J Korean Acad Prosthodont.  2019 Jan;57(1):88-94. 10.4047/jkap.2019.57.1.88.

A review of biocompatibility of zirconia and bioactivity as a zirconia implant: In vivo experiment

• Suh DW
• Kim YK
• Yi YJ

• KMID: 2432007
• DOI: http://doi.org/10.4047/jkap.2019.57.1.88

Abstract

Increasing demands for esthetic dental treatment, zirconia, which has high mechanical and esthetic properties, had been applied more and more in clinics. Therefore, assessment of biocompatibility of zirconia is necessary. In this article, a review of in vivo studies of zirconia compatibility was performed. In vivo studies showed zirconia had great biocompatibility both on soft and hard tissue. Studies with various animals and patients reported high biocompatibility of zirconia. In terms of bone synthesis and bone adhesion, zirconia showed similar biocompatible properties to titanium. On the other hand, zirconia could be used as implant. For using as an implant, various methods of Hydroxyapatite (HA) coating had been suggested. Since HA coating on titanium implant showed some problems such as low bonding strength and degeneration of HA, HA-zirconia composite, HA-coated zirconia, and HA-zirconia functionally graded material (FGM) or intermediate layer of alumina had been proposed. These methods showed higher bonding strength and biocompatibility.

Keyword

Bioactivity; Biocompatibility; HA coating; Implant; Zirconia

MeSH Terms

Aluminum Oxide
Animals
Durapatite
Hand
Humans
Titanium
Aluminum Oxide
Durapatite
Titanium

Reference

1. Helmer JD, Driskell TD. Research on bioceramics. Symposium on use of ceramics as surgical implants. Clemson, SC: Clemson University;1969.

2. Deany IL. Recent advances in ceramics for dentistry. Crit Rev Oral Biol Med. 1996; 7:134–143.

3. Garvie RC, Urbani C, Kennedy DR, McNeuer JC. Biocompatibility of magnesia-partially stabilized zirconia (Mg-PSZ) ceramics. J Mater Sci. 1984; 19:3224–3228.

4. Hulbert SF, Morrison SJ, Klawitter JJ. Tissue reaction to three ceramics of porous and non-porous structures. J Biomed Mater Res. 1972; 6:347–374.

5. Christel P, Meunier A, Heller M, Torre JP, Peille CN. Mechanical properties and short-term in-vivo evaluation of yttrium-oxide-partially-stabilized zirconia. J Biomed Mater Res. 1989; 23:45–61.

6. Ichikawa Y, Akagawa Y, Nikai H, Tsuru H. Tissue compatibility and stability of a new zirconia ceramic in vivo. J Prosthet Dent. 1992; 68:322–326.

7. Bianchi AE, Bosetti M, Dolci G Jr, Sberna MT, Sanfilippo S, Cannas M. In vitro and in vivo follow-up of titanium transmucosal implants with a zirconia collar. J Appl Biomater Biomech. 2004; 2:143–150.

8. Degidi M, Artese L, Scarano A, Perrotti V, Gehrke P, Piattelli A. Inflammatory infiltrate, microvessel density, nitric oxide synthase expression, vascular endothelial growth factor expression, and proliferative activity in peri-implant soft tissues around titanium and zirconium oxide healing caps. J Periodontol. 2006; 77:73–80.

9. Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A. Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study. J Periodontol. 2004; 75:292–296.

10. Rimondini L, Cerroni L, Carrassi A, Torricelli P. Bacterial colonization of zirconia ceramic surfaces: an in vitro and in vivo study. Int J Oral Maxillofac Implants. 2002; 17:793–798.

11. Scarano A, Di Carlo F, Quaranta M, Piattelli A. Bone response to zirconia ceramic implants: an experimental study in rabbits. J Oral Implantol. 2003; 29:8–12.

12. Sennerby L, Dasmah A, Larsson B, Iverhed M. Bone tissue responses to surface-modified zirconia implants: A histomorphometric and removal torque study in the rabbit. Clin Implant Dent Relat Res. 2005; 7:S13–S20.

13. Piconi C, Burger W, Richter HG, Cittadini A, Maccauro G, Covacci V, Bruzzese N, Ricci GA, Marmo E. Y-TZP ceramics for artificial joint replacements. Biomaterials. 1998; 19:1489–1494.

14. Akagawa Y, Ichikawa Y, Nikai H, Tsuru H. Interface histology of unloaded and early loaded partially stabilized zirconia endosseous implant in initial bone healing. J Prosthet Dent. 1993; 69:599–604.

15. Schultze-Mosgau S, Schliephake H, Radespiel-Tröger M, Neukam FW. Osseointegration of endodontic endosseous cones: zirconium oxide vs titanium. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89:91–98.

16. Warashina H, Sakano S, Kitamura S, Yamauchi KI, Yamaguchi J, Ishiguro N, Hasegawa Y. Biological reaction to alumina, zirconia, titanium and polyethylene particles implanted onto murine calvaria. Biomaterials. 2003; 24:3655–3661.

17. MacDonald DE, Betts F, Stranick M, Doty S, Boskey AL. Physicochemical study of plasma-sprayed hydroxyapatitecoated implants in humans. J Biomed Mater Res. 2001; 54:480–490.

18. Kong YM, Kim S, Kim HE, Lee IS. Reinforcement of hydroxyapatite bioceramic by addition of ZrO₂ coated with Al₂O₃. J Am Ceram Soc. 1999; 82:2963–2968.

19. Kong YM, Kim DH, Kim HE, Heo SJ, Koak JY. Hydroxyapatite-based composite for dental implants: an in vivo removal torque experiment. J Biomed Mater Res. 2002; 63:714–721.

20. Alam I, Asahina I, Ohmamiuda K, Enomoto S. Comparative study of biphasic calcium phosphate ceramics impregnated with rhBMP-2 as bone substitutes. J Biomed Mater Res. 2001; 54:129–138.

21. Kong YM, Bae CJ, Lee SH, Kim HW, Kim HE. Improvement in biocompatibility of ZrO₂-Al₂O₃ nano-composite by addition of HA. Biomaterials. 2005; 26:509–517.

22. Silva VV, Lameiras FS, Lobato ZI. Biological reactivity of zirconia-hydroxyapatite composites. J Biomed Mater Res. 2002; 63:583–590.

23. Torricelli P, Verné E, Brovarone CV, Appendino P, Rustichelli F, Krajewski A, Ravaglioli A, Pierini G, Fini M, Giavaresi G, Giardino R. Biological glass coating on ceramic materials: in vitro evaluation using primary osteoblast cultures from healthy and osteopenic rat bone. Biomaterials. 2001; 22:2535–2543.

24. Kim HW, Georgiou G, Knowles JC, Koh YH, Kim HE. Calcium phosphates and glass composite coatings on zirconia for enhanced biocompatibility. Biomaterials. 2004; 25:4203–4213.

25. Guo H, Khor KA, Boey YC, Miao X. Laminated and functionally graded hydroxyapatite/yttria stabilized tetragonal zirconia composites fabricated by spark plasma sintering. Biomaterials. 2003; 24:667–675.

26. Quan R, Yang D, Wu X, Wang H, Miao X, Li W. In vitro and in vivo biocompatibility of graded hydroxyapatite-zirconia composite bioceramic. J Mater Sci Mater Med. 2008; 19:183–187.

27. Afzal MAF, Kesarwani P, Reddy KM, Kalmodia S, Basu B, Balani K. Functionally graded hydroxyapatite-alumina-zirconia biocomposite: Synergy of toughness and biocompatibility. Mater Sci Eng C. 2012; 32:1164–1173.