe reaction and had to have them taken off and replaced with ceramic. I have hashimotos and other concerns. what allergy testing is the most accurate?
    Thanks

    • Hello Bonnie,

      Since you have had previous allergic reactions to metals, I would highly recommend getting a MELISA test before any implants are placed. You probably haven’t had any titanium in your mouth since you previously only had crowns so we would have to see what the MELISA test comes back with. This would be my best recommendation for you before continuing with treatment.
      All the best,
      Dr. Stanley

  13. Dr. Matt,

    I heard of a newer brand of Zirconium implants called Ceraroot……..which is supposed to be a great improvement over other zirconium implants………… do you have any experience with this brand?

    • Hello Bruce,

      Thanks for the comment. Yes, Ceraroot is a well known Zirconia implant although it still lacks in some aspects based on the one-piece design meaning that cementable implant crowns are only available and two-stage surgery is not an option. In certain cases, these Zirconia implants can work fine but sometimes it is difficult to predict if we can get primary stability when placing the implant.
      Thanks,
      Dr. Kyle Stanley

  14. I have lost 2 back teeth on both upper jaws….
    My dentist put two fixed permanent bridges on both sides….He done root canal to the adjacent teeth and put fixed bridge on both sides….I feel relax….But suddenly heard about that bone loss can be occur on missing regions and leades to loss of adjacent teeths….Then i am really scared….I am 22 now…. i want to done a implants on both sides….But I am really confused that its make any consequences in future like oral cancer,Gum problems,etc…..My dentist said that Titanium cant make oral cancer….Its strong,Biotype,etc….But Some fears left in my mind….I dont know how to overcome my fear…..Sir please help me….Whats ur opinion in my case….God bless u….

    • Hello Akshay,

      Thanks for your comment. You are correct that areas where teeth are missing and no implants are placed can lose bone over time. Your dentist is correct in that Titanium doesn’t lead to oral cancer. I am not aware of any studies or case reports stating this. As stated in this blog, titanium is very bioinert and has been used for half a century with very little problems based on the reaction in the body. To overcome your fears I would trust the millions of dental implants that have been placed with no problems. However, if you are still uneasy about it, you can opt for the Zirconia version but understand the drawbacks of the implant designs. Good luck with your situation!
      Dr. Kyle Stanley

  15. Due to my dentist’s substandard care, I ended up needing root canal on my front teeth #8&9. He prepped my teeth for 3/4 but cut too much away and exposed the nerves; I only had stain on one tooth to begin with but he recommended crowns. I had my root canals done but one might fail because I am having pain still even after 3wks later. My endodontist prescribed antibiotic and advised to wait it out. I may need implant if the tooth is fractured. I’m over stressed and depressed; I don’t want to lose my tooth. I may be allergic to titanium. How would I find out if I’m really allergic to it; do I go see my doctor for the test? If allergy isn’t a concern, which would you recommend titanium or zirconia? I read that zr is aesthetically pleasing since it’s tooth color, is it true? If you had to get implants, what would you get? Thanks

    • Dear Jane,

      I am sorry to hear about your situation. Its hard to be certain if you are allergic for certain, but we have an article exactly on that topic. Check it out HERE. In summary, there are a couple tests and it seems the MELISSA test is the most accurate to determine your reactivity to titanium. In general, I recommend titanium for a number of reasons, however, if you have a high fear of allergy or known issues with metals, then I think zirconia would be a good compromise. The color is not a consideration when the implant is placed correctly and the part that sticks out of the gums can easily be made out of zirconia. When we talk about the implant, we usually mean the part that goes into the gums and bone, but with zirconia implants its often all one piece so it gets confusing. Theres a lot of considerations, but I myself would get titanium and I do not have any known allergy or any fear of metal reactivity. However, please remember we are all different and I think its important to follow your gut feeling. The downside to zirconia implants is the lack of long-term proven track-record and limitations in the implant restorative process. Best, Matt Nejad

  16. Hi…I had to have the very last molar (on the bottom of the right side) removed after a root canal failed and the remaining tooth was cracked all the way through. Two questions: Do you have to have an implant put in if it is the very back tooth (I’m not sure of the long term ramifications if I do nothing)? If I have to do something, I would opt for the zirconia implant due to already having an autoimmune issue (thyroid). Would a zirconia implant be ok in that location? I already wear a night guard (covering the top teeth) every night due to clenching. Any information you could provide would be greatly appreciated!

    • Dear Steph,

      I’m sorry about your molar complication. Let me answer your questions. 1) the last tooth in the mouth is usually not critical. One of my favorite implant textbooks agrees that it is the least important tooth in the mouth to replace and often times the complications are higher so it may not be worth doing at all. The opposing tooth may drift down if it is un-opposed but your nightguard may help prevent that as you mentioned. 2) Reportedly it is ok, but if you truly understand the nature of zirconia, it is an extremely brittle material. Such a brittle material doesn’t make sense for such a high load area as your first choice unless you are completely against titanium or have a known allergy. I personally would prefer to avoid an implant on the second molar position but this also depends on other factors like your other teeth condition, clenching/grinding, bone level, bone density, number of restorations, occlusion, and prognosis of remaining teeth to name a few. – Best, Matt Nejad

  17. I have had allergy to metals all my life. I can’t wear anything, but 14K gold. Earrings, necklaces, glasses, rings, buttons, watches cause contact dermatitis with skin itching and redness. Would I be at higher risk for allergic reaction to implants? Would an allergy test to titanium prior to implants be recommended in my case?

    • Hi Elena,

      If it were me, I would say its best to go ahead and test you prior to having an implant. I think you would be at higher risk given what you have mentioned. -Best, Matt Nejad

  18. After years of dealing with patchwork dental work to keep up with damage and wear and tear primarily associated with a very bad bite I am undergoing some restoration work of all jaw teeth. (A lot for a dental phobic person) I have had 2 new crowns are 8 restored and recrowned. Unfortunately, the restoration process revealed 2 teeth that could not be saved and I had already lost 2. So the next phase is some implants. Which is a bit scary. I am very concerned about the risks tied to the titanium and the alloys included. (this is already a big hit to the budget, I don’t want to add additional costs having the undo anything that goes wrong!) Some years ago I was told to stop having tetnanus vaccines due to a reaction to a shot. I was told it was a reaction to the aluminum in the vaccine. I have had no other reactions to any metals. I have been told this is not an issue to be concerned about and would like your opinion. Thank you, your site is very useful. (Dentist uses BioHorizions)

    • Hi Alice,

      This is very specific. There is no direct correlation between what you said about the tetanus vaccines and titanium implants. A vast majority of people that get titanium implants are completely fine with no reported symptoms, however, if you are uneasy or uncertain, why not get the MELISSA test and then decide? Try to remember that no matter what, there is no 100% guarantee that there will not be complications but if it’s a big concern, this may help you make a more informed decision. Besides that, there is no way I can be sure it is not an issue, but like I mentioned earlier, I have never heard of a direct correlation and it would not usually be something of concern to me. -Best, Matt Nejad

  19. While my prosthodontist was hoping to provide a new crown for a decayed root canal tooth (#31), the decay was too extensive and now requires the tooth to be removed. My options are to have the tooth removed and let it heal up ( I may not miss it), or install an implant. I am a holistically healthy 67 year-old and have no wisdom teeth. I’ve been researching the implant options (zirconia vs titanium). I’m also concerned about any long term reactions my body may have to any implants. In your experience, what should I consider when making the decision for this tooth (#31).
    ~Thank you.

    • Hello Chris,

      Thanks for the comment. I’m sorry to hear you are losing a tooth. I would evaluate if you have ever had any issues with metal either with jewelry or anything else in your life. If you haven’t, there is very little chance that a titanium implant will cause any problems. Like I have mentioned before, after 50 years of implant dentistry, the problems that are usually happening are not related to the material but more of the technique and experience of the clinician. I always ultimately leave the decision up to the patient because it is their mouth. I hope this helps and good luck with your tooth!
      -Dr. Kyle Stanley

  20. I need to get a canine extracted due to tooth resorption in that tooth. I am considering expanding my family as well so the toxic qualities of the materials is especially important to me at this time. Is there any research that shows whether zirconia implants are less toxic than titanium ones? For example, that measures how much aluminum or other ingredients are in the blood before and after implant? Also what is your opinion on whether it’s best to do the implant on the same day as extraction? Thanks in advance.

    • Hello Lara,

      I’m sorry to hear that you must have a canine extracted and congrats on wanting to expand your family. My wife and I just had a child this year.

      There are no current studies showing the difference in metal ion release from zirconia vs. titanium implants. There is only one study on metal ion release where blood levels of titanium, aluminum, and vanadium were measured preoperatively and at intervals over a 3-year period for 52 patients (17 men, 35 women), each of whom had three lower jaw titanium dental implants. The results showed that there was no evidence of change from preoperative to long-term values for the three metals measured in the study. These findings are reassuring, but do not rule out local or remote accumulation of released ions, which was not measured in this study.

      This means that IF there were any metal ions released, it was at a low enough threshold where it was not detectable in the blood. I hope this helps and thank you for your comment.
      -Dr. Kyle Stanley

  21. AGE: 22
    *Had an implant removed by cutting the bone. (1st molar, down, left)
    *The dentist put synthetic graft but only till halfway.( not up to the brim). Half of the bone is lost.
    * the earlier implant was 3.5 × 13 mm, and now the dentist says We are gonna put a bigger implant of about 4.5 mm so it won’t matter.
    1) Should I go forward with the implant as I can not afford a second implant failure.[ earlier was taken out because it was a substandard company so the screw threads had worn out and screw kept getting loose)
    2) If yes, Nobel Replace ? Or Nobel active ? Or straumann ?
    3) Internal external hex ? Give me the best and an exact implant name .
    Thank you.

    • Hello Walter,

      I’m sorry to hear that you had an implant failure. Although implants are very successful, everyone still has failures. I would recommend any conical connection Nobel Biocare implant (NobelActive, Nobel Replace Conical Connection, Nobel Parallel). All of these implants are internal hex and are at the top of the market. If you have a good implant company, the company will guarantee the implant. You may need some more bone grafting procedures to get the bone ready to receive a larger implant and possibly a tissue graft for long term stability. Good luck in your implant journey!
      -Dr. Kyle Stanley

  22. Dr. Stanley and Dr. Nejad,

    I have an extreme mandibular angle and TMJ in my jaw. Mainly left side. My bite is very askew. ( off ) Reading the comments here has lead me to believe that tooth replacement will not work for me unless I have my jaw re structured first. I have advanced periodontis as well and a loosening front upper incisor as well as a mouth full of restorations due to grinding my teeth in my sleep for years. ( I didn’t get a bite guard until 2 years ago ) The fact that I was negligent of my teeth in my youth has not helped either… I am 41 now. I am hopeless and very scared to wind up a toothless old man before I am 45. I pray that you guys can give me some hope. My dentist is doing all she can with me.

    • Hi Jason,

      it is impossible to understand the true extent of your current situation with just words. However, I can say that there are always some good options for whatever your goal is. Sometimes it becomes impossible to replace missing teeth with implants because of the condition of the surrounding bone from periodontal disease and the high chance of failure or complication. In these cases, sometimes treatment becomes a little more aggressive like removing adjacent teeth and bone grafting.

      My advice and wish for you is to find a long term plan that suits your goals. First, identify what is the most important goal of treatment for you. Sometimes a goal such as keeping every single tooth may interfere with the goal of having the most cosmetic outcome, so it helps to know what is the absolute priority. Once you know your priority, it will really help both you and your dentist make the best treatment plan. We restore patients in a similar position as you frequently and the outcomes are life-changing. Please stay positive and consider additional opinions if you think something doesn’t make sense. Wishing you all the best -Matt Nejad DDS

  23. Dr. Nejad
    I have already had all of my teeth extracted. I have titanium screws that are healing with the temporary implants/arches. I have received a quote that is respectable for the lab to create individual Ziroconian teeth that are set one by one, on both arches. I would be the first person to receive this type of procedure through my current dentist so their information is not exactly thorough. If cost is not a factor in the decision, could you shed some light on the pros and cons specifically with full arches of individually set Zirconian teeth? I am concerned about tooth density, fracture rate and the propensity for that to occur down the line with tightening or unexpected contact. The lab is wiling to give me a 5 year warranty on any replacement procedures but I obviously am worried about longevity, aesthetics and functionality.
    thank you
    Chad

    • Hi Chad,

      It sounds like you already have your implants placed and everything went well. The next step is getting the final teeth. There are many ways to restore teeth over implants with multiple choices of materials. You can have individual implants with individual teeth, a set of multiple bridges, or a full horse shoe of teeth. On most full arch cases, we go with the horse shoe approach for strength, ease of the patient, and long term stability. It is hard to tell what you mean by individual Zirconia teeth. This could be a full horse shoe or bar with the teeth cemented onto the bar or this could mean individual implants with individual teeth. The second option would require plenty of implants that aren’t necessary. Full contour Zirconia crowns are very difficult to break and I think that a 5-year guarantee is pretty good from the lab. No implant treatment is without complications in the long term regardless of material. The complications that could happen would mostly be due to design, the expertise of the clinician and laboratory technician, and above all a nice stable occlusion (bite). If the bite is off, no material will last, but if the bite is great then even a softer material can have good longevity.

      For full arch cases that patients chose to have a fixed option (it doesn’t come out of the mouth), we usually prefer to NOT have individual teeth due to staining, plaque accumulation which can form a bad smell on the prosthesis, and added junctions of materials can ultimately cause more problems. Another note is that you never really want to be the first patient to get a certain treatment from a doctor as they do not have the expertise that each material and design can offer. I hope that this helps you in your quest for a beautiful smile. Thank you for your question!
      Dr. Kyle Stanley

  24. Hi doctor,

    I’m allergic to all metals; I’m missing a canine; would it possible for me to get zirconia?

    • Hello Lina, yes it most likely is possible for you to get a zirconia implant but it really depends on your individual situation to see if you are a candidate for a Zr implant. The negative aspect would be that it is in the esthetic zone and zirconia implants have some drawbacks and options for the doctor. Good luck!
      Dr. Stanley

  25. Dr. Nejad,
    I have been advised to extract tooth #5 due to continued bone loss in that tooth.
    I was recently treated for an abscess that developed in that tooth and am concerned about my upcoming extraction to prepare for the zirconia implant. I have thyroid problems and can’t take a chance with the titanium implants.
    Problems with that tooth began when I needed a root canal(2008), and during the procedure a piece of the appliance broke off and remained in the area, unbeknown to me. The endodontist and the dentist did not advise me of it.
    Since it was my first crown I did not know a post should have been put in to hold the crown. Three years later I went to another dentist who educated me about the lack of a post on tooth #5 and about the metal as seen in an x-ray that he took. Last August I went for a third crown even though the dentist thought it was time to remove the tooth because bone loss had already set in. I had hoped to prolong the implant since I don’t like the option of a bridge.
    Can you tell me if the location of #5 tooth makes a zirconia implant more vulnerable to a fracture or crack?

    • Luba,

      I’m sorry to hear about your situation. It is always difficult emotionally to lose a tooth. First of all, a post IS NOT needed in modern dentistry. We currently don’t use any posts in our practice because we have done the research to prove that it is not needed. Dr. Nejad may chime in on this as well.

      Having an implant at the #5 is a good place for an implant. The forces aren’t as high as the molars and it isn’t an esthetic issue in the front of the mouth. I would probably stay away from immediate zirconia implants however, due to their design. You should have the tooth removed and a graft place. Then come back 6 months later to place the implant. Without seeing you, it is difficult to give any more advice on your situation but I hope that this can help you in your journey. All the best to you!
      -Dr. Kyle Stanley

  26. At age 65, I am in need of a complete upper teeth replacement. Treatment plan outlined to me consists of removal of [3] teeth, bone grafting for [3] teeth, [4] implants and 7-10 crowns/teeth (or much dreaded and least preferred dentures). I have come across your article regarding zirconia and would like to know whether zirconia implants are suitable for my procedure. Also, what cost should I expect for such procedure?

    Thank you and regards, Kathrine

    • Hello Kathrine,

      I’m sorry to hear that you are losing some teeth. This can be difficult to deal with.

      Unfortunately, zirconia implants are not a good idea to use in your situation because they are not meant for full arch situations for many reasons (one-piece design mainly). It sounds like you are having the All-on-4 treatment concept which is one that I teach often. It is a great way for patients to leave in one day with temporary teeth in their mouth when they have a failing dentition. The price of this treatment can vary by region, expertise, and implant components but you should expect to pay $35-50,000 per arch. Please make sure you are being treated by an implant expert that has a team that understands both the surgical and restorative or esthetic aspect of the treatment. When done correctly, this can be a life changing treatment but if done improperly, these cases can be a disaster. Good luck in your treatment and we wish you all the best.
      -Dr. Kyle Stanley

  27. Thank you for your prompt reply Sir.
    The implant screw kept getting loose after every three months, after the crown had been put.

    I read that biohorizons implant(alloy) has almost double the strength than commercially pure Nobel biocare.
    The only thing that troubles me is the auto immune skin disease which kept recurring once in every three months, and I had to use a topical steroid ointment to clear it !
    It has never recurred since the old equinox uniti implant has been removed.
    I can not continue using the topical corticosteroid so frequently if god forbid the disease starts recurring after I get an implant done.( will Nobel Biocare be safer ?)

    I also have an option of getting a bridge treatment, but given my age(20) what do you recommend. ?
    Thank you.

    • Vedant,

      It sounds to me like the screw was becoming loose and this was causing a local reaction to the gums which is common when screws become loose. The cause of the screw loosening can be multifactorial based on implant design, the bite on the crown, torquing of the screw, etc so it is difficult to determine why this was the case without seeing anything. I don’t think you had an autoimmune disease because I think it was due to the screw loosening and localized inflammation. I have seen this on other screw loosening cases. I would advise against a bridge for your because you are so young. You should see a well respected dental implant expert that understands both the surgical and prosthetic phase of implant dentistry. I would recommend someone who lectures and is a university professor if possible. Also, most large implant companies use the same type of titanium in their implants. The only thing that varies is the design and surface treatment which doesn’t affect strength. I hope this helps you. Good luck!
      Dr. Stanley

  28. Hello Doctor,
    I have a missing left first molar(36),
    I have 3 options:
    #Nobel biocare: CP Titanium implant with Ti unite surface.
    #Biohorizons laser lock implant which is a titanium grade 23 alloy (ELI)
    #& Straumann Pure zirconia implant.
    I had an equinox uniti implant removed coz the abutment screw kept getting loose and moreover I had a recurring auto immune skin disorder, which has stopped recurring since it has been removed.
    I am still in favour of a titanium implant since I am 20 yrs old.

    So should I use a grade 23 alloy (ELI)(*contains vanadium , Aluminium ..etc but is stronger than CP Ti) or CP Ti, so as to not initiate the recurrence of auto immune disorder.(*I don’t know if the equinox uniti implant is CP Ti or alloy, and I suspect it is the cause , I have no metal allergy)

    Thank you.

    • Hello Vedant,

      I’m sorry to hear that you had a failing implant. Although this is rare, it does happen in some cases. When did the implant fail? Before it had a crown on it or after? If after, how long after?

      I don’t think you can go wrong with any of the above companies Nobel Biocare, Biohorizons, and Straumann. Nobel Biocare and Straumann are the top two companies in the world and have been around the longest. The Straumann Zr implant is the only ceramic implant from a highly regarded implant system, however, this implant hasn’t been around very long and still has most of the negative factors that Zr implants usually have (only cementable, must adjust it in the mouth, etc.). Since you stated that you do not have a metal allergy, I would still go with the Nobel Biocare Tiunite surface as I have a lot of experience with this surface but like I said before, I don’t think you can go wrong with any of the implants mentioned above. Good luck in your treatment!

  29. I know for sure that I am allergic to Nickel. My glasses were gold plated, with nickel underneath, and I felt the burn and saw the blisters where the plating wore off. I need a a full upper and lower, I am 70 years old. Do you still recommend Titanium for me?

    • Hello Allen,

      I think the next step would be to get tested to see if you show any actual allergy to titanium. As we said in the blogs, the titanium implants have a much longer track record and are really ideal for full arch treatment like you need. If the tests were to come back negative, I would go ahead with the treatment with titanium. However, if the test showed titanium allergy, we would have to look at other options.

  30. DR, I have a question, I don’t understand what you said “Zirconia implant crowns can generally only be cemented”, can you explain why we can’t make screw zirconia crown clear? Very appreciate?

    • Hello Albee, and thank you for your question. There are two types of implant crowns: cement retained and screw-retained. They both have their advantages but we prefer screw-retained due to recent studies showing how bad cement can be around dental implants. With the one-piece Zr implants, they only leave the option of having cement retained implant crowns. I hope this helps. Thanks!

  31. Dr. Nejad,

    I’ve contacted you earlier regarding the titanium vs zirconium implant discussion. Thanks for your quick response. I’ve since heard about the Maryland bridge option. My two front teeth are missing and I’m trying to find an another option to implants or standard bridge. I’ve discussed the Maryland bridge with my dentist and he said he could do this but said this is not a long term or permanent fix or may not be as aesthetically desirable for front teeth. As I have stated earlier on this forum, I am hesitant to do the more invasive implant procedure because of possible health issues down the road. I’m 74 years young in fairly good health so I don’t know how much concern I should have about the “long term”. The “aesthetically desirable” effect is of course concerning. What is your experience with this procedure and how often do you perform this procedure in your practice. Thanks for your service to this forum.

    • Hi Nick,

      I completely disagree with Maryland bridge not being an esthetic option. Which teeth are you missing? If you are replacing your lateral incisors, then the Maryland bridge has a good prognosis. Some of these restorations have over 20 years success. The worst thing that would happen is that it debonds or fractures and that is a pretty harmless failure but even then if it is done properly, there is a good chance it will last. You will not want to bite directly on it, and you probably want to avoid ripping into anything like apples, hard bread, etc. That type of force is very damaging to Maryland bridges. Also, depending on how your bite is, you might not be a good candidate but it is rare for that to be the case. I do this procedure 5-10 times per year. At age 74, I think it is a great option. Earlier in life, we use these for people who want implants but are not finished with their development yet. We also use Maryland bridges for patients (like yourself) who are uncomfortable with the idea of implants. It is a very safe and effective treatment, just functionally you need to be careful and minimize forces on that front teeth if you have Maryland bridge/s. I do agree that an Implant is the most ideal solution, but I just do not agree that Maryland bridges are not aesthetically desirable. That is completely dependent on the provider. patient, lab combination.

      My pleasure.

      Best,
      Matt Nejad

    • Thanks for your quick response Dr. Nejad. I actually made a copy of your response to take to my dentist when I go for my next visit. I will have him do the Maryland bridge based on your recommendation. I really appreciate your service.

    • Hi Nick,

      I just wanted to mention that not all dentists are comfortable with or experienced in doing maryland bridges. My recommendation would not be to ask your dentist to do something they are uncomfortable with or do not believe will work well. Chances are, it won’t work out well if that is their mentality going into it. Discuss it with him and if he is really not comfortable with it, it is your decision what would be best. You can consider getting a second opinion. As dentists, we do not all do 100% the same thing and there is a variety of experiences and skills among different dentists. Keep in mind, there are a couple factors I mentioned that might not make you a good candidate but I have no way of assessing that. Best- Matt Nejad

  32. Hi I’ve read titanium impacts can corrode over time causing bacteria to grow up inside the gum and bone and that having the 2 separate pieces screwed together will give more place for bacteria. Zirconia does not have these issues.
    Would if I put in the zirconia implant without a crown (because it is an unseen back top molar) would that keep my bone intact and also then have no concern with fracture to the implant? Hoping this is a great idea.cheryl

    • Titanium implants can corrode, but it is not common. The titanium oxide layer prevents this process, however certain conditions can result in the exposure of the implant surface and corrosion. As I have always said, there are pros and cons to each material/implant system and there is no 100% perfect combination. Overall, titanium implants, with conical connections seem to have the best balance of success, esthetics/cosmetics, minimal complications, tolerability and so on. When you focus on only 1 of these factors such as tolerability, you often sacrifice in other areas. The concept of 1 piece implant is ideal in some ways: there are less parts, less chance of bacterial accumulation in the junction areas, strength, no chance screw loosening, stripping, fracture, etc. However, in other ways, 1 piece prohibits the most ideal final restoration (screw retained), and it is not very friendly for multiple unit scenarios. With a 1 piece implant, the final crown must be cemented. My preference is for a screw-retained crown because it is retrievable, serviceable, and prevents any cement from causing periodontal complications around the implant. There are other reasons as well but it is really complicated to explain unless you are really familiar with every aspect of implant dentistry, but please just trust me that a 1 piece implant system is not ideal in everyway. I would tend to prefer 2 piece implants overall if you consider everything.

      Now to address your question about placing the implant without a crown. This would be pretty useless. An implant without a crown would not be functional. If you placed a 1 piece implant, you would not be able to chew on the implant without a crown because it would be impossible to control the occlusion (bite) on the implant without having the contours of a crown to help. If you did have bite on the implant, it would likely fail from fracture or bone loss because you could not control the bite forces well. It would also accumulate food and have hygenic concerns. Additionally, there are studies that show placing an implant but having no bite force on it is not sufficient to maintain the bone levels as you mentioned. Bone needs pressure/stress on it to have the natural bone remodeling process occurring and this is what maintains the bone levels. Therefore, I would not say this is a great idea.

      Best,
      Matt Nejad

  33. Hello Dr Nejad,

    Thank you for sharing your knowledge and for the respectful and helpful manner of your advice.

    In my lower jaw, my adult tooth 26 never grew (I had all my milk teeth but this one was fused to my canine. When I lost these, only the permanent canine grew). My teeth were all straight but due to a dentist insisting to my parents that I would get over crowding in my teen years, pulled 2 upper molars when I was 15 and I had braces. I am not exaggerating, when my braces came off he asked me to ‘bite’ to see how it was, but I couldn’t find a comfortable position to close my mouth. I never got a retainer either. Anyway, my smile ‘looked’ great.

    Two decades later I discover that my molars have worn away down to the dentin because of this malocclusion (and my lower jaw was pulled back) and that pain I have had since I was 18 is a TMJ disorder probably caused by the orthodontic treatment I received.

    I am now one year into correcting my lower jaw position with spilt and braces. However, now that I am in the middle of my treatment, my orthodontist suggests I open the space where the tooth should have been and get a bridge. I really hoped not to intervene with my teeth apart from trying to find the best position possible with what I have got. I am worried about cleaning, if I have problems if I have a bridge and most of all that it would involve filing the two neighbouring teeth. I am also not keen on an implant but idea felt more ‘comfortable’ in the long run and, until I read your advice, I would have gone for zirconium implants . I have no other implants/crowns (just one white filling). At the end of the day, I would prefer not to interfere with my other teeth (the ones that would be on either side of the bridge). In the future I hope we could be regenerating teeth (I am in my forties now). Then I would not hesitate have made a space for it! I would really like to here your thoughts on my case.

    Thank you. Mari

    • Hi Mari,

      Sorry for you circumstances and I wish for the best outcome for all the energy and effort you have invested in your oral health. I am very hopeful you will have a good outcome. Even though you have given me all the specifics of your case, I have never seen you in person to get more specific but I will tell you my general thought process for missing tooth # 26 (lower right lateral incisor). The best solution, space and bone (width, volume, quality) permitting, is an implant. You have already explored this option. Titanium is my preference, zirconia is not a bad option either, especially for this tooth which does not have the most amount of stress or pressure on it. I would avoid a traditional bridge very adamantly for several reasons including the inconvenience of cleanability, the preparation and possible damage to the adjacent teeth, etc. Fortunately, there are another couple options. One is called a maryland bridge (adhesively retained bridge) and this would be a very good treatment option for this #26, however, the details of your occlusion are important to evaluate this option. Assuming occlusion does not contraindicate this option, I have had very good results with no failures for these types of restorations. With the proper technique, I expect them to survive for 10-20 years before needing replacement. If they are not done properly, the usually have a lower survival rate but the major benefit regardless is that no drilling on your adjacent teeth is necessary so it is a very conservative option. The last and final option I can think of is a removable device. I don’t think it is a great option for this tooth because it is a lot of material to go in your mouth to replace one missing tooth.

      To recap, I would personally explore the options of Implant or Maryland Bridge. Have a great weekend.

      Best,
      Matt Nejad

    • Hi Gerald- There are no 2 piece zirconium implants currently on the market for screw retained crowns. If you know of one, please let me know. I believe these will be available in the near future and I am very excited for this. At this point, the 2-piece systems involve cementing the abutment to the implant which is not very desirable for a few reasons.- Best, Matt Nejad

  34. Hi Dr. Nejad,

    Your honest explanation of the trade-offs is very helpful. I am planning ahead for what to do if I lose one of my front teeth because I have a history of allergic reactions to dental applications. 24 years ago I had mercury amalgam fillings removed after a severe and extended reaction, and 18 months ago I had a titanium implant removed after three weeks of debilitating reaction. Both times my symptoms completely abated once the substance was gone from my mouth — looks like I’m one of the unusually allergic few. Your thoughts would be appreciated on whether I’d be a candidate for a zirconia implant.

    -Kathy

    • Hi Kathy,

      I think there is enough information to say you should avoid any more titanium implants. If I had the same symptoms you describe, I would go with an alternative approach. You could consider zirconia implant, adhesive maryland bridge, traditional bridge, or a removable appliance. I wish you the best. Let me know how it goes. Make sure you have a really good surgeon. Sometimes failures are not just due to your body reaction but the planning, placement technique, etc.

      Best,
      Matt Nejad

  35. Hi Dr. Nejad,

    I am in need of getting both my front teeth (7&8 I think?) replaced with implants. The teeth have been removed but I have stalled getting the implants because I too am one of those health nut types and I am a bit nervous with having a foreign metal implanted into my body, especially in my face/head. I was told by my general dentist, not the implant doctor, that he wouldn’t recommend zirconia implants for front teeth because as you have stated, they are not as strong as the titanium especially for replacement of front teeth. Would you agree??? I just accidentally came across your site and I am impressed by your frankness and fairness. Thanks for your public service.

    • Hey Nick,

      I understand your concern. Zirconia is more brittle and therefore more likely to fracture but this risk may ultimately be acceptable. The other drawback is the restorative options are limited. With all this said, I would get a Zirconia implant if the thought of titanium is something that really concerns you or makes you nervous. I would get titanium myself, but in my opinion, if you are reluctant/hesitant to get something, then you are more likely to have problems with it and regret it.

      Best,
      Matt Nejad

  36. The question about 2 metals in the mouth was unanswered. I have read that titanium can react electrically with metals in adjacent teeth. What say you?

    thanks,
    LD

  37. Hi Dr Matt
    I am a /hygienist working in boil office. Many patients asking us about Zr implants . I know Melisa test is helpful for Ti, Au and Ni. They rather have it vs Ti for “metal” reasons. Since its still an “foreign object” in the body, do you know if affects meridian path in the body?
    thanks
    florentina

    • Hi Florentina,

      I consider myself holistic to a reasonable extent but not to an extreme. I can confidently say there is very little research to support most of these claims and some of the science that is being used is looking at Titanium him replacements and which is not comparable to a dental implant just due to the sheer volume of material we are talking about and also the location it is implanted. Variables matter a lot in scientific study. The only perfect solution is to take care of teeth and avoid losing them in the first place. From there, I think that titanium or zirconia are both acceptable. Best- Matt.

  38. Hi Doctor Nejad,

    I am going to do one implant and got two options-titanium and zirconia. Some doctors said that titanium is the best and they have a long history of high success rate, while other doctors said for sure zirconia is the best due to it is non-metal nature. But the price for zirconia is basically three times more than the titanium…I would like to get your opinion on whether it makes sense to pay that much for zirconia, if titanium works so well?

    Thank you in advance!
    Carol

    • Hi Carol,
      I’m surprised to hear the price is 3 times different. It honestly should be pretty similar. Good implant components for titanium are expensive. Perhaps there is a price difference if you are comparing cheaper implant components or one of the discount implant centers but I would urge you to stay away from those in general and do your research. Most the providers I know only charge the cost difference of the components which is not 3x (more like 20%-40% more). With that said, I personally would get Titanium for myself and my family. I firmly believe that this is the best, most stable, and most proven option. However, I believe there are some patients that truly do benefit from Zirconia and I evaluate each patient on a case by case basis. Do you have any reason to believe Titanium implants would be an issue for you?

  39. Hello Dr.
    I am planning to to have an implant next week.
    Is Zirconia abutment better than porcelain abutment?
    I am going to the the Zirconia crown.

    • Hey Antonio- Porcelain is not a common abutment for an implant. The common abutment choices are zirconia and titanium. Each abutment has certain advantages but Zirconia is usually my choice for abutments.

  40. Hey .. I decided to choose the zirconia implant because the titanium one is toxic .. but in my country I can’t find any doctor to do the zirconia implants , only titanium ! Can I buy it online and choose a doctor to do the implant!

    • Dear Ami- I do not agree about the toxicity, but regardless it is not possible to buy an implant as a patient. There are different sizes and lengths and only a dentist can purchase these. What country are you in? Your other option would be to travel to someone who does a zirconia implant in another country.

  41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753052/
    Make sure you get tested for allergy to Titanium.
    The ”pure” Titanium and ”hypoallergenic free” is a myth…
    I got 5 of them. Seems that I am allergic as my body REJECTED one…so yes REJECTION is not a fairy-tale.
    Also make sure of other allergies you have as I just discovered that the anesthetic used on me (Articaine) has sulfa ingredients and wrote in my intake am allergic to Biseptol (antibiotic containing sulfa), and experienced in last 4 month vaginal hemorrhage and swelling of my legs and bloating and overall sickness.
    I consider myself having a robust health or better said had a robust health. Not so sure now after all about the damage that was done to my body due to all above. Will know more soon as am going to be checked by a physician.

    • HI Mihaela. I am sorry for your health conditions and hope you get some answers and recovery as soon as possible.

      Regarding rejection of an implant, that does not indicate allergy. Not all implants successfully integrate, it is a surgery and it does have a low but inevitable failure rate. Many failures are completely unrelated to allergy and patients do not experience any symptoms on other implants. My point is not to discredit any possible allergy, but to inform you of alternative causes for rejection such as infection, delayed healing, less than optimal surgical site, etc.

      Articaine is not contraindicated in patients with sulfa allergies; there is no cross-allergenicity between articaine’s sulphur-bearing thiophene ring and sulfonamides. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511938/

      I wish you the best and hope your recovery process goes well.

    • I myself, would do titanium. However, I respect that our bodies are similar but different. Some people are more sensitive to materials and procedures than others. For some patients, zirconia is probably the best.

    • Hey Onyx. That is definitely possible and very common. There are some exceptions and I don’t know the specifics but it is very common to have a titanium implant, a zirconia abutment, and a zirconia crown. Ask your dentist what the plan is! – Dr. Nejad

  42. I am going to get 2 implants tomorrow and I am really confused because I suffer from autoimmune disease (rheumatism) and I ´ve read that zirconia implants are hypoallergenic and corrosion resistant so probably less risky for the body and less inflamation risk which is very very important fact for me so I don´t know now.

    • I am sorry, it is really impossible to assess and diagnose these things adequately over the internet. What did you end up doing ? How is it going? Let me know.

  43. I am a general dentist and I appreciate this blog/article. Nicely well written and contains current information based on current research. Thank you.

  44. Important fact that Both titanium and zirconia are very bioinert materials, meaning that they do not cause local inflammation and are not rejected by the body

  45. Hey Guy, I am planning on getting implants in a few weeks once I finally move to California but im still undecided, one question I’ve had for a while regarding these type of implants is discoloration over time a factor? Like is one more resistant to stains vs the other or do they both maintain their original color over time?

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