This week we had a patient in the office with a complex treatment planning dilemma. A number of years ago she lost tooth #10 and replaced it with a bridge from the central to the canine. The bridge decision was based on the fact that she has severe metal allergies. The allergy testing was done at the Mayo clinic and the results were so significant that although she needs joint replacement surgery they have told her she can not have it done due to the trace metal contamination. Tooth #8 is fractured and the old post core crown is loose and highly mobile. #7 has a prior all ceramic crown on it, no endodontic therapy and a short root. #9 has had a root canal, has a post in it and is the existing bridge abutment on the upper left.
So the dilemma of a multi-unit, multi pontic anterior bridge on already compromised teeth lead me to try and do some research on zirconia implants. I know people in dentistry who are raving fans and others who are reticent to try them. The bell curve from early to late adopters always exists and is always skewed in one direction when something first launches. The leans int he other direction once it has been around a significant period of time.
My periodontist was eager to partner with us for this case as he has wanted to try them out, so that was a plus. The patient isn’t normally someone who would be an early adopter, but the limitations of the other choices were convincing. I launched into research and education about Zirconia Implants. For me in the anterior I wonder about tissue development, placement of the pre-determined margin relative to the tissue at time of placement for one piece systems, implant angulation and facial tissue esthetics, and cement retained versus screw retained. As with so many things in dentistry what I learned is that proper case selection paired with the most appropriate materials and techniques is the key to optimal success and minimizing the technical limitations.
As it turns out a CBCT revealed a very large incisive canal, inadequate bone and anatomy that would make implant placement of any kind highly risky. My new learning on Zirconia implants will have to go from information to implementation some time in the future, but I am intrigued and will continue to evaluate them.