Purpose: After some initial setbacks in the 1970s, ceramic implants seem to be a promising alternative to titanium implants. Since the surface of an implant system represents the interface to surrounding biologic structures, the study focuses on cleanliness and surface topography. Clinical documentation of the corresponding systems completes the picture and allows a better evaluation of zirconia implant systems.

Materials and methods: Five different ceramic implant systems were selected randomly and purchased via blind-shopping: Z5s (Z-Systems), ZiBone (COHO), W implant (TAVDental), ceramic. implant (vitaclinical), and BioWin!/Standard Zirkon Implantat (Champions-Implants/ZV3 system). Three samples of each implant system underwent scanning electron microscopy (SEM) imaging and elemental analysis (EDS). Where appropriate, subsequent Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) was performed to identify the chemical nature of impurities. Surface topography was evaluated, and a search for clinical trials in the PubMed database, on the websites and by written request to each dental implant manufacturer, was performed.

Results: Surfaces of Champions implants (ZV3) and Z-Systems implants were relatively clean, whereas the other investigated surfaces of vitaclinical, TAV Dental, and ZiBone implants all displayed organic contaminations on their surfaces. Four of the investigated ceramic implants showed a moderately rough implant surface. Only the vitaclinical ceramic.implant had minimal surface roughness. Three ceramic designs-vitaclinical, ZV3, and Z-Systems-had clinical trials documented with up to 3 years of follow-up and results varying between 82.5% and 100% survival. TAV Dental W and ZiBone implant systems lacked properly conducted clinical recording of results.

Conclusion: The results of this study showed that it is technically possible to produce zirconia implants that are largely residue-free. On the other hand, the variety of significant residues found in this analysis raises concerns, as contamination may lead to undesirable biologic effects. The lack of clinical studies in peer-reviewed journals does not seem to be relevant for the approval of marketing, nor does the lack of surface cleanliness. In the authors' opinion, a critical analysis of these aspects should be included in a more stringent future analysis prior to the marketing of oral implant systems.