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Ceramics: the future material for tooth replacement ?
An interview with Joachim Maier, Master Dental Technician, Oral Design Bodensee, Germany
Ceramics play a major role in modern dentistry. What makes them so important?
The discovery that high-performance ceramics could be used in dental engineering was made more than ten years ago, when zirconium oxide had proven to be highly resilient in extreme conditions, for instance in hip prostheses, or in motor vehicle brakes. The stability it showed was comparable to that of precious metal alloys in common use, but it was lighter and biocompatible. Ceramics are particularly attractive to patients who prefer to have what are considered ‘bio-materials’ in their mouths rather than metal alloys. In my lab, the bio-lifestyle has led to an enormous increase in demand over the past few years. At the same time, there has been a clear increase in the number of people who have allergies to metal. For them, metal-free replacements are the solution.
Will demand for ceramics in dentistry continue to increase?
I’m certain it will. In Switzerland and Germany, probably 80 percent of all crowns and bridges will be metal-free in ten years’ time. The trend towards biocompatible materials is increasing, because people today are well-informed, especially by the specialist health and lifestyle magazines, and selective. The most compelling argument for ceramics is their aesthetic properties. It is crucial for the patient that a bridge or a single artificial tooth should look natural. We apply up to five ceramic layers one on top of the other, which in turn are stained with up to 15 different shades. It is the interplay between these different stains that confers a natural look. This process is done by hand, which means that on average our dental technicians make only one or two units a day.
Then a ceramic bridge must be more expensive than a conventional metal bridge?
No, in some cases a ceramic solution actually costs less than, for example, a crown with a gold substructure. Although making substructures from high-performance ceramics is labour-intensive, the material costs are considerably lower and usually offset the labour charge. This is especially true for gold crowns, which have become very expensive with the rising price of gold. Ceramic solutions are an affordable alternative and make it possible for the patient to invest in an aesthetically more sophisticated and more appealing veneer. The colour, shape, natural appearance and aesthetics of new teeth are like a personal visiting card, especially in the anterior region of the mouth. Here, too, we do our utmost for the patient.
What developments are necessary in the next few years?
There is still quite a lot to do in the field of ceramic veneering. For example, silicate ceramic is a material that offers outstanding optical properties for natural looking prosthetics but its mechanical resilience has to improve before it can be used more widely. Alternative veneering ceramics are available, which meet our company’s stability requirements.
Are ceramic prosthetics subject regulatory requirements e.g. for quality?
Of course they are tested and have to meet certain standards. But the loads in the mouth are many and diverse and different for every individual. It is difficult to exactly simulate these loads in studies.
What would be the biggest breakthrough in dental ceramics?
A really big breakthrough would be if the osseointegration of ceramic implants could be improved to increase their success. Then it would be possible to offer an all-ceramic, metal-free solution, which would go a long way towards satisfying preferences for biomaterials. The most well-known ceramic implants have a one-piece design. During the healing phase of 4–6 months they have to be protected from the tongue and cheek pressure. The splints and interim prostheses used for this are not always comfortable for the patient. A further problem at the moment is also the lower success rate of these implants in the more porous bone of the mandible. In this respect ceramics are still at the stage where titanium implants were 20 years ago. In the mandible, the osseointegration characteristics of the best titanium implants are far superior. But this can change.
