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Implant TribuneAsia Pacific Edition | 10/201522 TRENDS&APPLICATIONS Agreatdealofprogresshasbeenmade in terms of materials, techniques and designofdentalimplantssincethebe- ginningsofmodernimplantologyover 50 years ago.While titanium and tita- nium alloys have always been in use, the search for metal-free implantable materials began in the late 1960s and early1970s,andduringthelastdecade, zirconia has emerged as the most reliable implantable bioceramic. The International Academy of Ceramic Implantology (IAOCI) is an organisa- tion entirely dedicated to ceramic and metal-free alternatives to metal implants. It was founded in 2011 by Dr Sammy Noumbissi, with whom Dental Tribune had the opportunity to speak about the mission and vision of the IAOCI, as well as the state of ceramicimplantologytoday. Dental Tribune: Dr Noumbissi, could you please provide some background information on the development of ceramicimplants? Dr. Sammy Noumbissi: The use of dental implants to replace teeth has increased very rapidly in the last 15 or more years. With this increase in dental implant procedures, the number of manufacturers has in- creased too. Also, we have witnessed the introduction of various alloys of titaniumovertime. Now, just like with any pharma- ceutical or medical product, the increase in demand and changes in production methods come with problems and challenges. Although initially anecdotal, reports of tita- niumandtitaniumalloyintolerance have increased and are increasingly being investigated and demon- strated in the scientific dental litera- ture. Based on the body of research available today, this intolerance of implant alloys can in great part be attributedtothereleaseofmetalions in the host bone and surrounding tissue as a result of the breakdown and corrosion of metal alloys in the presence of body fluids and the oral environment in particular. Such facts have been established and widelyrecognizedinorthopedics. In the late 1960s, pioneers in ceramic implantology and notably Professor Sami Sandhaus began the search for modern non-metal im- plantable ceramic materials. How- ever, many of the early ceramic im- plantsweremonocrystallineintheir structure and could not survive the demands of the oral environment. Then came the use of polycrystals and in the early 2000s yttria-stabi- lized zirconia bioceramic emerged as the material of choice for metal- free intrabony implantation in den- talimplantology. How did you become involved in re- searchonceramicdentalimplants? My interest in ceramic implants came about in two ways. First, on a personal level, when I discovered that the metal fillings and implant I had in my own mouth were de- termined to be the source of some of the health problems I had expe- rienced. Second, on a professional level, where a few of the patients to whom I had provided metal implants returned for check-ups or more implants, and upon reviewing their medical and dental history, it was also determined that the im- plants were at least in part respon- sible for the health problems they were experiencing. I then began to actively look for alternatives and at the scientific literature, including case reports in both medical ortho- pedics and dental implantology. It wasclearthatbioceramicsinthelast two decades had established them- selvesinbothmedicineandimplant dentistry as the most bio-inert im- plantablematerialavailable.In2011, two colleagues and I decided to cre- atetheIAOCI. WhatistheprimaryaimoftheIAOCI? Associations and academies exist around various types of trades and industries. The common purpose of such groups is to organise and createasupportiveenvironmentfor thoseinvolvedintherespectivearea. TheIAOCIwascreatedwiththesame spirit, not only to organize metal- free implantology but also to pro- vide the profession as a whole with quality and high-level continuing implant education on bioceramics as implantable materials. The IAOCI isalsoaresourceforthepublicseek- ing practitioners who have experi- encewithceramicimplants. Inyouropinion,what arethedangers ofmetalimplants? Metal and most particularly titanium implants have been very successful. Their use has grown exponentially and with that manu- facturers have multiplied, as well as manufacturing protocols. As a result,wehaveobservedasteadyin- crease in the alloy elements mixed with titanium during the manufac- turing process. The problems begin when the metal implant highly al- loyedornot,onceplacedissubjected to functional stresses, galvanism, body fluids and the harsh oral en- vironment. The combination of mechanical, chemical and electrical events induces cracks and pitting of the metal, as well as breach in the oxide layer, and the implant under- goescorrosionattack.Thecorrosion attack, which is essentially an oxi- dation process, leads to the release of metal ions that studies have shown to be found in the surround- ing bone, lymphatics, spleen, liver and in some cases crossing the blood–brainbarrier. What alternatives to metal dental implants are currently available on themarket? “Consumers are pushing dentists toward metal-free implantology” An interview with Dr Sammy Noumbissi, founder of the International Academy of Ceramic Implantology Dr Sammy Noumbissi “…reportsoftitaniumandtitaniumalloy intolerancehaveincreasedandareincreasingly beinginvestigatedanddemonstrated inthescientificdentalliterature.” Dr Sammy Noumbissi presenting clinical cases at the recent AnnualWorld Dental Congress in Bangkok. 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