Dr. Saurabh Gupta
Education Director of The International Academy of Ceramic Implantology
Graduated from Manipal College of Dental Science, Manipal, India
Master’s Degree in Oral & Maxillofacial Surgery from RGYHS College, Bangalore
Board Member/Education Director of The International Academy of Ceramic Implantology
Member of The Zirconia Implant Research Group (ZIRG)
Member of the Bio-Ceramic Division at The American Ceramic Society, Ohio, US
Ambassador & Fellow at The Cleaning Implant Foundation, Germany
Founder & Director of WhiteZ Denta
Location: 6th Stage Further Extension, Banashankari Ksit, Raghuvanahalli, Bengaluru, India
IAOCI 2021 Event: https://www.iaoci.com/iaoci2021/
Digital Dental Design Clinic &DVG’s lab (3M Authorized), Bangalore, India
In Conversation with Dr. Saurabh Gupta
Zirconia implants have come a long way in recent years. The growing body of research around zirconia implants and their enhanced capabilities with biointegration clearly show that they have the potential to replace titanium as the material of choice. However, despite promising results and increased acceptance from patients, dental professionals are often hesitant to embrace zirconia implants.
Dr. Saurabh Gupta, the education director of The International Academy of Ceramic Implantology, provides insight on the growing body of research surrounding zirconia implants and their place within the large context of implantology. Our team at Zircon Medical recently hosted Dr. Gupta on our podcast series to discuss how and why zirconia implants represent the gold standard in implantology.
Introducing Dr. Saurabh Gupta, the board member/ education director of The International Academy of Ceramic Implantology
Dr. Saurabh Gupta graduated from Manipal College of Dental Science, India, one of Asia’s leading dental schools, and acquired a Master’s Degree in Oral & Maxillofacial Surgery from the Rajiv Gandhi University of Health Sciences, Bangalore. He is the founder and director of WhiteZ Dental, a family, cosmetic, and implant dental clinic located in Bengaluru, India.
Dr. Gupta is the education director/ board member of The International Academy of Ceramic Implantology, the first organization to work on metal-free implantology in the US. He also leads research work in the field of metal-free implantology as a member of The Zirconia Implant Research Group (ZIRG). He is also involved with the Bio-Ceramic Division atThe American Ceramic Society,Ohio, US.
Dr. Gupta is an ambassador and fellow at The Cleaning Implant Foundation, Germany, an organization that assesses the quality of products and cleanliness of implant surfaces available commercially. And he’s currently working on research studies focused on digital dentistry and implant materials. Due to his expertise with zirconia implants, he’s often invited to present guest lectures at national and international conferences.
Personal experience with zirconia implants
Dr. Gupta says he’s had an outstanding experience in the 5 years he’s been working with zirconia implants. He highlights two essential factors that impress him most about zirconia implants — biointegration and aesthetics. When it comes to biointegration, Dr. Gupta says soft tissues love the zirconia surface, allowing them to make great contact with zirconia implants. As for aesthetics, he says placing white implants gives him a deep sense of satisfaction, and they’re more readily embraced by patients.
When asked if he places 100% ceramic implants, Dr. Gupta emphasizes the need for incremental changes — the majority of the implants he’s placing are still titanium-based. He attributes this to a lack of awareness about zirconia implants, the cost factor, and numerous other factors. While he’s confident that the future of dental implantology belongs to zirconia, he believes the shift will happen gradually. Scientific research, he says, is essential to facilitate greater awareness about zirconia implants.
Ongoing research on zirconia implants
Dr. Gupta is the education director at The International Academy of Ceramic Implantology, an education platform where scientists come together to discuss all concerns regarding zirconia implants, including the material and surgeries. “We extract the best out of ceramic implants,” he says. “We’re currently training more physicians to place ceramic implants in a more precise and predictable manner, and we spread information and awareness about ceramic implants.”
In his multiple roles with organizations dedicated to zirconia implants, Dr. Gupta has realized that there’s a strong need for research and long-term studies.
“If we look into research,” Dr. Gupta says, “we have a good number of papers for short-term studies, but the long-term studies are lacking. The idea of this research group (ZIRG) was to have more scientific papers and clinical studies. We have already finished 10 to 15 papers in the last couple of years, and we’re also connecting with material scientists to learn about the material itself.”
The future of implantology belongs to zirconia
Dr. Gupta firmly believes that zirconia implants will form the standards of dental implantology in the near future, a shift that has already been precipitated by the inherent problems with titanium implants. He emphasizes three distinct reasons for his belief that zirconia implants will represent the gold standard in implantology — growing capabilities and research, patient acceptance, and flaws with titanium implants.
1. Zirconia implants haven’t reached research saturatio
Dr. Gupta says junior colleagues are often concerned about the risks of fracture and inadequate osseointegration with zirconia implants. However, a lot of that assumption comes from outdated information, and zirconia implants are constantly improving. He says, “the technologies and standardization are improving, the material is improving, and we’re successfully tackling problems that were commonplace 10 years ago.”
Dr. Gupta firmly believes that zirconia implants may soon display better osseointegration capabilities than titanium implants. He attributes this belief to the fact that zirconia implants, unlike titanium implants, haven’t reached research saturation. “In the past 30 years of titanium implants, everything that could be done has been done. With zirconia implants, a lot more development is in process.”
Dr. Gupta cited a study in UCLA which found that the amount of bone formation around zirconia implants was much higher than that of titanium implants. This shows that zirconia implants already comparable to titanium implants and still have a long way to go.
2. Patients want more organic and biocompatible implants
Dr. Gupta says surveys in Germany and Switzerland show that patients are actively demanding zirconia implants. He also says that he receives patients from UAE demanding zirconia implants in his clinic. While most patients still aren’t aware of zirconia implants, there’s a clear shift where patients are actively looking for “organic and more biocompatible materials for their bodies.”
As such, patients are much more likely to accept zirconia implants than titanium implants in the near future.
3. Zirconia overcomes flaws inherent in titanium implants
Dr. Gupta believes zirconia implants’ growing prominence is also precipitated by the inherent problems with titanium implants.
Currently, titanium implants are manufactured by over 400 companies, and many of them use different forms of titanium with impurities that can cause problems. Titanium implants already account for a 22% risk of peri-implantitis and a 43% risk of peri-mucositis, not including other potential problems, such as allergies to titanium and other metals mixed with titanium. These problems keep coming up, and zirconia is the only real solution.
An upcoming event on zirconia implants in Las Vegas
Dr. Gupta says the International Academy of Ceramic Implantology is currently organizing its 10th congress in Las Vegas to promote education on zirconia implants. The congress will be held from the 19th to the 21st of August and will include lectures from 20 speakers from across the globe, including Germany and the US. The conference will include discussions on all aspects of zirconia implants, including the materials, prosthetic cases, tissue parts, biointegration, clinical cases, and more.
Goals for the future
Dr. Gupta says he has three major goals for the near future:
Promote education on ceramic implantology.
Come up with more long-term studies for ceramic implants.
Encourage companies to improve manufacturing processes and standardization in testing.
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How Zirconia Implants Facilitate Optimal Biointegration
An independent article by the Zircon Medical Team
In the podcast cited earlier, Dr. Saurabh Gupta mentioned that he’s particularly drawn to zirconia implants because of two essential components — biointegration and aesthetics. We believe zirconia’s link with biointegration is worth exploring in greater detail because it’s a truly groundbreaking concept that can potentially revolutionize how dental professionals assess dental implants.
ince the early days of implantology, there has been a strong emphasis on osseointegration to ensure that titanium implants stay in the bone for long periods. However, titanium implants are associated with the risk of peri-implantitis, a specter that’s ever-present with all implants, including those performed using the most competent techniques and products.
Today, osseointegration isn’t enough to ensure long-term success. Instead, stable soft and hard tissue levels are critical — and that’s where biointegration and zirconia implants come into the picture.
What is biointegration?
Biointegration is the process whereby living tissues bond directly to some type of implant or foreign device implanted into the human body. Rather than simply ensuring the optimal integration of bone tissues, biointegration also focuses on soft tissue integration with complete stability under mechanical load for extended periods.
How is biointegration different from osseointegration?
According to the renowned Swedish anatomy professor, Per-Ingvar Brånemark’s, “Osseointegration is the direct connection between living bone and a load-carrying endosseous implant at the light microscopic level.” Osseointegration focuses on how bone tissues integrate with the implant without accounting for the integration and healing of gum tissues, which is just as important.
Biointegration is more holistic — it emphasizes hard tissue integration and soft tissue integration under mechanical load over a long period.
Why are zirconia implants more capable of biointegration than titanium implants?
In order to achieve optimal biointegration, a dental implant must display three essential features — the correct material, proper surface characteristics, and stable mechanical implant-abutment connection. Based on these features, zirconia implants are better placed to facilitate biointegration than titanium implants.
Zirconia is hypoallergenic and repels plaque-forming bacteria, it’s soft-tissue friendly, and it doesn’t oxidize, thereby minimizing the risk of inflammation. Meanwhile, titanium implants undergo an oxidation process that’s essential for osseointegration, but it also causes low-grade inflammation in the long run. As such, zirconia implants are better capable of preventing inflammation.
The ideal dental implant must have a very rough surface that allows newly-forming bone tissues to nestle along with the implant. The rough topography allows cells to mechanically anchor the surrounding implant bone in and around the implant.
Titanium implants have significantly evolved in this regard. They’ve moved away from machined implants, and all current titanium implants have rough surfaces essential for osseointegration. Titanium has historically been the preferred material because of its strength and mechanical properties even after achieving surface roughness, whereas zirconia implants had an early history of fracturing.
While zirconia implants are tissue-friendly, they initially struggled to find methods to achieve sufficient roughness. Earlier methods relied on adding surface roughness after sintering, which led to surface cracks that eventually caused mechanical failure. However, recent implants created in the pre-sintered stage can prevent fractures — the micro-cracks are closed in the following sintering process wherein the implant shrinks by approximately 20%.
The right implant system must have a stable and mechanical implant-abutment connection that transfers the force from the mouth to the implant properly.
Titanium implants have been the standard choice because they’ve developed deep internal connections that allow stable long-term usage. However, the abutments are usually connected with screws that weaken the implant, leading to a high risk of the screw loosening, especially if the implant doesn’t have a deep conical connection. If there’s micro-movement and screw loosening, the tissues around the implant can get destabilized, thereby preventing complete biointegration.
However, zirconia implants with cemented implant-abutment connections can eliminate micro-gaps and the possibility of screw loosening, thereby maintaining soft tissue stability.
The soft tissue stability of zirconia implants has been documented in the studies from Brüll et al. and Becker et al. (1,2) based on Patent™ implants.
Further Reading: Biointegration (Prophylaxis for Periimplantitis)