Your Body’s Struggle With Titanium

Your Body’s Struggle With Titanium

Your Grandpa’s Implant Material

Your Body’s Struggle With Titanium | Sammy Noumbissi DDS

It seems more and more people are becoming aware of and concerned with the myriad chemicals, compounds, and materials that are going into their bodies.  It’s a legitimate concern indeed, as new substances seem to be finding their way into our food, medicine and overall environment at an increasingly rapid rate.  With all of these new molecules popping up for us to check out, it can be easy to take for granted that the materials we’ve already been using for generations are inherently safe.  As we’ve seen in the cases of mercury, lead and asbestos, that is certainly not always the case; toxic materials can sleep through the cracks of public awareness and remain in use for very long periods of time.

Thankfully, there are no doctors to my knowledge that are placing asbestos dental implants.  There are different materials being used in the dental implant industry today, however, and it is extremely prudent to be aware of the potential risks involved with any material that is being permanently inserted into your body.

As with many biological prosthetics, titanium has been the primary material of choice for dental implants placed around the world for many years.  It was seen as an ideal choice due to its light weight and durability.  It is relatively less difficult to integrate with the body than a lot of other metals, and under normal environmental circumstances it was believed to be practically impervious to corrosion.

What We Know Now

It turns out, however, that titanium is susceptible to corrosion as a result of contact with saliva and other bodily fluids.  Corrosion can also occur in dental implants as a result of stress caused by bite forces.  There is a possibility that the same bacteria-borne acids that cause tooth decay may also have the potential to corrode titanium implants over time, though further research of this issue is still needed.

As titanium corrodes it creates an electromechanical disturbance in the body, causing pain and discomfort.  Ultimately it can lead to the body rejecting the implant all together.  The broken down titanium can cause metal toxication as it seeps into the soft tissue, blood stream, and even the bone.  Symptoms include irritation and burning sensation in the soft tissue, pharyngeal swelling, labored breathing, narrowed larynx and abdominal pain.  In addition, titanium oxide nano particles have been shown to induce emphysema and lung redness in adult mice.

The surface of the remaining metal structure becomes more abrasive as it breaks down, which can contribute to bone loss and can also be a factor in soft tissue irritation.  Compared with a superior implant material like zirconia, titanium has an especially difficult time bonding with your gum tissue.

Allergic sensitivity to titanium is also a concern.  Studies have shown that 20% – 25% of the population has some kind of metal allergy, and titanium allergies specifically are believed to occur in 4% – 10% of all people.  Symptoms include oral ulcers, hyperplastic gingivits, oral dryness and loss of taste.

The Newer, Better Implant Material

Ceramic dental implants made of zirconia have many positive attributes that stand on their own merits.  It is definitely worth noting, however, that none of the risks listed here regarding titanium are a significant factor with zirconia implants.  It is a bio-compatible, nontoxic material that is not a known allergen.  In fact, patients who had their titanium implants replaced with ceramic ones due to their titanium allergy have experienced full-mouth rehabilitation from their allergy symptoms.  It’s no wonder why Dr. Noumbissi has been placing ceramic dental implants in his patients for so many years.  The real question is, why isn’t everyone else?

Zirconia AKA Zirconium Dioxide Implants Are Not Metal

For the last two decades, the use of dental implants as a method of teeth replacement has seen an exponential growth. The predominant material used for dental implants for the last forty plus years has been titanium and titanium alloys. Both titanium and titanium alloys are metals and with the increase in implant procedures there has been a rise in reports of sensitivity and reactions to such materials.

In the early eighties and in light of the increased reports of metal sensitivity and symptoms in people implanted with metal alloys, the search began for an alternative to metal  for dental and orthopedic implants. Various materials were and continue to be tested and evaluated. With regards to dental implantology following in the footsteps of medical orthopedics twenty five years prior, zirconia aka zirconium dioxide is now a reliable and acceptable non-metal material for dental implantation. Zirconia is also used to make metal free crowns and bridges in restorative dentistry and dental laboratories in the United States have reported an exponential rise in the use of zirconia  by dentists in the last ten years especially on posterior teeth of bruxers. Today zirconia has emerged as a truly biocompatible and most importantly bio-inert implant material in dentistry. Contrary to popular belief both among many clinicians and the public, zirconia is not a metal and not prone to breakage and fracture. Zirconia is the crystal form of the metal zirconium just like alumina is for aluminum. As a matter of fact if you look at the periodic table of elements in chemistry below, zirconium, aluminum and even titanium are in a group called transition metals (second row and second column in the yellow area), however the titanium used to make implants is used in its metal phase . That means that after extraction from the earth, upon certain specific, highly sophisticated and complex treatment such as Yttria stabilization and transformation protocols such as HIP (Hot Isostatic Press), zirconium is converted into its crystal phase which is non-metal and ceramic. Therefore the ceramic phase of the transitional metal zirconium is zirconia which is also called zirconium dioxide and used to manufacture bio-inert, biocompatible and structurally stable zirconia dental implants.

The Case For Ceramic Dental Implants


When it comes to options for tooth replacement patients are increasingly opting for dental implants over the usual dental prostheses such as dentures or conventionally placed bridges. Since implants sit securely in the jaw and look like natural teeth, they offer superior durability and outstanding aesthetics when compared to conventional bridges. However there is an increasing resistance to metals among people and in implant dentistry there is a shift away from metal or metallic based crowns, partials and implants.

There are four major categories of restorations available for tooth replacement:


Bonded dental bridges use the teeth adjacent to the empty space to help support the missing tooth by using a very thin piece of metal or tooth-colored material to overlay and bond to the back of the adjacent teeth. A tooth replacement or “dummy tooth” is set between these two bonded pieces in order to fill in the empty space. Failure rate is about 25 percent after just five years of use. Furthermore the gap widens because the bone recedes as a result of no longer having a tooth in place. This ultimately results in the weakening of the adjacent teeth which can become loose and eventually fall out.


A cantilevered restoration uses the closest tooth next to the empty space to support the missing tooth using the either the back of the neighboring tooth or a full crown to help support the missing tooth. Success rate is higher than with a bonded bridge depending on how much pressure the actual replacement endures due to grinding and normal wear. This method of tooth replacement has fallen out of favor because the supporting tooth gets torqued and fatigued and more often than not eventualy fractures.


Getting fitted for a dental bridge requires shaving down and modifying of the teeth on either side the space where the tooth or teeth are missing. This is done in order to fit a conventional bridge. This is a process that significantly weakens the ground teeth and sets them up for fracture and root canals in the future. Unfortunately conventional dental bridges predictably fail at a range from 20 percent over 3 years to 3 percent over 23 years.                                                                                                      With dental implants the dentist does not need to affect the health or longevity of neighboring teeth at all. Once placed, implants are firmly set into the bone making them more natural than dentures or conventional bridges, with none of the shifting that dentures normally display.


  • They are bonded to the adjacent tooth with a glue-like substance, bridges more often become loose and fall out
  • They cracks and fissure form over time, due to normal wear and tear and become fragile and prone to breakage
  • Improper fit can lead to either tooth decay or irritation to the surrounding soft tissue around them.


A ceramic dental implant is created from a high performance material (zirconium oxide) that is inserted into the bone to act like a natural tooth root. Zirconium oxide also called zirconia is a crystal phase of zirconium and due to its nonmetallic construction the ceramic dental implant does not interfere with the body’s immune or meridian systems and therefore significantly reduces the potential for rejection. Furthermore ceramic implants do not interact with electromagnetic fields such as those emanating  from cell phones, cell phone towers and microwaves. Once inserted into the jaw, the implant integrates directly into the bone to give firm support to the artificial replacement that it is built to hold and should last the lifetime of a patient. Routine maintenance of a dental implant is exactly the same as a person would follow for normal teeth.


Patients who prefer dental implants say that they are more comfortable and provide a more secure fit than fixed bridges or removable dentures. However all implants are not equal and ceramic implants unlike metal implants are made in one piece from the root to the top just like a natural tooth. Therefore ceramic implants do not have joints and do not retain plaque and harbor billions of bacteria like two-piece metal implants. For those who no longer have any natural teeth, ceramic implants can be placed to support and retain dentures and eliminate the embarrassment and discomfort they can cause in social situations when they slip and click. Loose and ill-fitting dentures hamper the everyday pleasure of eating comfortably.


  • preserves healthy natural tooth and bone structure
  • looks and feel like natural teeth
  • enhances a sense of self-confidence when eating, talking and smiling
  • no gooey denture adhesives to deal with
  • no embarrassingly loose dentures
  • improves quality of speech
  • no electrical or electromagnetic activity in your mouth

Anyone who is missing one or more of their teeth may be a candidate for implants. If more than a few of the teeth are missing, implants in supporting a crown or bridge can replace those teeth and function as normal teeth without concern for loss of bone and decay. If all or most of the teeth are missing, then implants may be placed to fix in place a full-mouth non-removable set of teeth.


Ceramic dental implants are recommended to patients because:

  • Chewing is easy with excellent biting pressure provided by implant
  • When done properly and dilligently cared for, dental Implants are reliable and provide long-standing service, for decades with few, if any complications
  • Comfortable fit and lifetime durability because they are well secured and integrated with the bone and gums
  • They remain clean because they do not accumulate plaque and bacteria
  • Metal-free bioceramic
  • They do not generate nor conduct electricity

Considering the overall advantages patients can expect to benefit from as a result of choosing a dental implant, they are better able to enjoy a healthier and greener lifestyle without the restrictions many denture and bridge wearers face. The more secure foundation offered by a dental implant, the better biting pressure becomes, making it possible to enjoy the foods that a patient probably would not be able to eat using a dental prosthetic. As a result improved chewing ability leads to better nutrition and improved overall health.

Metal-Free Implant Dentistry Summit: Dec 7 & 8, 2012. Miami, FL USA

Metal-Free Implant Dentistry Summit: Dec 7 & 8, 2012. Miami, FL USA

Metal-Free Implant Dentistry Summit Dec 7 and 8 2012 Miami FL USA | Miles Of Smiles Implant DentistryThe first of its kind, the Metal-free Implant Dentistry Summit will be held in Miami Florida at the Hilton Bentley in South Beach.  Dr. Noumbissi will be one of the main podium speakers at this conference. The summit will be held December 7 & 8, 2012, zirconia as an implant material will be presented in multiple aspects of implant dentistry including prosthetic and surgical. Aesthetic, single and multiple top-to-bottom metal-free teeth replacement cases will be presented and discussed. Dr. Noumbissi will present his ongoing clinical evaluation of zirconia implants for full mouth reconstruction.

Dentures, Bridges, Or Dental Implants?


While both dentures and implants will fill the gaps left by missing teeth, there are other important considerations to be aware of when making a choice for dental repairs:

  • biocompatibility
  • durability
  • comfort
  • cost


The higher cost of dental implants can be the biggest obstacle for many patients to overcome when it comes to replacing one or more missing teeth. Despite their aesthetic and greater functional superiority the initial price of dental implants can cause many people to lean towards more conventional and less expensive options like bridges or dentures.


Second to cost, another attractive aspect to dental bridges or dentures is the quick turnaround time since they can be ready and fitted at about 2 weeks, while dental implants take longer to become fully integrated into the mouth and jaw before they reach their peak performance level

However, there are a few additional costs associated with dentures and bridges which can include:

  • restoring decayed teeth surrounding bridges
  • treating gum disease caused by improperly fitted dentures and difficult to reach pockets created by bridges
  • maintaining, repairing and replacing partial or fully removable dentures


The actual physical structure of a jaw without teeth will initially shrink quite rapidly most particularly during the first six months — and more slowly over time for the remainder of the patient’s life. Consequently, when a denture is made to fit a person’s jaw it will need to be remade and refitted as the jawbone shrinks.

The teeth in a denture appliance eventually wear down and become less effective at chewing food. Worn denture teeth naturally cause a person to bite and chew with more force, pushing the denture into the jawbone, causing the bone to shrink at an even faster rate. Jawbone deterioration and loss is the major problem with removable dentures, a problem that also works to increase the speed of a person’s aging process. Grinding of the teeth will decrease the life of a denture also.

When a dental bridge is used to replace missing teeth, the supporting or adjacent teeth have to be ground down in order to make room for the support post of the bridge. Once the adjacent teeth have been altered in this way they become susceptible to damage and tooth decay. It is quite difficult for patients to properly clean the areas around and under dental bridges, which causes an accumulation of dental plaque and an increased susceptibility of tooth decay and gum disease. As in the case of dentures, the jawbone in the area where teeth are missing will shrink, weaken and deteriorate over time, which can cause the surrounding teeth to become loose, change position and even fracture in some cases. This mobility of the teeth will then create a situation where the structural integrity of the bridge is at risk.


The average long term success rate of dental implant surgery in a healthy patient with good bone structure is over 95 percent. This figure can change to between 85 and 90 percent in patients who require bone grafting to increase density and to ensure that the implant will anchor well. For smokers, the failure rate of dental implants is about two times higher compared to non-smokers. Experienced implant dentists have success rate records as high as 99 percent for patients with healthy jawbone and gums. One of the most appealing aspects of a dental implant is that it works just like a natural tooth, without requiring any special care and without causing any damage to adjacent teeth. The only requirement to ensure the long life of a dental implant is for the patient to continue to maintain good dental health and proper daily oral hygiene – exactly as they would for natural teeth.


Once a dental implant has been placed and has properly integrated into the bone (a process called osseointegration) that implant can be expected to last for a lifetime, whereas dental bridges require replacement every ten years on average (due to bridge failure or adjacent teeth failure). Dentures also need to be replaced or modified about every five to ten years due to improper fit and bone loss. Therefore, although the initial expense for dentures and bridges may be relatively low, over time that cost will rise as repairs and replacements are needed, and as oral treatments are required due to gum disease and repair or loss of surrounding teeth. General health will also be affected as ill-fitting dentures do not allow for proper and efficient chewing.

Dental implants provide a much better aesthetic and functional results compared to alternative dental restorations. They help to ensure that a patient will be able to maintain their usual eating habits, keep a natural appearance and speak and chew without the embarrassment often caused by removable dentures.

Ceramic Implants For Teeth


In the world of medicine, zirconium oxide is being used more consistently as the material of choice for bone related reconstruction, particularly hip prosthesis. This growing trend has led to substantial clinical reports which confirm the high biocompatibility and quality of zirconium oxide, making it an attractive component for use as dental implants. Not only does Zirconium Oxide overcome most of the pitfalls of other dental implant products (such as Titanium), but patients now have a choice of a material that is esthetic, strong, pure, corrosion-free, biocompatible and capable of being used for all dental implant and appliance applications.


The immune system will typically respond to non-compatible dental materials as if they were infections or ‘invaders’ by initiating a cascade of reactions geared toward eliminating that ‘invader’. A good analogy to this would be how your body reacts to a cold or flu by elevating levels of lymphocytes and activating the immune system, a reaction that eventually rids the body of the cold or flu. The difference is that with dental toxicity the source of the problem is permanently imbedded in the mouth, and therefore there is no way for the ‘infection’ to be eliminated by the immune system.

Using only quality biocompatible materials that are proven to have very low adverse allergic reactions and present no negative responses from the immune system is highly important for the health of our patients. It is also the reason that biological, natural and holistic dental practices strive to use only materials that are as neutral as possible. Zirconium is a very strong, inert material with very low allergic potential and therefore a higher biocompatibility than other materials used as dental implants.


Considering that every person’s body and physiology is unique, some individuals will be more compatible than others with certain types of materials used in dental treatments and procedures. But ultimately, a biocompatible material will not cause:

  • allergic reaction
  • irritation
  • inflammation
  • foreign body response (rejection)
  • cancer and other autoimmune disorders

An all-ceramic dental crown over an all-ceramic dental implant looks and functions very much like the missing tooth did. Ceramic implants provide metal-free tooth replacement solutions, eliminating concerns of allergies and biocompatibility issues thereby lessening concerns for damage to the immune system. Zirconium Oxide provides safe, holistic results that are comfortable, natural in appearance and biocompatible:

  • Zirconia implant is the holistic dental implant for absolute metal-free dentistry
  • The white color of Zirconium far surpasses the metallic appearance of Titanium
  • Ceramic implants and crowns retain less plaque and calculus than Titanium and therefore promote healthier gums and mouth

Our objective is to make as many biocompatible options available to our patients as possible and it is important to us to achieve the highest level of biocompatibility, particularly in cases where patients have compromised immune systems. Whenever considering a dental restoration we strongly suggest that extensive biocompatibility and metal allergy testing be done beforehand to ensure the best results.