Ever since Per-Ingvar Brånemark’s chance discovery of the osseointegrative properties of titanium, the metal has set the standard for dental implant materials. In recent years, however, increasing patient demand for more natural esthetics has seen ceramic materials like zirconia become a popular alternative. A strong, biocompatible material, zirconia’s viability as a long-term implant option has continued to improve as developments in its manufacturing processes have occurred.

Discovery of osseointegration

The history of dental implants: a happy accident

The history of scientific breakthroughs is filled with unintentional or purely accidental findings that have gone on to revolutionize how medical professionals treat their patients. X-rays, vaccinations and penicillin are just a few examples of common treatment options whose usefulness was discovered by chance. Titanium’s use as a dental implant material can be added to this list.

In the 1950s, the young Swedish researcher Per-Ingvar Brånemark was busy studying the anatomy of blood flow. For this purpose, he attached an optical device to the leg of a rabbit, allowing him to observe the microcirculation in the animal’s bone tissue. The device was encased in a titanium chamber, and when it came time to remove the optics from the rabbit, Brånemark found that the metal and bone had become almost inseparable. The phenomenon of the human body accepting a foreign, non-biological material—something that was considered near impossible to achieve at the time – was termed “osseointegration” by Brånemark, and his research shifted to study it in-depth.1

In 1965, Brånemark placed his first titanium dental implants in a patient’s mouth. The patient, Gösta Larsson, was orally disabled at the time, born with a malformed jaw. When Larsson died in 2006, his initial set of implants were still in situ, working as the foundation for oral prostheses that had allowed him to eat and talk with ease – a clear sign of success for Brånemark’s work.

First dental implant patient

Titanium as the primary dental implant material

Other materials apart from titanium, such as cobalt-chromium and stainless steel, were occasionally used for dental implants during the practice’s infancy. However, their relatively low rates of success and poor osseointegrative properties soon rendered them unsuitable for long-term application.

Since 1965, titanium has become the go-to option for dental implants. Its low level of toxicity and allergenic potential, as well as its high resistance to corrosion, mean that it provides an ideal material for implant success. By 1977, Brånemark had already published the results of a 10-year study on the osseointegrative ability of implants inserted into edentulous patients,2 and when he presented his findings a few years later the audience was enthralled. Brånemark’s work demonstrated that titanium-based dental implants could be a long-term solution.

Experience success with TiUnite

TiUnite dental implant surface

Image © Schüpbach Ltd

Since its introduction in the Brånemark System in 2000, TiUnite has been one of the most thoroughly tested and documented implant surfaces on the market, clinically documented in more than 465 publications.3

A recent systematic review and meta-analysis, the largest ever of a single brand of dental implants, found that TiUnite surface implants had an estimated survival rate of more than 99% after one year, and 95.1% after ten years, at implant level.4 By maintaining implant stability as well as marginal bone and soft-tissue levels, TiUnite allows for peri-implant health and overall long-term implant success.5 Thanks to a wealth of supporting clinical research and sophisticated surface modification techniques, titanium’s position as the leading metal-based dental implant material is secure for the foreseeable future. However, there has been a recent increase in interest in metal-free implants,6 driven primarily by patients desiring as natural esthetics as possible.

NobelPearl: A ceramic dental implant


Ceramic-based implants: A brief history

As an alternative type of dental material to titanium, ceramic implants have been around for a surprisingly long time. In 1960, Prof. Sandhaus created the first ceramic implant made from aluminum oxide.7 In 1975, Dr. Schulte led a team which placed implants made of this material immediately after tooth loss, with the intention of maximizing soft tissue preservation.8 Though they initially appeared to be successful, these implants turned out to have a high rate of failure.9

Since Schulte’s initial research, the quality and reliability of ceramic materials has increased greatly thanks to improved manufacturing processes. Leading the charge is zirconium dioxide – or as its more commonly known, zirconia. Zirconia is a strong, biocompatible metal-free material that has the potential to be processed to possess an optical and esthetic rendering very close to natural teeth. This mimetic effect allows zirconia-based implants to blend in a natural fashion with the surrounding dentition and gum tissue.

Since the early 2000s, the most common type of zirconia used for ceramic dental implants has been yttria-stabilized zirconia (Y-TZP). Through an attribute known as transformation toughening, Y-TZP is able to be far more resistant to fracturing than previous iterations of zirconia.10

Another popular zirconia material is alumina-toughened zirconia (ATZ). Compared to Y-TZP it demonstrates reduced risk for low temperature degradation11 and more reliability over long-term use.12

NobelPearl: An esthetic, soft tissue-friendly alternative

NobelPearl: Two-piece ceramic dental implant

Through NobelPearl, Nobel Biocare is now able to supplement its industry-leading range of titanium dental implants with its first metal-free implant solution. NobelPearl is a two-piece ceramic implant system designed to support a natural soft-tissue appearance.13 Its high-performance metal-free VICARBO® screw allows for two-piece flexibility and a strong ceramic-to-ceramic connection. In addition, a cement-free abutment connection avoids the risks associated with intraoral cementation. NobelPearl also has a broad indication range, suitable for single-unit or multiple-unit restorations in anterior or posterior regions. NobelPearl provides a metal-free alternative to titanium that is bound to give you peace of mind and a successful start in ceramic implantology.

VICARBO® is a trademark of Dentalpoint AG



More to explore




  1. Brånemark, P-I. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-410.

  2. Brånemark, P-I, Hansson BO, Adell R, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl. 1977;16: 1-132.
  3. TiUnite literature search. Nobel Biocare Services AG. July, 2017.

  4. Karl M, Albrektsson T. Clinical performance of dental implants with a moderately rough (TiUnite) surface: a meta-analysis of prospective clinical studies. Int J Oral Maxillofac Implants 2017;32(4):717–734. Read more

  5. Karl M, Albrektsson T. Clinical performance of dental implants with a moderately rough (TiUnite) surface: a meta-analysis of prospective clinical studies. Int J Oral Maxillofac Implants 2017;32(4):717–734. Read more

    Östman PO, Hellman M, Sennerby L. Ten years later. Results from a prospective single-centre clinical study on 121 oxidized (TiUnite) Brånemark implants in 46 patients. Clin Implant Dent Relat Res 2012;14(6):852-860.

  6. Osman RB, Swain MV. A critical review of dental implant materials with an emphasis on titanium versus zirconia. Materials. 2015;8(3):932-958. 
  7. Ducheyne P, Hutmacher DW, Grainger DW et al.: Comprehensive Biomaterials II. 2nd ed. New York: Elsevier; 2017:114.
  8. Schulte W, Heimke G. Das Tübinger sofort-Implant [The Tübingen immediate implant]. Quintessenz, 1976;27:17–23
  9. Melinghoff J. Ceramic implants: Yesterday a vision, tomorrow a challenge? Ceramic Implants. 2017;1:14-17.
  10. Casellas D et al. On the transformation toughening of Y-ZrO2 ceramics with mixed Y-TZP/PSZ microstructures. J European Ceramic Society. 2001;21(6):765-777.

  11. Kohal RJ, Wolkewitz M, Mueller C.Alumina-reinforced zirconia implants: survival rate and fracture strength in a masticatory simulation trial.Clin Oral Implants Res. 2010 Dec;21(12):1345-52.

    Chevalier J. Low-Temperature Aging of Y-TZP Ceramics. J. Am. Ceram. Soc., 82 [8] 2150–54.

  12. Kawai Y, Uo M, et al. Phase transformation of zirconia ceramics by hydrothermal degradation. Dental Mater J. 30(3): 286-292.

    Spies BC, Sauter C, et al. Alumina reinforced zirconia implants: effects of cyclic loading and abutment modification on fracture resistance.Dent Mater. 2015 Mar;31(3):262-72.

  13. Cosgarea R, Gasparik C, Dudea D, et al. Peri-implant soft tissue colour around titanium and zirconia abutments: a prospective randomized controlled clinical study. Clin Oral Implants Res 2015; 26(5):537–544.

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