Do ceramic implants show less bacterial colonisation?

When a bacterial biofilm is formed on implant materials this can lead to infections and finally to implant failure. For these reasons the attachment of bacteria and early biofilm formation have been tested for dental restoration materials made from zirconia in comparison to titanium.

Studies show a reduced bacterial colonization and adhesion, as well as reduced biofilm formation on ceramics compared to titanium implants.

Rimondini et al. 2002 and Scarano et al. 2004 showed reduced numbers of bacteria present on zirconia compared to titanium surfaces in the oral cavity of healthy human volunteers after 24 h. Similarly, Silva et al. (2018) and Wiessner et al. (2023) observed less in vivo biofilm formation on zirconia compared to titanium after 48 h and 24 h, respectively. Roehling et al. 2017 applied study set-ups that mimic the in vivo situation: a three species biofilm model and human plaque model. For both in vitro models a statistically significant reduction of biofilm thickness was measured on zirconia compared to titanium after 72 h, while biofilm metabolism was similar on both materials. In vitro, Al-Radha et al. (2012) detected less attachment of Streptococcus mitis and Prevotella nigrescens on zirconia compared to titanium (after 6 h), and Minkiewicz-Zochniak et al. (2021) measured weaker biofilm formation of patient-isolated S. aureus on zirconia compared to titanium and CoCr alloy (after 48 h). Sadid-Zadeh et al. (2020) observed reduced in vitro biofilm formation of P. gingivalis and A. actinomycetemcomitans, the main pathogens involved in periodontitis/peri-implantitis, on zirconia compared to titanium (after 72 h). Similarly, Chiou et al. 2023 found reduced early biofilm formation (3 days) on zirconia dental implants in vitro, while the number of bacteria was comparable between titanium and zirconia implants after the biofilms developed for a longer time (14 days).

In the German S3 guideline on the use of dental ceramic implants the authors write that “The highest bacterial load was found around titanium implants, followed by the zirconia implant and the natural tooth” (Thiem et al. 2022).

Of note, the surface texture strongly affects bacterial adhesion to biomaterials, with generally reduced bacterial attachment on smoother and more hydrophilic surfaces. Studies by Lu et al. (2020) and Dutra et al. (2017) compared bacterial attachment to zirconia surfaces of different roughness (Dutra: 0.13 - 1.16 µm; Lu: 1.1 - 205 nm). The results by Lu et al. (2020) were in favor of the smooth nano-scaled surface. Dutra et al. (2017) conclude “[…] that the Y-TZP ceramic may have low susceptibility to bacterial adhesion regardless of the surface condition”, and “[…] that this low susceptibility to bacterial adhesion can be considered an advantage of this material.”

References

Al-Radha AS, Dymock D, Younes C, O'Sullivan D. Surface properties of titanium and zirconia dental implant materials and their effect on bacterial adhesion. J Dent. 2012;40(2):146-153. doi:10.1016/j.jdent.2011.12.006.

Dutra D, Pereira G, Kantorski KZ, et al. Grinding with diamond burs and hydrothermal aging of a Y-TZP material: effect on the material surface characteristics and bacterial adhesion. Oper Dent. 2017;42(6):669-678. doi:10.2341/16-108-L.

Lu A, Gao Y, Jin T, Luo XC, Zeng QR, Shang ZT. Effects of surface roughness and texture on the bacterial adhesion on the bearing surface of bio-ceramic joint implants: an in vitro study. Ceram Int. 2020;46:6550-6559. doi:10.1016/jceramint.2019.11.139.

Minkiewicz-Zochniak A, Jarzynka S, Iwańska A et al. Biofilm formation on dental implant biomaterials by Staphylococcus aureus strains isolated from patients with cystic fibrosis. Materials (Basel). 2021;14(8):2030. doi:10.3390/ma14082030.

Chiou LL, Panariello BHD, Hamada Y, Gregory RL, Blanchard S, Duarte S. Comparison of in vitro biofilm formation on titanium and zirconia implants. Biomed Res Int. 2023;2023:8728499. doi:10.1155/2023/8728499.

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(6):793-798.

Roehling S, Astasov-Frauenhoffer M, Hauser-Gerspach I, et al. In vitro biofilm formation on titanium and zirconia implant surfaces. J Periodontol. 2017;88(3):298-307. doi:10.1902/jop.2016.160245.

Sadid-Zadeh R, Willis J, Forgo G, Haraszthy V. Comparative analysis of biofilm formation on materials used for the fabrication of implant-supported prostheses. Braz Dent J. 2020;31(4):380-384. doi:10.1590/0103-6440202003385.

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(2):292-296. doi:10.1902/jop.2004.75.2.292.

Silva TSO, Freitas AR, Pinheiro MLL, do Nascimento C, Watanabe E, Albuquerque RF. Oral biofilm formation on different materials for dental implants. J Vis Exp. 2018;(136):57756. doi:10.3791/57756.

Thiem DGE, Stephan D, Kniha K, et al. German S3 guideline on the use of dental ceramic implants. Int J Implant Dent. 2022;8(1):43. doi:10.1186/s40729-022-00445-z

Wiessner A, Wassmann T, Wiessner JM, et al. In vivo biofilm formation on novel PEEK, titanium, and zirconia implant abutment materials. Int J Mol Sci. 2023;24(2):1779. doi:10.3390/ijms24021779.