Implants · patient case question
Apart from esthetics, what advantage does a zirconia implant offer over titanium?
Patient case: Implant planning in compromised bone
Patient: Female, 66 years old
Chief Complaint: “I would like an implant to replace this back tooth.”
Background: DEXA scan two years ago showed OSTEOPENIA at the lumbar spine. She has never taken a bisphosphonate or denosumab. Non-smoker, no diabetes.
Vital Signs: BP 130/78 mmHg · HR 72 bpm
Findings: Tooth #30 was extracted eight months ago and the site has healed. Adequate ridge width and height on CBCT. She has read about ceramic implants and asks whether zirconia would be better than titanium.
Show answer and explanation
Correct answer: D. Reduced bacterial adhesion to the implant surface with a favourable soft-tissue response
- A. Zirconia implants are generally MORE expensive than titanium, not less.
- B. Fracture toughness is zirconia's WEAKNESS relative to titanium, not its strength. Zirconia is a ceramic — it is brittle, subject to crack propagation and to low-temperature degradation (ageing) in a wet environment, and one-piece designs cannot be angle-corrected after placement. This is the principal reason titanium remains the default.
- C. Narrow ridges argue AGAINST zirconia. Because it is brittle, narrow-diameter zirconia fixtures carry a meaningful fracture risk, whereas titanium tolerates reduced diameters far better.
- D. CORRECT. Zirconia shows LOWER BACTERIAL ADHESION and less plaque accumulation on its surface than titanium, together with a favourable soft-tissue response and excellent biocompatibility. It is also highly resistant to CORROSION, avoids the grey show-through visible at a thin buccal gingiva, and is an option for the small number of patients who report titanium hypersensitivity.
Note: Titanium remains the standard of care on the strength of decades of documented survival data and the restorative flexibility of two-piece designs. Zirconia's case rests on soft-tissue response, esthetics in a thin biotype, and the absence of metal — not on mechanical superiority.