With the support of Wichita State University AEGD Program, its Director Dr. Dexter Woods and Mr. James Francis President of Z-systems USA, Dr. Noumbissi just completed the first ever metal-free dental implantology course in Kansas at Wichita State University. Eight residents, four faculty members and five private practice dentists attended. The two-day program started by introducing the participants to zirconium dioxide (zirconia) as a dental implant material. The properties, characteristics and benefits of zirconium which is a bioceramic were presented and discussed. Through multiple real case scenario presentations and discussions the participants were allowed to learn and practice how to identify, select and treatment plan patients who need to have their teeth replaced with ceramic dental implants. On the second day we had a live surgery demonstration on a patient which was performed by Dr. Noumbissi. During the live demonstration most of the concepts, techniques and considerations discussed prior were demonstrated in real time.
“CAN I BE ALLERGIC TO TITANIUM DENTAL IMPLANTS?”
DISCOVER THE LINKS BETWEEN METAL ALLERGIES AND DENTAL IMPLANTS
By far, the most commonly implanted metals used in orthopedic and dental restoration devices are cobalt/chrome, stainless steel and titanium. Virtually all implants are alloys, meaning they are a combination of several different metals. The base metals (iron, nickel, lead, zinc and copper) are found in the highest quantities, but smaller amounts of other metals are also found in the implant. Considering that roughly ten to fifteen percent of the population experiences some form of allergic reaction to metal it is important to consider alternatives to metal implants.
WHY ALL THE FUSS ABOUT METAL ALLERGIES?
An allergic reaction is a response of the body’s immune system when it detects an invasion of foreign substances, whether living or non-living. Allergic responses can range from a mild rash to death from a multi-system shutdown known as anaphylaxis. A person can become allergic to virtually anything, anywhere and anytime, including metals.
Environmental exposures to metals include; joint replacement, dental implants, dental restorations, jewelry, body piercings and even mobile phones. Traditionally nickel, cobalt and chromium have been the most prevalently reported contact allergens; however gold and palladium (primarily alloys that contain more than one metal) have drawn more attention recently. In the United States, studies show that the prevalence of nickel allergy is on the rise (likely due to the growing popularity of body piercings). Metal allergy is also being reported in association with certain device failures following surgical placement such as stents into coronary (heart) blood vessels, hip and knee prostheses, as well as dental and other implants.
METAL DENTAL IMPLANTS – ORIGINALLY THE ONLY CHOICE
Metal dental implants were originally made out of commercially pure titanium or titanium alloy, providing the only option for anyone wishing to undergo implant tooth replacement. One aspect of titanium and titanium alloys is that they are generally considered ‘osteophilic’ (bone-friendly) and therefore considered to be biocompatible, providing a clear improvement over dentures and bridges. With a growing body of evidence to the contrary provided by researchers and patients alike, we now know that placing metallic dental implants and other restorative devices can potentially provoke allergic reactions and implant failure. One study involving 1,500 patients helped to drive the fact home when it demonstrated that titanium allergy could be clearly detected in dental implant patients. A notably higher risk of positive allergic reaction was found in patients whose implants failed for no other known reason other than that they had a higher incidence of allergic reaction.
WORST CASE SCENARIO – AUTOIMMUNE DISORDERS
The most significant symptom which can cause the most severe problem is ‘chronic fatigue’. Muscle pain and chronic fatigue presenting without any known cause are the more serious symptoms associated with an allergy to metals. Unfortunately, since people don’t usually link overall fatigue with an immune disorder stemming from a metal implant they can suffer from this type of reaction for months or years before seeking help.
AUTOIMMUNE DISORDERS ON THE RISE
Between 15 and 25 million Americans are reportedly affected every year by one autoimmune disorder or another. When you realize that an allergic reaction is actually the immune system turning on itself in a state of hyperactivity of the immune system then you can begin to see the correlation between autoimmune disorders and allergies, and doctors are now beginning to realize that allergies are quite often a precursor to autoimmune disease.
A growing list of health problems are suspected to be related to metal allergies potentially instrumental in the onslaught of autoimmune diseases such as Chronic Fatigue Syndrome, Psoriasis, and Scleroderma, Lupus, Rheumatoid arthritis, type I diabetes, Multiple Sclerosis, Hashimoto’s thyroiditis, Guillain-Barre syndrome, and others. With this alarming rise in autoimmune diseases and the suspicion of a correlation between metal allergies and a weakening immune system it only makes sense to take whatever steps we can to ensure that our patients are biocompatible with an implant before allowing any substance or material to be permanently affixed into the mouth.
THE BETTER ALTERNATIVE THAT CAN LAST A LIFETIME
Today, ceramic dental implants are considered to be the best and safest alternative to metal implants. The advantage of these implants is that they are ceramic, they are made from zirconium oxide also called zirconia and thus there is no concern of corrosion, allergic reaction or electronic interference. Overall qualities of ceramic dental implants include;
Biocompatibility: the zirconium used in the manufacture of ceramic dental implants is an inert material with very low allergic potential.
Strength: The strength of the dental implant is exceptional compared to other metal implants.
Metal-free: no corrosion, no galvanism effect, no metallic taste, no electronic disturbances and no Gum irritation.
Hygienic: Oral plaque and tartar do not accumulate on the surface of zirconium imlpants, therefore they remain clean and allow for a healthy environment around the implant bone and soft tissue.
ALLERGY TESTING – AN IMPORTANT PART OF THE WHOLE
Our goal is to treat the whole person through the use of safe, natural and painless methods. Our innovative approach to dental care focuses on the health and wellness of the mouth in relation to the whole body, including identifying and treating issues pertaining to metal allergies and autoimmune disorders. We only recommend products that we know to be safe and that will provide the most positive, lasting results for our patients, such as ceramic dental implants. To learn more call to schedule your free personal consultation today.
On Thursday and Friday August 2 and 3, 2012 we successfully completed our two-day-summer session zirconia implantology training and certification course. In attendance were seven doctors from five US States and Canada. This course on the Z-Systems one-piece ceramic dental implants was focused on case selection, advanced clinical and radiographic diagnostics, treatment planning and guided surgery. The first day was consisted of lectures on implant prosthetics and surgery planning. We concluded the day with a live surgery demonstration by Dr. Noumbissi on one of his patients.
Friday August 3, we focused on the use of the InVivo implant planning software from Anatomage during the 3D implant placement planning session. The basics of how to plan for and use three-dimensional data to order surgical guides were covered The use of guide handles when placing ceramic dental implants was also taught during this course. One very unique feature of this second session is that we used real patient jaw models generated from the dental CT scan models submitted by the participants. Therefore they were able to practice on a stereolithographic reproduction of their own patient jaw in preparation for the surgery they would perform when they return to their respective offices.
Congratulations to Drs. Lowell Weiner, Robert Johnson, Marylin K. Jones, Robert Clinton, James Lewer, Paul Wilke and Eric Taylor who attended this certification course. Very Much thanks to Z-Systems USA, Anatomage, Northern Virginia Dental Laboratories and Technology4Medicine for their support.
Sammy Noumbissi DDS MS
THE QUESTION OF RADIATION IN DENTAL CERAMICS
It may be surprising that one of the ‘risks’ associated with Zirconium based implants is radioactivity. But what does the research say, and is there really any risk to patients? The truth is that Zirconium just like aluminium and many other commonly used materials can contain a certain number of radioactive isotopes, which in extreme cases can increase the chance of oral cancers. However, oral implants are produced from a highly purified and stabilized form of Zirconium also called zirconia or zirconium dioxide which contains extremely low radiation emission levels. Furthermore all manufacturers of zirconia dental implants are required to provide a declaration of radioactivity for their zirconium based dental products. Therefore all zirconia products and materials are not created equal, because the quality and safety of each lies in the the processing of the raw material zirconium.
THE RADIOACTIVITY OF COMMERCIALLY AVAILABLE ZIRCONIA POWDERS
Zirconium compounds are refined from naturally occurring ores, notably zircon, which usually contain trace amounts of other elements depending upon the source of the original ore. In particular, zirconia typically contains trace amounts of radionuclides. As a consequence there were some concerns about the use of zirconia ceramics as implant materials.
In 1992 the question of radioactive ceramics was officially addressed by Anusavice KJ in an article titled ‘Degradability of dental ceramics’ which observed in part that … “The degradation of dental ceramics generally occurs because of mechanical forces or chemical attack. The possible physiological side-effects of ceramics are their tendency to abrade opposing dental structures, the emission of radiation from radioactive components…”
However alarming that may sound further research indicated that the radiation emitted by a dental ceramic powder (3 mol% Y2O3-ZrO2) was the same order of magnitude as alumina powder, both of which were several orders of magnitude less than that typically measured for water, milk, vegetables and meat (based on European standards). The radioactivity of zirconia femoral heads (Y-TZP artificial hip joints) for example, has been shown to be similar to that of alumina and cobalt-chrome. The radiation dose of each material was recorded at that time to be well below European radiation limits specified for general external exposure of the human body and also for local internal exposure of organs and tissue, and was well recognized as no more than the ambient radiation of environmental surroundings.
In another similar study, radiation levels of several commercially available zirconia powders commonly used to manufacture implants in Australia (Nilcra Ceramics, Melbourne) were declared to be minimal and well below acceptable limits. The Radiation Health Committee of the National Health and Medical Research Council of Australia now consider that magnesia partially stabilized zirconia artificial hip joints made from these powders pose “very little hazard to surrounding tissue”.
The main raw material for the manufacture of zirconium dioxide (zirconia) in the US is the mineral zircon silicate (ZrSiO4) which is translated to a higher form of purity zirconium dioxide (ZrO2) when melted with coke and lime. Since extremely pure initial products must be used for the production of high-performance ceramics used in dental implants, special synthesis methods have been developed specifically for this product; a process that works to create the strongest, most durable dental ceramic product available today.
Research has shown that in a dense ceramic almost all radiation is absorbed within the bulk of the material. In the case of artificial hip joints, any radiation from the femoral head is absorbed primarily by the surrounding artificial materials.
From these tests and others, it is widely recognized in the medical implant field that the actual radiation risk of zirconia ceramics is negligible, certainly no more than that of alumina – and consistent with the level of radiation found to occur naturally in healthy environments.
THE BENEFITS OF ZIRCONIUM IMPLANTS AND DENTAL CERAMICS
Overall, Zirconia (zirconium oxide) implants are valued by dentists and patients alike for being highly resistant to corrosion and superior to other available implant options such as titanium, both as related to biocompatibility and resultant color. They are ideal for those patients whose immune systems do not accept titanium implants and for patients who may have allergic reactions to metals. Zirconia implants are far more durable with less risk of breakage and is capable of holding up to the drastic changes in temperature and chemistry found in the oral environment. Being bright white in color, zirconia implants have a definite advantage or aesthetic value over titanium dental implants by eliminating the possibility of corrosion and the unsightly grey appearance that titanium exhibits.
Is There A Renewed Trend of Radioactive Compounds In Dental Materials? — Ulf Bengtsson, 2000-01-01
Abstracted from Ph.D Thesis “Application of Transformation-Toughened Zirconia Ceramics as Bioceramics”, University of New South Wales, Australia, 1995.
Anusavice KJ. Degradability of dental ceramics. Adv Dent Res 1992 Sep 6:82-9
Wichita State University: Certification Course In Zirconia Implantology In Kansas August 24 And 25, 2012. Presented By Dr. Sammy Noumbissi
On Friday and Saturday August 24 and 25, 2012 Dr. Noumbissi who is an adjunct professor of implant dentistry at Wichita Sate University will be teaching the first ever zirconia implantology certification course in Kansas at the university’s Advanced Education in General Dentistry department. A total of fourteen (14) C.E. credits will be awarded for both days. This course will feature the Z-Systems one-piece ceramic dental implants and will cover the areas of case selection, advanced clinical and radiographic diagnostics, site specific implant selection, guided surgery and one-piece zirconia implant temporization modalities.
Participants to this course will be introduced to the InVivo implant planning software from Anatomage during the 3D implant placement planning session. On Saturday August 25, a real-time live surgical procedures will be performed by Dr. Noumbissi on a live patient. Attendance for this course is limited to twenty dentists and will be held at Wichita State University’s/AEGD Simulation Laboratory and conference room.
METAL-FREE DENTAL IMPLANTS VS. DENTAL BRIDGES
The science of ceramic, metal-free dental implants provides a comfortable and natural alternative to bridges for patients who have suffered tooth loss. Metal-free dental implants are made of the ceramic component of zirconium also called zirconium oxide or zirconia. Due to zirconia’s physical and optical properties, metal-free implants are all-white in color , highly attractive in appearance, and look and feel like natural teeth so much so that you might forget that you ever lost a tooth (for more information about the cosmetics of metal-free dental implants, please read The Cosmetics of Ceramic Dental Implants).
WHAT’S THE DIFFERENCE BETWEEN DENTAL IMPLANTS AND BRIDGES?
A conventional dental bridge can be made with a metal framework or entirely from porcelain or zirconia. However whether its metal based or ceramic, it is created by using adjacent teeth to support a pontic, or fake tooth. In this way, otherwise healthy teeth are often ground down and crowned (or “capped”) to facilitate a bridge to span the space where teeth are missing. So what is the difference between a bridge and a dental implant? A dental implant is applied directly into the jawbone mimicking the tooth’s natural structure without touching the surrounding teeth. An even better method of tooth replacement is by using zirconia implants therefore taking advantage of its metal-free and extremely stable physical properties. Zirconia dental implants do not corrode or breakdown when in contact with oral fluids, furthermore little to no plaque (tartar) accumulate on their surface.
HOW LONG DO DENTAL IMPLANTS AND BRIDGES LAST?
FAQ ABOUT DENTAL BRIDGES:
Most dental bridges last from 5-10 years before needing to be replaced. A bridge relies on the adjacent teeth and on the bridge’s structure for support. Surrounding teeth lose their strength due to being ground down to support a bridge and are susceptible to decay and even fracture due to loss of enamel and tooth structure in the process.
FAQ ABOUT METAL-FREE DENTAL IMPLANTS:
Metal-free dental implants can last a lifetime and are placed directly into the bone where the teeth are missing. They do not adversely affect the adjacent healthy teeth, do not corrode or conduct low level electrical currents in the oral cavity. These low level electrical currents also called galvanic currents will lead to events ranging from weakening of conventional metal implants to the death of bone cells around implants; this eventually leads to implant loosening and failure. Zirconia implants bond to the jaw bone and become part of it without affecting it – making a connection often stronger than a natural tooth root.
DO BRIDGES AND METAL-FREE IMPLANTS CAUSE BONE LOSS?
Dental implants act as substitute tooth roots, providing the same function as natural tooth roots including stimulating the bone in the most natural way possible. When teeth are removed or lost due to trauma or infection the underlying bone is no longer used, frequently resulting in a weakened jaw and bone loss. This makes it difficult to smile, chew and do other things most of us take for granted.
FAQ ABOUT DENTAL BRIDGES:
When teeth are lost or extracted, the bone that previously supported those teeth no longer serves a purpose and begins to deteriorate, or ‘resorb’. When a bridge is used to connect two teeth, normal pressure is not applied on the jawbone in such a way that the bone is stimulated as it would be in a healthy mouth, leading to bone loss in the area where the tooth was lost. Eventually the bone loss spreads to the supporting teeth of the bridge which over time gets loose, fractures and/or fails.
FAQ ABOUT METAL-FREE DENTAL IMPLANTS:
Just like metal (titanium) implants, replacing teeth with metal-free dental implants involve placing an artificial root made of zirconia back into areas where there are no teeth. This results in renewed stimulation of the bone in the jaw preventing long term bone loss, thereby preserving and strengthening the structure of the jaw.
Not only do dental implants sit securely in the jaw and look like natural teeth, they also offer superior durability and outstanding aesthetics. Implants of a variety of materials have been used successfully for about 40 years and the latest generation of ceramic implant systems made of zirconium oxide (zirconia) take the science of dental implants to the next level.
ARE DENTAL BRIDGES OR CERAMIC IMPLANTS EASIER TO CLEAN?
Caring for dental implants is very much like caring for natural teeth by following standard oral health care measure such as brushing and flossing.
FAQ ABOUT DENTAL BRIDGES:
Flossing bridges is not an easy task and requires time, patience and consistency making it difficult to follow routine everyday oral hygiene which can leave the underlying natural tooth structure at risk of decay and gum disease. Almost invariably over time decay occurs under supporting crowns of the bridge leading to the need for root canal treatment or tooth loss altogether.
FAQ ABOUT METAL-FREE DENTAL IMPLANTS:
Individual dental implants allow easier access between teeth making it possible for patients to resume normal dental care. Furthermore zirconia dental do not collect plaque around them allowing for healthier gums and underlying bone.
SHOULD YOU CHOOSE A METAL-FREE DENTAL IMPLANT OR A BRIDGE?
The bottom line for most people who have experienced tooth loss is that dental implants are a better solution. Implants are the closest thing possible to natural teeth, are fixed in place and offer a healthy alternative for oral and bone health, plus they support general well-being. Patients, who have metal-free dental implants a less likely to develop metal sensitivity over time, remark that they look better, feel better and are more confident.