Zirconia vs. Titanium














Originally the first dental implants (1980’s) had two parts: the fixture (which goes screwed into the bone) and the abutment (where the prosthetic crown is cemented).

The improvements in new ceramic materials made it possible on 2000 to have the abutment part made of ceramic. This material was commonly known to be more tissue friendly than titanium.

In 2005, the CeraRoot full ceramic implant (fixture and abutment in one body/part) was introduced into the European market and in 2011 accepted by the FDA to be used in U.S. dental clinics. The main advantage of a one-piece zirconia implant is that it has no prosthetic connections, where bacteria can grow, and therefore have better gum health. Another big advantage is that the implant is 100% white. This means that no metal will ever be visible when smiling or communicating with other people.

Titanium is a metal, and suffers corrosion.

Corrosion, the gradual degradation of materials by electrochemical attack is a concern particularly when a metallic implant is placed in the hostile electrolytic environment provided by the human body.

The term corrosion is defined as the process of interaction between a solid material and its chemical environment, which leads to a loss of substance from material, a change in its structural characteristics, or loss of structural integrity.

The clinical importance of degradation of metal implants is evidenced by particulate corrosion and wear products in tissue surrounding the implant, which may ultimately result in a cascade of events leading to periprosthetic bone loss. Furthermore, many authors have reported increased concentrations of local and systemic trace metal in association with metal implants.

Zirconia is a ceramic and does not suffer any corrosion.


Throughout the decades, the materials that have been used for the dental treatments have been made with metal. The main reason was to give mechanical strength and therefore augment the longevity of the treatment. Overtime, the scientific research contributed enormously to the improvement of the ceramic’s mechanical strength. In the beginning, ceramics were introduced into the patients mouth because of it’s fabulous esthetic properties. However, the latests research shows that the esthetic is not the most important characteristic of this material. Ceramics due to its inert, non-corrosive and nonallergic properties, it is actually many times more beneficial to the patient than any other dental material ever made. We encourage patients to demand treatments without metal. Metal-free treatments. All-ceramic treatments.


Titanium allergy is barely recognized in mainstream medicine – yet laboratories using the MELISA® technology have reported that about 4% of all patients tested to titanium will be allergic to it (Valentine-Thon E., et al. “LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity”. Neuro Endocrinol Lett 2006; 27(Suppl 1):17–24). For those affected with titanium allergy, the symptoms can be multiple and bewildering. These can range from simple skin rashes to muscle pain and fatigue.

From foodstuff to medicine, titanium is now an everyday metal. Several brands of candy, such as Skittles and M&M, have titanium dioxide in the coating – often described by its E-number: E171. Some brands of toothpaste contain titanium particles. Hospitals use titanium implants to rebuild bones after accidents.

More than just a rash: the effects of titanium allergy

Like all metals, titanium releases particles through corrosion. These metals become ions in the body and bind to body proteins. For those who react, the body will try to attack this structure. This starts a chain reaction which can lead to many symptoms including Chronic Fatigue Syndrome. The MELISA® test is the only scientifically-proven test which can objectively diagnose titanium allergy and measure its severity.

Those who test positive are advised to avoid exposure if possible. This may include switching to titanium-free toothpaste and cosmetics, or in some cases, consider removing a titanium implant from the body.

Titanium: where to find it

Titanium dioxide (TiO2) is widely used in consumer products, as it is non-toxic – even though it triggers allergies in certain people. It is known as a “pearling agent” as it makes paper and paint glossy and white. Always check the content of food stuff, pills and cosmetics for titanium dioxide. It is found in the following:
Body implants, such as Brånemark (for teeth) or to rebuild bones.
Dentistry: as a color pigment in composites
Sunscreen agents: Finely ground titanium dioxide will block the harmful ultraviolet rays from the sun.
Confectionery: Used to make candy look brighter and adding a crunchy coat to for example chewing gum.
Cosmetics: Used to brighten and intensify the color of make-up. It is regularly found in shadow, blush, nail polish, lotions, lipstick and powder.
Toothpaste: Used as a pigment agent to make the toothpaste whiter.
Paint: TiO2 will improve the durability of coatings and gives white color.
Plastic carrier bags: Improves durability and gives white color.
Medical pills and vitamin supplements may also get their white coating from titanium dioxide.
Piercing & Jewelry: For example watches and all types of body piercing. Fewer people are allergic to titanium than for example to nickel.
Titanium polluted with nickel
Several studies show that titanium alloys contain traces of nickel as a result of the production process. This can pose trigger health problems in patients with nickel allergy, and also mean that a reaction may be falsely attributed to titanium itself.


Do you suspect you have titanium allergy?

If a health problem starts after you have received a titanium implant it is possible that you are allergic to titanium. You can take a MELISA® test for titanium allergy through one of the clinics we cooperate with or send a sample to a laboratory. If you are planning to have a test before receiving a titanium implant it is advised to find out the exact composition of the implant. Vanadium, aluminium and other metals are sometimes added to improve the properties of titanium implants, and allergy to these metals can also be tested.

How about clinical studies?

The articles Hypersensitivity to titanium: Clinical and laboratory evidence and LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity published in 2006 can be downloaded from our Article page.

In the former article fifty-six (56) patients who had developed clinical symptoms after receiving titanium-based implants were tested in MELISA® against 10 metals including titanium. Out of 56 patients, 54 were patch-tested with titanium as well as with other metals. The implants were removed in 54 patients (2 declined explantation), and 15 patients were retested in MELISA®.

Of the 56 patients, 21 (37.5%) were positive, 16 (28.6%) ambiguous, and 19 (33.9%) negative to titanium. In the latter group, 11 (57.9%) showed lymphocyte reactivity to other metals, including nickel. All 54 patch-tested patients were negative to titanium. Following removal of the implants, all 54 patients showed remarkable clinical improvement. In the 15 retested patients, this clinical improvement correlated with normalization in MELISA® reactivity.

The conclusion of the article is that these data clearly demonstrate that titanium can induce clinically relevant hypersensitivity in a subgroup of patients chronically exposed via dental or endoprosthetic implants. Below, you will also find several articles which discuss the issue of corrosion of titanium implants and possible reactions due to hypersensitivity.

Medical articles relating to titanium allergies:

Titanium allergy or not? “Impurity” of titanium implant materials. Harloff T, et al.. Health 2010(2)4:306-310

Download full article HERE.



Titanium: A New Allergen. Laurence Evrard

Download the full article HERE.



The Epidemiology of Contact Allergy to Metals in the General Population:

Download the full article HERE.


OJSTCorrosion aspect of dental implants—An overview and literature review

Download the full article HERE.



th_Neuroendocrinol_Lett Hypersensitivity to titanium: Clinical and laboratory evidence

Download the article HERE.



dovepressAllergy related to dental implant and its clinical significance

Download the article HERE.


PLOSOral Factors Affecting Titanium Elution and Corrosion: An In Vitro Study Using Simulated Body Fluid

Download the article HERE


More articles for your reference:


Corrosion of titanium implants (publication  January 2015) 

On this research performed by Dr. Wheelis, shows that after using liquids such as Citric Acid, Fluoride toothpaste, peroxyacetic acid there is corrosion on titanium surfaces.

Journal Name: Clin Oral Implants Res. 2015 Jan 12
Title of scientific publication: Effects of decontamination solutions on the surface of titanium: investigation of surface morphology, composition, and roughness.
Authors: Wheelis et al
To investigate the impact of treatments used to detoxify dental implants on the oxide layer morphology and to infer how changes in morphology created by these treatments may impact re-osseointegration of an implant.
Pure titanium (cpTi) and the alloy Ti6Al4V were subjected to a series of chemical treatments and mechanical abrasion simulating surface decontamination of dental implants. The morphology and roughness of the surface layer before and after treatment with these solutions were investigated with optical and atomic force microscopy (OM, AFM). The solutions employed are typically used for detoxification of dental implants. These included citric acid, 15% hydrogen peroxide, chlorhexidine gluconate, tetracycline, doxycycline, sodium fluoride, peroxyacetic acid, and treatment with carbon dioxide laser. The treatments consisted of both immersions of samples in solution and rubbing with cotton swabs soaked in solution for 1, 2, and 5 min. Cotton swabs used were analyzed with energy dispersive spectroscopy (EDS).
The microscopy investigation showed that corrosion and pitting of the samples were present in both metal grades with immersion and rubbing methods when employing more acidic solutions, which had pH <3. Mildly acidic solutions caused surface discoloration when coupled with rubbing but did not cause corrosion with immersion. Neutral or basic treatments resulted in no signs of corrosion with both methods. EDS results revealed the presence of titanium particles on all rubbing samples.
It was demonstrated in this study that acidic environments coupled with rubbing are able to introduce noticeable morphological changes and corrosion on the surface of both titanium grades.
AFM ; corrosion; detoxification; oxide layer; titanium

75 thoughts on “Zirconia vs. Titanium

  1. I have read studies that say that zirconia implants are more susceptible to fracture from forces/ load. Do you have links to other studies that may disprove this? I’d really like to consider CeraRoot but am hesitant 1) because of fracture risk and 2) lack of studies showing success/ failure rate over time, due to them being so new.

    1. Hello Donna,

      There are many factors that can lead to fractures or failures of treatments performed in the mouth.
      Because dental professionals have to adapt to all kinds of occlusions and bone quantities and qualities and health conditions,
      it is not possible to guarantee (100%) that a treatment, material or product will never fail or break.
      All the materials or products used in the mouth can suffer a failure sometimes due to multiple factors.
      Titanium Dental implants suffer more fractures than CeraRoot implants, because the conventional metal implants are made
      of multiple parts or prosthetic accessories that weaken the whole system. Because CeraRoot is made of one-piece
      and it’s not hollow inside (titanium implants are hollow) it suffers less accidents.

      There are other ceramic implant brands that are manufacturing two-piece implants (multiple components are cemented or screwed into each other, and this increases a lot the risk of fracture or failures…

      CeraRoot implants are one-piece to avoid these problems.

      You can take a look at this page to see all kinds of titanium dental implant fractures:


    1. Hello Cassie Dicks, we don’t recommend to replace each tooth with one implant. The implants last longer if they are more spread in the mouth so that they are easier to clean. The more amount of implants, the more difficult is to maintain the mouth. Without an xray is difficult to give an estimate. Many times you need bone graft (several procedures if there is a lot of bone missing) and many times you also need gum graft. The price of the treatment can go anywhere between 8000 Euros to 20.000 Euros. You can send a PANORAMIC x-ray to info@ceraroot.com and we will be able to give you an Estimate. Panoramic xrays are easy to send by email because they are not heavy files. Once we take a look at the Panoramic xray, and once you have an orientative treatment quote, it is 100% important to perform a CTscan or 3D Cone Beam to see all the dimensions of the bone and which areas arer better to place the implants.

  2. I am very interested in getting zirconia implants but have read that they can be subject to hydrolysis and potential breakage. Is this really a risk? Would one or two piece be better if this is the case? Thank you.

    1. Hello Helen, the first CeraRoot implants were placed in humans 15 years ago, and so far they are doing fantastic. We keep track of many patients that had CeraRoot implants placed years years ago. If there had been any breakage issue we would have had to change the material or the implant design, but so far they are doing great. As you may not know, titanium implants do break, and much more often than CeraRoot because they are hollow from the inside and therefore more weak. You can read more info here: http://www.ceraroot.com/patients/titanium-implant-fractures-vs-ceraroot/

  3. Although I would certainly agree that it is impossible to provide a quote, one would think that your office could provide at least an estimate for: example…a full set bottom, and a full set top. The site highlights what implants should cost, but none of the sites disclose anything about cost. Frankly it is the cost that stops people from pursuing this procedure and if interested most Canadians would not even look into it without at least a general estimate of the cost for the procedures.

  4. I’m from Canada and I had 2 implants tatanium put in5yrs ago had one removed 1month ago.ihave a full bottom plate and 2implants were not enough to keep them locked in can any thing be done

    1. Hello Mr. Morgan, thank you for writing in our website. It is necessary to have an XRAY done of your mouth in order to give you a treatment plan and quotation. Do you have one available? Which country and state are you located at?

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