This article was written by Dr. Noumbissi and published in the January 2013 edition (International Section) for the Orofacial Chronicle Journal from Bhopal, India.

Background

Since Dr. Brånemark first introduced titanium dental implants, a variety of materials have been used successfully for about 40 years. Today implants are made either of commercially pure titanium (cpTi) or titanium alloys.  In addition to its biocompatibility, titanium was also initially believed to be inert, nontoxic and nonallergenic1,2. However, several drawbacks have been documented in the literature with the use of titanium and titanium alloys as implant materials in medicine and dentistry. High concentrations of titanium have been detected in tissue surrounding dental implants mostly as a result of wear or corrosion of the titanium implant surface.  In an animal study Weingart et al.3   showed that nine months after titanium implantation, titanium particles had spread and were found in adjacent lymph nodes. This indicates the possibility that phagocytes could transport titanium particles to the lymph nodes without any initial or immediate inflammatory response and potentially cause later immunologic reactions.

The Facts

An increasing number of people who suffer some form tooth loss are choosing to replace their teeth with dental implants. For the last thirty plus years the only and highly successful option for freestanding tooth replacement available in the United States and other countries has been titanium and titanium alloy dental implants. There are increasing reports both in dentistry and medicine of individuals developing sensitivity and allergies to titanium and/or titanium alloys. Even of more concern some of these implants are corroding once exposed to body fluids such as saliva and developing electrical activity when they are coupled with prosthetic components made of other metal alloys. Titanium implants as they corrode are known to release metal ions which create low level electrical currents through the body but also weakens the structural integrity of the implants. With recent advances in implantable biomaterials research and technology, bioceramics such as zirconia (zirconium dioxide) are now available and a new generation of modern implants is made of zirconia. Zirconium Silicate (ZrSO4) is mined and is treated and transformed into zirconium dioxide which is also called zirconia. Zirconia is the crystal form of the material zirconium which is a transitional metal. After mining and processing of zirconium silicate, zirconium is isolated and further processed under high temperature and pressure. Zirconium then undergoes an oxidation and crystallization process which allows it to transition into a structurally stable and inert crystal. This bioceramic crystal is called Yttrium Stabilized Tetragonal Zirconium Polycrystal (Y-TZP) also called zirconium dioxide. Therefore zirconium dioxide is not a metal and presents exceptional physical and biological properties. Zirconia can sustain an extreme load capacity, features a very long service life, and presents no conductivity or interference in the body’s meridian systems; it is the most hygienic, non-electricity conducting and stable material for dental implantology and orthopedics. Zirconia implants also present no danger of corrosion, something that is often a serious problem with metal based dental implants. Corrosion of a titanium dental implant occurs when it is coupled with the metal framework or abutment of the crown which more often than not is a less noble metal or alloy than that of the titanium implant. The implant and crown assembly bathes in saliva which is an electrolyte and a good conductor of electricity; this leads to all sorts of chemical and electrical imbalances in the body and to a phenomenon called “battery mouth”. Another advantage of zirconia is its low affinity for plaque (picture#1). Clinical observations and studies show that zirconia implants compared to or next to titanium implants accumulate much less plaque and allow for superior gingival health (picture #2).

Radioactivity and Zirconia Implants

There is a controversial and highly misunderstood aspect of zirconium dioxide in terms of its radiological output. Zirconium Silicate (ZrSO4) depending where it is mined can be contaminated with natural radioactive isotopes including radium (226Ra) and thorium (228Th). This was a major concern in the early 1990’s because the ores selected were contaminated. Today zirconium dioxide processing plants have the technology to remove these contaminants and are able to yield and use very pure powders. For example, the radiation emitted by a 3 mol% Y2O3-ZrO2powder was the same order of magnitude as alumina powder, both of which were several orders of magnitude less than that typically measured for water, vegetables and livestock. Zirconia hip ball replacements weigh approximately 100mg and have a natural radiological output of 1mSv per year. The average weight of a zirconia dental implant is 1g, translating into a natural radiological output of roughly 0.01mSv/year. Therefore the radiation risk of zirconia bioceramics is negligible and given that the World Nuclear Association states that the typical background radiation experienced by most people in North America is 3.4mSv, there is little concern for adverse biological effects on the implant recipient.

Conclusion

Zirconia dental implants are a sensible and clearly a healthier alternative to conventional and titanium implant bridges, partials or Overdentures. Furthermore zirconia by virtue of its translucency and all-white color makes it the most aesthetically pleasing option available today for tooth replacement (picture #3 & picture #4). This is a new era in implant dentistry and the science of oral implantology.

Referrences:

1-  Rabin, Steven I., MD; Calhoun, Jason H., MD, FACS, editor: Immune Response to Implants  

2- Allauddin A Siddiqi, Alan G T AG Payne,Warwick J WJ Duncan. Titanium allergy: could it affect dental implant integration? Clin Oral Implants Res 22(7):673-80 (2011)  

3- Weingart D, Steinmann S, Schili W, Strub JR, Hellerich U, Assenmacher J, Simpson J. Titanium deposition in regional lymph nodes after insertion of titanium screw implants in the maxillofacial region. Int J Oral Maxillofac Surg.1994 Dec:23 (6Pt2): 450-2  

4- 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 Feb;75(2):292-6

What’s the Best Way to Replace a Tooth?

While both dentures and implants will fill the gaps left by missing teeth, there are other important considerations to be aware of when making a choice for dental repairs:

• biocompatibility
• durability
• comfort
• cost

The expense associated with implants

The higher cost of dental implants can be the biggest obstacle for many patients to overcome when it comes to replacing one or more missing teeth. Despite their aesthetic and greater functional superiority the initial price of dental implants can cause many people to lean towards more conventional and less expensive options like bridges or dentures.

Success in the short term

Second to cost, another attractive aspect to dental bridges or dentures is the quick turnaround time since they can be ready and fitted at about 2 weeks, while dental implants take longer to become fully integrated into the mouth and jaw before they reach their peak performance level

However, there are a few additional costs associated with dentures and bridges which can include:

• restoring decayed teeth surrounding bridges
• treating gum disease caused by improperly fitted dentures and difficult to reach pockets created by bridges
• maintaining, repairing and replacing partial or fully removable dentures

The real cost of short sightedness

The actual physical structure of a jaw without teeth will initially shrink quite rapidly most particularly during the first six months — and more slowly over time for the remainder of the patient’s life. Consequently, when a denture is made to fit a person’s jaw it will need to be remade and refitted as the jawbone shrinks.

The teeth in a denture appliance eventually wear down and become less effective at chewing food. Worn denture teeth naturally cause a person to bite and chew with more force, pushing the denture into the jawbone, causing the bone to shrink at an even faster rate. Jawbone deterioration and loss is the major problem with removable dentures, a problem that also works to increase the speed of a person’s aging process. Grinding of the teeth will decrease the life of a denture also.

When a dental bridge is used to replace missing teeth, the supporting or adjacent teeth have to be ground down in order to make room for the support post of the bridge. Once the adjacent teeth have been altered in this way they become susceptible to damage and tooth decay. It is quite difficult for patients to properly clean the areas around and under dental bridges, which causes an accumulation of dental plaque and an increased susceptibility of tooth decay and gum disease. As in the case of dentures, the jawbone in the area where teeth are missing will shrink, weaken and deteriorate over time, which can cause the surrounding teeth to become loose, change position and even fracture in some cases. This mobility of the teeth will then create a situation where the structural integrity of the bridge is at risk.

The best long term solution

The average long term success rate of dental implant surgery in a healthy patient with good bone structure is over 95 percent. This figure can change to between 85 and 90 percent in patients who require bone grafting to increase density and to ensure that the implant will anchor well. For smokers, the failure rate of dental implants is about two times higher compared to non-smokers. Experienced implant dentists have success rate records as high as 99 percent for patients with healthy jawbone and gums. One of the most appealing aspects of a dental implant is that it works just like a natural tooth, without requiring any special care and without causing any damage to adjacent teeth. The only requirement to ensure the long life of a dental implant is for the patient to continue to maintain good dental health and proper daily oral hygiene – exactly as they would for natural teeth.

Lasting results

Once a dental implant has been placed and has properly integrated into the bone (a process called osseointegration) that implant can be expected to last for a lifetime, whereas dental bridges require replacement every ten years on average (due to bridge failure or adjacent teeth failure). Dentures also need to be replaced or modified about every five to ten years due to improper fit and bone loss. Therefore, although the initial expense for dentures and bridges may be relatively low, over time that cost will rise as repairs and replacements are needed, and as oral treatments are required due to gum disease and repair or loss of surrounding teeth. General health will also be affected as ill-fitting dentures do not allow for proper and efficient chewing.

Dental implants provide a much better aesthetic and functional results compared to alternative dental restorations. They help to ensure that a patient will be able to maintain their usual eating habits, keep a natural appearance and speak and chew without the embarrassment often caused by removable dentures.

Cell Phones May Pose Increased Health Hazards to Patients with Metallic Dental Implants

All cell phones emit electromagnetic radiation called RF (radio frequency) and EMF (electromagnetic fields). Considering the close proximity of the cell phone to the head during use, there is clear potential for EMF emissions to be harmful to any of the 300 million healthy cell-phone users in the United States today. However, patients who have undergone metal implant surgery as well as those who may still have amalgam fillings and/or dental fixtures are potentially at a much higher risk of harm than someone who has no metallic structures in their mouth whatsoever.

The use of metallic implants and fillings in the mouth is known to have the ability to create a potentially dangerous situation called ‘galvanism’. The body’s normal electrical (bioenergetic) current fluctuates at about 450 millivolts. Galvanism occurs when saliva mixes with amalgam (or metal) fillings and/or implants resulting in a jump of the normal oral electric current up to 1,000 millivolts or higher. This jump in oral electric current is without factoring in the amplified EMF fields associated with cell phone use and other types of exposure to electromagnetic fields. This kind of highly charged electrical current can quite easily overpower the body’s normal electrical flows and potentially interfere with energy flow to the brain. It is also suspected of causing various irritations to the nervous system.

What kind of damage are we talking about?

Studies have shown that the radiation from cell phones to which the user is exposed may in fact be the culprit behind a wide range of health problems including headaches, pressure or tingling in the head, earaches, eye problems including distortion of vision, memory loss, fatigue, brain tumors, DNA alteration or damage and changes in the brains electrical activity. Some studies have shown rats to develop lymphoma from prolonged electromagnetic fields exposure. For patients who have metallic dental repairs, the risk is quantified significantly. Additional symptoms may include:

• Increased arthritis
• Skin problems
• Ear problems
• Risk to leukemia
• Childhood cancer
• Sleep problems
• Depression
• Difficulty in concentrating
• Mental conditions

For more than thirty years, research conducted at the Electric Power Research Institute (EPRI) has focused on whether EMF associated with electricity can cause biologic changes or negatively affect health. Hundreds of studies have also been reviewed in health risk evaluations by the World Health Organization and other national and international organizations concerned with public health.

While some red flags have been raised over the years, what is being debated now at the national and international level is just how much radiation should be considered ‘unsafe’, and if there are any potential long-term side effects of continued cell-phone radiation exposure. Nobody knows with certainty what long-term health consequences EMF-induced biological effects may lead to – or how co-mingling metal implants and dental repairs with EMF radiation might affect the human body. The issue remains quite controversial. However, due to the growing depth of evidence pointing to various problematic interactions, concern is justified. Regardless, research has clearly shown that electromagnetic emissions from cell phones can cause significant biological effects and we know for a fact that metallic dental implants and fillings can create an electrical resonance of their own. When you combine these two disparate elements together, you have a potential recipe for disaster – one that can pose serious challenges to the long term health and wellness of anyone who has been fitted with metallic dental materials.

How metal implants may exaggerate harmful effects posed by cell phone use

Having dissimilar metals in the teeth (e.g.-amalgam; or gold and mercury, or stainless steel and mercury and/or titanium) causes a measurable galvanic action, or electrical currents, this is what is called “battery mouth”. These types of currents cause the amalgam levels (more often than not containing mercury vapor) to rise in surrounding tissues. The average mercury levels in gum tissue near amalgam fillings is about 200 ppm, and are the result of mercury flowing directly into the mucous membrane by way of galvanic currents. Dental amalgams also release significant amounts of silver, tin and copper which have well known toxic effects of their own. Even more alarming is the fact that amalgam containing zinc produces even higher galvanic currents.

Electrical currents can harm the immune system

Among other things, the electric currents and ionic flow between various dental alloys has been shown to cause irritation in the trigeminal nerve which is the main cranial nerve system; blocking the flow of major acupuncture meridians. This blockage can lead to greater overall dysfunction throughout the body and it can significantly challenge the immune system, which in turn can lead to chronic and debilitating health issues. It doesn’t take a much of an increase in the flow of energy to create harmful effects in the human body. Scientific studies associated with oral galvanism have determined that currents of just over 5 microamps is usually enough to cause significant health problems such as headaches, migraines, dizziness, nausea, etc. Removing the amalgam filling, metal fixture or dental repair essentially eliminated the problem in patients participating in this study.

Some studies have also found persons with chronic environmental exposure to electromagnetic fields including microwaves or MRIs to have higher levels of mercury exposure and excretion. And, interestingly enough, post MRI saliva mercury levels for a sample of patients reported on average 31 percent higher after MRI than before.

What the research reveals about metallic implants and cell phone use

Researchers in one study involved two basic types of implants: metallic pins and rings in the surface layers of the human body – positioned near the mobile phone. The goal in this case was to discover ‘the worst case scenario’ with respect to energy absorption. Researchers noted that “Based on the simulations of this study, the local absorption of EM field in a limited volume may be significantly (even by a factor of 700) enhanced by a conductive implant in the surface layer of a human body. The mobile phone and the metallic implant are strongly coupled, especially when the implant is close to a mobile phone, its length is in resonance with the field, and it is aligned with the antenna. This coupling can be either conductive, magnetic or both (Troulis et al 2003).”

Immediate symptoms of heightened danger

A few recommendations for reducing exposure to harmful EMF radiation when using a cell phone might include making only short and essential calls, and always use hands-free wired kits. Some studies suggest that positioning the phone’s antenna far away from the body during the calls may also be helpful. But, how can you tell if your cell phone is causing a problem? Several topical symptoms are immediately recognizable and they include:

• Fatigue
• Headache
• Warmth behind the ear
• Warmth on the ear
• Burning skin

The long term solution

Removing any amalgam fillings, metal fixtures or dental repairs will more than likely eliminate potential and confirmed health problems in patients. Overall, ceramic dental implants and repairs are the best alternative and they are highly resistant to corrosion and superior to other implant materials such as titanium and amalgams. They also have a higher level of human biocompatibility with the added benefit of a far superior aesthetic value for patients.

Sources:

JOÓ, ERVIN, ANDRÁS SZÁSZ, AND PÉTER SZENDRÖ. “Metal-Framed Spectacles and Implants and Specific Absorption Rate Among Adults and Children Using Mobile Phones at 900/1800/2100 MHz.” Electromagnetic Biology and Medicine, 25: 103–112, 2006.

H Virtanen, J Huttunen, A Toropainen and R Lappalainen. “Interaction of mobile phones with superficial passive metallic implants.” Physics in Medicine and Biology 50 (2005) 2689–2700.

H Virtanen, J Keshvari and R Lappalainen. “The effect of authentic metallic implants on the SAR distribution of the head exposed to 900, 1800 and 2450 MHz dipole near field.” Physics in Medicine and Biology 52 (2007) 1221–1236.

Has the Dental Work in Your Mouth Turned You Into a Walking Antenna? http://www.drlinagarcia.com/view_articles.php,t=30

The prevention of occupational risks of electromagnetic fields. http://www.officiel-prevention.com/protections-collectives-organisation-ergonomie/rayonnements/detail_dossier_CHSCT.php?rub=38&ssrub=126&dossid=338

Dr. Sammy Noumbissi from Miles of Smiles Implant Dentistry now proudly places both CeraRoot and Z-Systems zirconia ceramic, metal-free dental implants at his office in Silver Spring, Maryland.

Thursday, May 10, 2012 Silver Spring, Maryland — Ceramic implant dentist, Dr. Sammy Noumbissi, offers patients from the Washington DC and Maryland area metal-free, ceramic (zirconia or zirconium oxide) dental implants at his CeraRoot and Z-Systems certified dental practice.

Ceramic, metal-free dental implants are a natural and biological solution to dental implants. They provide natural looking, comfortable, permanent, and attractive replacements for natural teeth, eliminating the need for painful and unattractive dentures and partials.

At Miles of Smiles Implant Dentistry, Dr. Noumbissi believes in a holistic and biologic approach to dentistry as a whole and more specifically dental implantology. Maintaining the integrity and health of your mouth and teeth is increasingly proven to be paramount to your overall health; today more than ever the mouth-to-body connection is well established and having all your teeth allows for better nutrition and health. As such, missing teeth should be replaced. The best option?

“Dental implants,” says Dr. Noumbissi. “However, the only option in the United States up until January 2011 were titanium implants. We are now offering ceramic metal-free dental implants; these biocompatible dental implants have been the tooth replacement of choice in Europe for several years. They are made of a natural ceramic material called zirconia and, by virtue of its superior biocompatibility, it has a higher bone integration rate than the widely used titanium implants.”

Zirconia is one of the hardest substances known to man — harder even than titanium. Also, because it is white it allows for natural and superior esthetic results. Therefore, ceramic implants eliminate the gray metal lines that often show through gums with traditional titanium implants.

For patients who are sensitive or allergic to many materials, ceramic dental implants can be a terrific option. There is no known allergy to zirconia and, unlike titanium, implants they will not corrode.

Patients now have the choice of a material that is esthetic, strong, pure, biocompatible and capable of being used for single teeth, long span dental bridgework and even for a full mouth of teeth replacement.

Call now to receive more information: (301) 588- 0768 or visit www.milesofsmilesdental.net

About Dr. Noumbissi:
Dr. Noumbissi is a certified dental implantologist for both CeraRoot and Z-Systems dental implants — the only FDA approved ceramic implants in the United States. His office provides Maryland and Washington DC residents with safe, effective, lasting dental implants. For more information about Dr. Noumbissi please call 301-588-0768 or visit online: http://MilesofSmilesDental.net

Contact:
Dr. Sammy Noumbissi
301-588-0768

http://MilesofSmilesDental.net

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When You Look Good – We Look Good

With the alarming number of Americans who suffer some form tooth loss every year, ceramic dental implants represent the most important and aesthetically pleasing option available today for tooth replacement. We find that the newest form of ceramic implants is comfortable for our patients, and due to their all-white color they are highly attractive in appearance. Dental implants are a sensible alternative to bridges, partials or dentures and most importantly; ceramic dental implants look and feel like natural teeth, so much so that you might forget that you ever lost a tooth.

How it works

A dental implant is created from a high performance material called zirconium oxide that is inserted into the jaw bone to act like a natural tooth-root. Due to its nonmetallic construction the ceramic dental implant does not interfere with the body’s immune or meridian systems and therefore does not create a potential for rejection. Once anchored into the jaw, the implant integrates directly into the bone to give firm support to the artificial replacement that it is built to hold.

Advantages of Ceramic Dental Implants

When it comes to options for tooth replacement patients are increasingly choosing dental implants over more conventional dental prostheses. Not only does and implant sit securely in the jaw and look like natural teeth, they also offer superior durability and outstanding aesthetics. Implants of a variety of materials have been used successfully for about 40 years and the latest generation of ceramic implant systems made of zirconium oxide takes the science of dental implants to the next level. Ceramic implants also present almost no danger of corrosion, something that is often a serious problem with metal based dental implants.

With a ceramic dental implant it is possible for patients to enjoy the most natural form of firmly anchored teeth, without having to resort to the inconvenience and embarrassment of dentures. In addition, the ceramic implant creates a beautiful restoration that is extremely stable and strong, able to withstand even the most intense chewing demands.

The material known as zirconium oxide comes from the mineral zircon, which possesses all the advantages that earlier forms of ceramics had to offer, plus it is able to sustain an extreme load capacity, features a very long service life, and presents no conductivity or interference in the body’s meridian systems. We value it for its striking resemblance to natural teeth which offers an aesthetically perfect final result for our patients.

Reasons to consider a ceramic dental implant:

• naturally replace the missing teeth without affecting/grinding the surrounding teeth
• no electrical currents between the titanium implant and the crown on the implant
• there is no ion release to your mouth and body
• no corrosion of the implant
• looks and feel like natural teeth
• increases self-confidence when eating, talking and smiling
• no gooey denture adhesives or embarrassing loose dentures
• improves speech
• perfect comfort and fit

Ultimately, not worrying about your dentures falling out of your mouth when you are speaking or eating offers a freedom that simply makes sense. The more naturally stable foundation offered by a dental implant certainly improves biting pressure, making it possible to enjoy the foods that you probably would not be able to using a dental prosthetic. With improved chewing ability you are also likely to have a better diet and therefore improved overall healthfulness.

A ceramic dental implant restoration is now more convenient and clearly a healthier alternative to metal implants. To learn more about ceramic dental implants and other services we offer, or to schedule an evaluation give us a call at 301-588-0768 or Request an Implant Evaluation by Clicking Here.