Inserted implants Inhabitants Inserted implants/ population (%) ing towards titanium intolerance playing a decisive role in patient condition.8 As stud- ies were able to show, zirconium dioxide reduces that risk because ceramic, unlike titanium particles, do not provoke signifi- cant secretion of messenger substances for osteolytic processes.9 Could ceramic implants be the (new) “next best thing”? After a rough beginning, with frequent material breakages and very limited num- bers of suppliers, ceramic implants are be- coming increasingly more present in the field of dental solutions. More and more, informed consumers are demanding treat- ment options which are holistic and thus considering the body as a whole. To date, there is very little data of known implant disease regarding ceramic implants—not a bad start but will this data change? And if so, when, how, and by how much? The now realised success with two- piece and specifically the new bone-level ceramic implants will lead to much greater use of ceramic implants, as a wide range of indications can be covered, that were until now reserved to titanium implants. Conclusion | research 2013 Brazil USA Italy 2,552,822 201,009,622 1,805,011 316,668,567 959,124 61,482,297 Germany 795,243 81,147,265 South Korea 773,492 48,955,203 Spain Japan France Russia China 630,028 47,370,542 496,287 127,253,075 389,115 65,951,611 285,001 142,500,482 269,917 1,349,585,838 Switzerland 231,311 22,457,336 Canada 203,952 34,568,211 the Netherlands 142,843 16,805,037 UK 133,131 63,395,574 Australia 89,050 22,262,501 Austria Portugal Sweden Total: 86,327 8,221,646 77,755 10,799,270 67,484 9,119,423 9,987,893 1.27 0.57 1.56 0.98 1.58 1.33 0.39 0.59 0.20 0.02 1.03 0.59 0.85 0.21 0.40 1.05 0.72 0.74 In summary there could be a change of focus turning from peri-implant disease to implant disease. Bringing more focus to the implant disease in general medicine will give us a chance to investigate this phenomenon more seriously. This is a task for all partic- ipants in the field of implantology because knowledge about implant disease could lead to widespread un- certainty in our patients and we need to be well informed in order to properly advise them. Literature Table 1: Overview of inserted implants by nation. (Source: Süddeutsche Zeitung [Uhlmann 2016], Press office DGI, KZBV, dental industry) the prevalence of peri-implant mucositis and peri-implan- titis in their practices is as high as 25 per cent. They es- timated that there is an even higher proportion within the general US population. Regarding this study and the fact that there is no proven therapy for this detrimental process, when consulting the published success rates it becomes obvious that more often than would be expected it results in implant loss. According to relevant literature, we can take 10 per cent as a minimum value for implant losses over the years.2–7 Even though aetiology is multifactorial and could not be clarified acceptably, there is a lot of evidence point- contact Dr Franz-Jochen Mellinghoff M.Sc., PhD Pfauengasse 14 89073 Ulm, Germany Tel.: +49 731 62158 jochen.mellinghoff@dr-mellinghoff.de www.dr-mellinghoff.de Author details 08 implants 1 2018