In our 2006 Annual Report, we published an interview with Dr Michael Gahlert and Prof. Heinz Kniha, who are pioneers in the use of ceramic implants. At their orthodontic practice in Munich, Germany, they have placed, tracked and documented more than 400 implants of this kind over the past six years and have been heavily involved in clinical trials.
What are the advantages of ceramic implants?

Ceramic implants are biocompatible and ‘inert’ in the body. They offer major advantages in terms of esthetics and are rarely colonized by bacteria – so we seldom find plaque on them. We also have clinical evidence of tissue apposition effects that are not apparent with titanium: a great benefit of this is that the gum ‘hugs’ the ceramic without irritation.

Are current ceramic implants difficult to place?

The ceramic implants we have today are single-stage designs, which means the abutment is integrated and cannot be used to correct the angle of the implant axis. The surgery has to be planned carefully to prevent divergences. Computer-guided surgery, position indicators, drill templates and other aids make it easier to position the axes precisely. Straumann is the first company to provide such tools in a ceramic implant set.

What about price?

Ceramic implants are more expensive that titanium, but they don’t need secondary components like abutments and cast-on components. When all the parts are taken into consideration, there is no major price difference between ceramic and titanium options. Price is important for some patients. As dentists, we need to work to raise awareness and explain that implants are high-tech medical devices that deliver topquality, sustainable performance and last a long time.

Have advances been made with regard to ceramic surface structure and osseointegration?

The micro-rough surface on the ceramic implants we use offers osseointegration that is equivalent to that of titanium implants, as we have shown in three preclinical studies. This means a high level of security. Ceramic implants are now an integral part of the work we do in our practice. For a long time there were no major clinical studies to support ceramic implants.

Has the situation changed?

Major studies have been published documenting the safety of ceramic implants. In addition, we have seen very good tissue attachment effects among the hundreds of ceramic implants, and three, five and seven year outcomes have already been evaluated. In a study of the first-generation ceramic implants, we did not – even after seven years – find a single case of even initial signs of inflammation around implant bodies.

When might ceramic implants make the breakthrough to widespread use?

The areas of application will be limited until a full range of ceramic implants becomes available. We don’t have a two-stage design yet, nor reduced-diameter ceramic implants for narrow alveolar ridges. Clinical data need to be collected to help build users’ confidence in this fascinating alternative to titanium implants.

Is your 2006 prediction of a 15-20% market share for ceramic implants still correct?

It is feasible that ceramic implants will achieve a 40% share of the US implant market in the long term. By contrast, the German market is more conservative and wedded to titanium. Health insurers are cautious about ceramic implants. Currently, about 10% of our patients want all-ceramic solutions. My forecast would be 25–30% in the medium term, rising to 50% in the long term.