The Importance of Vitamin D in Ceramic Implants

In Conversation with Dr. Alaa Narouz

  • Extensive use of ceramic implants for biocompatible implantology.

  • Combination of ceramic implants with vitamin D3, K2, and magnesium

  • The benefits of testing and restoring the patient's optimal vitamin D3 level

  • Natural increase of vitamin D3 level in the body

  • The value of overall health and holistic treatments in dentistry


Dr. Alaa Narouz

Owner of Dental Practice in Cologne

Vogelsanger Str. 456, 50829 Köln, Deutschland

In Conversation with Dr. Alaa Narouz


Until now, most dentists have been resigned to the low risk of chronic inflammation that occurs after the placement of titanium implants as part of osseointegration. Although titanium implants have been used successfully for decades, dentists must always expect a small risk of implant loss due to just such inflammation. In principle, tooth replacement materials can also be trigger factors for chronic inflammation. Metals in particular, but also in principle all dental materials with the exception of dental ceramics, can trigger cellular-mediated, allergy-induced inflammatory reactions.

Released metal ions act as half-allergens. This means that they alter the body's own proteins in such a way that they are recognized as foreign by the immune system. The immunopathogenesis of titanium hypersensitivity differs considerably from that of other metals. Unlike metals such as gold, mercury, or nickel, titanium is not present in a free ionized form and is therefore not able to modify endogenous proteins. Titanium-induced implantitis is therefore not due to an allergy but to an increased inflammatory reaction to the phagocytizable titanium oxide particles that are released. This corresponds histologically to chronic inflammation.

Chronic inflammation is increasing significantly and is the cause of allergies, diabetes, rheumatism, gastrointestinal or thyroid diseases, osteoporosis, cardiovascular diseases, periodontitis, and other chronic infections. Since dentists permanently place foreign materials in the body, they must be aware that they may be setting triggers for chronic inflammation. Ceramic implants made of zirconium oxide are not a trigger factor and cannot cause allergies or intolerance reactions. They are bioinert and therefore absolutely tissue-friendly.

Dr. Alaa Narouz combines ceramic implantology with holistic wellness and vitamin D treatments to ensure inflammation-free biointegration. Our team at Zircon Medical recently had Dr. Alaa Narouz as a guest on our podcast series to talk about the importance of ceramic implants and vitamin D to implant dentistry.

Introducing Dr. Alaa Narouz, the owner of a dental practice in Cologne, Germany

Dr. Alaa Narouz has been a licensed dentist since 1992 and the owner of a dental practice in Cologne since 1995. Since 2008, he has successfully participated in numerous continuing education courses in Germany and abroad on a wide range of dental topics, including minimally invasive implantology. In his 30 years of professional practice, he has performed numerous titanium implantations but is currently turning away from titanium implants and moving toward ceramic implants, a "game-changer" in implantology.

When asked when and why he decided to become a dentist, Dr. Narouz says the seed was planted at a young age. He had befriended the technician at his family's dental practice, who allowed Dr. Narouz to explore his lab as a teenager. The technician helped Dr. Narouz pour impressions to make models. He remembers casting Haribo gummy bears and strawberries with silver to present to his siblings. It was then that he discovered his passion for dentistry.

Dr. Narouz also knew he wanted to start his own business, and he combined that desire with his love of dentistry.

Extensive use of ceramic implants for biocompatible implantology

Dr. Narouz has performed numerous titanium implants for decades, but he is in the process of switching to ceramic implants. In his practice, the ratio of titanium to ceramic implants is currently 50:50, but he wants to bring it to 100% ceramic implants. He says ceramic implants are "game changers" in the field of implant dentistry because they heal patients, restoring their health. He also says patients are more likely to accept ceramic implants than titanium.

"When you look at titanium implants, there is always chronic inflammation," he says. The body always reacts to titanium implants. Ceramic implants, on the other hand, provide biocompatible healing - they are absolutely tissue-friendly, and that is especially evident in soft tissue. The gums surrounding the ceramic implant in combination with the adjacent bone, which he calls the "immunological door," are effectively closed, improving patients' overall health - not just their dental health. Placing ceramic implants (instead of titanium) removes the impetus for inflammation and replaces it with a material that has no tissue reaction. 

Dr. Narouz says that patient awareness of ceramic implants is currently low. But if patients are given detailed counseling and then given the opportunity to decide between titanium and ceramic implants, they opt for ceramic implants because of the biocompatibility and the associated immunological positive reaction. He says the decision is also often made based on the color scheme alone. He says all patients want white implants because they characterize "eternal light and youthfulness. " He continues, "Teeth are not black, and the God-given natural is not black.... it is white."

When patients are told that ceramic implants are biocompatible and produce only positive, healthy tissue responses, their decision in favor of placing a ceramic implant is clear. Dr. Narouz predicts that in the future, patients will increasingly opt for ceramic implants and less for titanium implants for the reasons described.

Combining ceramic implants with vitamin D3, K2, and magnesium

Dr. Narouz says that most dentists perform dental implants without taking vitamin D3, vitamin K2, and magnesium, and it works... conditionally. Over time, however, chronic inflammation of the bone can occur due to a variety of factors, which in turn leads to loss of the implant. Loss of bone density and structure can occur for a variety of reasons, but it is particularly common in the following cases:

  • Female patients often undergo hormonal changes due to menopause and other factors.

  • Taking certain medications or drugs for chronic diseases can affect bone structure.

  • Diabetes mellitus and other chronic diseases also lead to implant loss.

Vitamin D3 in combination with vitamin K2 and magnesium are particularly useful for these patients and thus support the healing of the implant without inflammation. Vitamin D3 in combination with vitamin K 2 and magnesium indirectly promote the activity of theosteoblasts and thus ensure optimal osseointegration of the implant in the bone tissue and, just as importantly, the adjacent gingiva grows onto the implant without inflammation. These are outstanding prerequisites for the complication-free, biological healing of the implant.

The combination of the above-mentioned vitamins and other micronutrients leads to an optimal result of successful insertion, especially of ceramic implants. In the run-up to a contemplated restoration with ceramic implants, the patient's holistic well-being and micronutrient profile should be ensured.

"What is vitamin D, anyway? " Dr. Narouz asks rhetorically. "Many people say it's simply a vitamin, but it's actually a hormone. It exists in the epidermis as 7-dehydrocholesterol, which is activated by U-VB radiation. The 7-dehydrocholesterol becomes a pre-vitamin, and the heat generated by solar radiation forms cholecalciferol. This goes back into the blood, where it is in a bio-inactive form. "However, vitamin D3 must interact with magnesium and other micronutrients to function.

When "bio-inactive" cholecalciferol interacts with magnesium, "it becomes a hormone in the liver or kidney that indirectly activates and controls calcium and phosphate metabolism. " Therefore, vitamin D3 must be combined with vitamin K2, which activates osteoblast activity in certain proteins. Vitamin D3 (bioactive calcitriol) ensures that calcium from the small intestine and food is well absorbed, and vitamin K2 transports calcium to the bones where it belongs.

If vitamin D3 is not combined with vitamin K2, the patient may eventually develop arteriosclerosis. Dr. Narouz says giving vitamin D3 alone is a "big mistake.”

Often, to correct a vitamin D deficiency, primary care physicians prescribe, for example, the preparation "Dekristol" ( 20,000 units). But this alone is not enough to indirectly raise the calcium level, which is relevant for bone metabolism. Vitamin K2 is necessary because it regulates proteins (osteocalcin) that ultimately bring calcium to the bones. It also regulates the protein Matrix - GLA, which removes excess calcium in the blood, creating the optimal balance of calcium - phosphate balance.

This highlights the importance of treating patients with vitamin D3, K2, and magnesium to ensure optimal healing ceramic implants.

The benefits of testing and restoring the patient's optimal vitamin D3 levels

Dr. Narouz says he tests all of his patients in his dental office.They draw three drops of blood from the finger and can determine the patient's vitamin D3 level within 15 minutes. The test measures the inactive form of vitamin D3 in the blood - 25 OH calcidiol. The body converts calcidiol (inactive form) to calcitriol (active form) in the presence of magnesium and vitamin K2 when it senses that there is insufficient calcium.

The patient's vitamin D3 level should ideally be between 40 and 60 nanograms - less than 20 nanograms is considered critical. If the patient is critical, he or she is given 10,000 units of vitamin D3 with K2 prepared with magnesium. The patient is then rechecked after three weeks. Vitamin D3 treatment actively interferes with the immune system and cures various underlying diseases, such as psoriasis.

Dr. Narouz cites the example of a patient who had been suffering from psoriasis with severe joint pain for three years. When he first checked his vitamin D levels, they were in the single digits. After high supplementation with vitamin D3, K2, and magnesium, the patient came back after three weeks, saying he no longer had psoriasis and that the joint pain was significantly reduced.

Another patient saw him for a supply of implants. Vitamin D levels were routinely obtained. This was also in the critical range. The patient told him in the course of the anamnesis that he had undergone hip replacement surgery six months ago and was still in pain. After a likewise high supplementation of the above-mentioned vitamin combination, the pain was completely gone..

When it comes to dental implants, Dr. Narouz always starts with pre-implant diagnostics (X-rays, etc.), and the vitamin D3 level is also collected. If the patient has a deficit in the field of micronutrients, an immune protocol is established, and thus the deficiency of other vitamins is compensated. The patient's vitamin D3 level should have reached 40 to 60 nanograms by the time of implantation, after which the patient undergoes surgery.

All these measures guarantee inflammation-free healing of the ceramic implants in the bone and soft tissue. The combination of biological agents (vitamin D3, K2, and magnesium) with the best ceramic material, zirconium oxide, creates optimal conditions for a successful treatment result.

Natural increase of vitamin D3 level in the body

Dr. Narouz often advises his patients to go out in the sun to stimulate their bodies to produce vitamin D naturally. He recommends standing with your back to the sun - the moment when the shadow created by the sun is shorter than the patient's body is the ideal moment for vitamin D production. At a 45-degree angle, the sun's rays hit the skin optimally. He recommends standing in direct sun for about 10 minutes without sunscreen to maximize vitamin D production. 

"Young people produce vitamin D themselves through the skin," Dr. Narouz says. “In older patients over 70, vitamin D production is no longer possible because the skin thins and metabolism deteriorates significantly.” Some of his patients say they are extremely tanned because they spent their vacation in Gran Canaria. However, Dr. Narouz counters this by saying, "The tomato also looks red, but it doesn't necessarily have vitamins in it.” That's why it's important to do tests, especially if the patient is older.

“Basically, anyone who doesn't live on the equator needs to substitute,” Dr. Narouz says. Testing has shown that primates, such as monkeys, have 60 nanograms of vitamin D. The same is true for people who live near the equator, walk around lightly clothed, and are kissed by the sun. They typically have 60 to 70 nanograms of vitamin D, which is why they have brilliant metabolic activity with high levels of bone health.

The value of overall health and holistic treatments in dentistry

Dr. Narouz believes in the philosophy of holistic treatments.

Rather than repairing or treating an isolated part of the body, he looks at the patient's overall health. For example, he describes dead teeth triggering pain in more distant organs. For example, he was able to show patients that by injecting them with a certain anesthetic on that dead tooth, the knee pain immediately disappeared. So there is a causality between dead teeth and pain or chronic inflammation in other organs in the body.

Dr. Narouz studies physiology and biology, and he encourages all dentists to do the same - understand holistic biological medicine.

Dr. Narouz believes that the future is white, organic, and sustainable. Those who don't follow suit will eventually be overtaken by time. That's why he has embraced ceramic implants and plans to move from a 50:50 ratio to 100% ceramic implants in his practice. To conclude the podcast, Dr. Narouz once again emphasizes the potential of implant dentistry with ceramic implants, which allow better healing than ever before and thus contribute to maintaining the health of the patient.

He also reiterates the importance of micronutrients, such as vitamin D, C, zinc, etc. Since modern civilization has taken people away from nature and the sun and into darkness, it is important to counteract what has been lost with supplements. Patients usually don't say no to supplements and treatments because everyone understands the value of overall health. "Especially in these times when we are facing so many serious illnesses," Dr. Narouz adds, "we should also take care of ourselves a little bit and take care of ourselves."

You can find Dr. Narouz at his dental clinic at Vogelsanger Strasse 456, Cologne, or his official website. You can also listen to him on our Zircon Medical podcast.

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