A system to revolutionize ceramic implants

An interview with Dr. Sammy Noumbissi
Dr. Sammy Noumbissi, founder and president of the International Academy of Ceramic Implantology (IAOCI) 

Dr. Sammy Noumbissi, founder and president of the International Academy of Ceramic Implantology (IAOCI), is currently organizing the academy’s 11th World Congress, to be hosted in Washington, D.C. (USA) from May 19 to 21. Recently in San Diego, Paul Delgado, Director International Sales and Education at Zircon Medical Management, had the chance to chat with the Maryland-based expert on metal-free full-arch reconstruction about the challenges with current ceramic implants, the impact that the upcoming 9-year prospective study on two-piece Patent™ Implants has on evidence-based implant dentistry, and what people can expect from the upcoming IAOCI World Congress this coming May.

Dr. Noumbissi, as president and founder of the IAOCI, are you starting to see any differentiation between the existing ceramic implants on the market?

A lot of the members of the IAOCI are true believers in ceramic implantology and are early adopters. Most members including me, have tried three or four different ceramic implant systems. What we are seeing among our members and in the broader community out there is that certain ceramic implants are targeting dentists in different ways. Some manufacturers are emphasizing only the biomechanical aspects and the technological marvel, whereas others are coming more from the biology and the understanding of how the patient heals and what you need to do to optimize the patient before surgery; therefore, they are emphasizing biological and natural dentistry concepts along with their ceramic implant systems. The IAOCI’s philosophy is a little bit of both: We like to see technological improvements to the material, the surface, the implant design, and the thread and connection design. However, we also like the biological side of things, because at the end of the day, we as dentists must be concerned about the general health of our patients and how their bodies respond to the implant materials. A surgery is always an injury. You drill a hole in the bone, you put something in there and you expect the body to embrace it and never reject it. For that to happen, you need healthy hosts and they need to be able to heal from that procedure as fast as possible and uneventfully.

What are the areas that need to be addressed by our industry in order to make ceramic implants mainstream?

On the technological side of things, I think a lot of progress has been made in terms of making the surfaces of ceramic implants very friendly to the osseointegration process. Today, we are starting to see more and more surfaces modifications that allow fast bone growth around the implant and superior soft-tissue attachment to their surfaces. The ultimate success of an implant depends on bone growing onto or into it so that the implant stays in place hopefully for a very long time. The surfaces of ceramic implant systems have been improved and continue to be improved to facilitate faster and more comprehensive osseointegration. Now we are seeing surfaces like that of the Patent™ Dental Implant System that even allow the soft tissue to attach to them. This is nothing short of revolutionary, because now we are evolving to what we see with natural teeth, in that the soft tissue is able to attach to them and to protect the bone below from bacterial infiltration. I’ve had the opportunity to look at Patent™ Implants very closely many times, I have colleagues and friends who are using them extensively now and the feedback is positive.

What concern, if any, do you have with the ceramic implant systems that are currently on the market? Have you seen any promising technology?

One thing that concerns me is that we have been observing that some companies that are now bringing ceramic implant systems to the market are adopting a copy-and-paste approach. They copy a titanium implant, make it into ceramic at least macroscopically, and then they introduce it on the market. This is of concern because we are talking about two different materials that behave in completely different ways. Oxide ceramics like zirconia have unique physical properties and respond differently to mechanical stress compared to titanium, for instance. This copy-and-paste approach makes me a little concerned, since these systems are going to be out there and will potentially have a lot of fractures and failures. This is where we then run the risk of people going out and claiming that ceramic implant materials simply do not work. It’s nice to see the larger companies adopting this technology, but I still think that it needs to be presented and implemented in the right way.

The Patent™ technology, and I’ve seen others try to do the same with less success, has this unique glass fiber post, which underlines the fundamental effort of the developers to fully understand the materials that they are working with. I’ve seen some of the Patent™ competitors try to have a ceramic abutment go into a ceramic implant, but this resulted in a lot of fractures and catastrophic prosthetic failures. Why? Because you have a small stiff piece going into a big stiff piece, which results in a lot of stress and frequent breakage. When it comes to the prosthetic connection, we know that we cannot take ceramic and have something with the same properties attached to it. A material has to be used in conjunction with ceramic that’s going to take mechanical stress for a very long time and away from the implant. The glass fiber post of the Patent™ Dental Implant System seems to be a great solution, because it has a certain flexibility to it. As a result, stress and force are not transferred to the implant. This is the reason why Zircon Medical has recorded very few implant or abutment fractures. Having said that, I would rather have a glass fiber abutment fracture, which is very easy to remove and replace versus a piece of ceramic abutment fractured within the implant; unfortunately in such cases it is much easier but more traumatic to remove the implant altogether.
International Academy of Ceramic Implantology - 11th World Congress in Washington

What is your opinion on ceramic implant systems that incorporate metal screws? 

These are the things that could confuse both the potential user and the patient. We have three categories today: the ceramic implant with a metal screw inside of it, the ceramic implant with a non-metal screw and the ceramic implant with a post, like the one used in Patent™. I believe that ceramic implants have to be metal-free all the way. Often, when I present different ceramic systems to my patients in my practice, and I have to tell them that the ceramic system has a metal component, I see their heads go down and they rather have a full metal-free solution. At this point, the whole message of metal-free is no longer valid. The Patent™ Implant system with the glass fiber post also offers a technology that is entirely metal-free without screws and the abutments are easily customizable and exchangeable. I think this is what doctors really need to understand: These implants are entirely metal-free and they can be customized to the anatomy of the patient. These things together are revolutionary and unique in the industry. 

One piece of research that was presented here at the 2022 Academy of Osseointegration (AO) annual meeting was the landmark results of the first ever nine-year prospective study on Patent™ Implants, research headed by Prof. Jürgen Becker of Heinrich Heine University Düsseldorf, Germany. What are your thoughts on this study?

Compared with titanium, ceramic implants do not have the benefit of 60 years of research and development. Of course, we’ve had people like the late Sami Sandhaus, who started developing ceramic implants in the early sixties. We’ve had a lot of systems come to the market with very little research behind them. However, some of the resources that were put into metal alloy implants are only now starting to be put to some degree into ceramic implants. This is starting to bear fruit and the Patent™ Implant is the first ceramic implant I’ve seen that has come out on the market with over a decade of research behind it. The presentations that were made on this study here at the AO annual meeting really highlighted a lot of aspects of ceramic implants that were probably clinically observed and verifiable, but that were never properly investigated and documented. That has really been a highlight of the presence of Patent™ here at AO this year in San Diego. I really see these soon-to-be-published long-term results as a game changer.

What can we expect from the IAOCI World Congress, which will be held in Washington this coming May?

We are very excited about this event. For this edition, the great news is that recently the World Health Organization determined that a great number of chronic diseases start in the oral cavity and that some of the materials used in dentistry can influence a person’s general health. We are going to have the privilege of having experts at the event, who will be sharing with us the United Nations’ findings on oral health—and as we know, ceramic implants are part of oral health. They are now known to be one of the best materials for dental implantation. The other side of it is that up to seven ceramic implant companies will be present with speakers and key opinion leaders who are going to offer workshops and training on their systems individually. The attendees will have the opportunity to compare different systems regarding their strengths and weaknesses and to attend hands-on training on the majority of systems represented. Patent™ will be present at the event as a platinum sponsor and will be demonstrating its unique technology of the glass fiber post and its cementable abutment. We are really looking at an event that’s going to be comprehensive and truly educational.
Bio-Integration of Patent™ Implants
Osseointegration was never enough