Currently, zirconia is widely used in biomedical area as a material for prosthetic devices because of its good mechanical and chemical properties. Largely employed in clinical area for total hip replacement, zirconia ceramics (ZrO(2)) are becoming a prevalent biomaterial in dentistry and dental implantology. Although titanium is used in dental implantology currently, there is a trend to develop new ceramic-based implants as an alternative to monolithic titanium. This article reviews the evolution and development of zirconia through data published between 1963 and January 2008 in English language. Articles were identified via a MEDLINE search using the following keywords: zirconia, zirconia/biocompatibility, zirconia/osseointegration, zirconia/periointegration, zirconia/review, and zirconia/bacterial adhesion or colonization. This review of the literature aims at highlighting and discussing zirconia properties in biological systems for their future use in dental implantology. In conclusion, zirconia with its interesting microstructural properties has been confirmed to be a material of choice for the "new generation" of implants, thanks to its biocompatibility, osseoconductivity, tendency to reduce plaque accumulation, and interaction with soft tissues, which leads to periointegration. However, scientific studies are promptly needed to fulfill gaps like long-term clinical evaluations of "all zirconia implants," currently leading to propose an alternative use of "hybrid systems" (i.e., titanium screw with zirconia collar) and also bacterial colonization of zirconia. Moreover, there is a permanent need for consistent information about topography and chemistry of zirconia allowing easier cross-product comparisons of clinical devices.
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