Direct answer
Both ceramic and titanium implants may be removed with reverse torque or bone-cutting techniques. Zirconia differs because it can fracture suddenly, is difficult to section, and may be weakened by grinding or surface defects. Titanium can also fracture, but it is generally more ductile and easier to cut. Evidence comparing removal outcomes directly is limited, so the surgeon must plan from the exact implant design, condition, and anatomy.
Key takeaways
- Removal technique is driven first by integration, position, infection, and fracture - then modified by material.
- Zirconia is brittle and may break during high reverse torque, especially when already cracked or heavily prepared.
- Titanium can be cut and implantoplasty can be used in selected peri-implantitis procedures; these concepts should not be transferred automatically to zirconia.
- Trephination removes surrounding bone for either material, but ceramic fragments may require different engagement and cutting strategies.
- Direct comparative clinical evidence on zirconia explantation is limited, so certainty should be stated honestly.
Evidence and decision snapshot
| Question | Established role | Possible value | Important limitation |
|---|---|---|---|
| Reverse torque | Used for both materials when an intact coronal portion can be engaged. | Can preserve bone compared with circumferential cutting. | Zirconia fracture risk and system-specific engagement require caution. |
| Sectioning or grinding | Titanium is relatively machinable with appropriate burs. | Can facilitate removal or surface modification in selected titanium cases. | Grinding zirconia can create defects, heat, and unpredictable fracture. |
| Trephine removal | Cuts bone around either implant. | Works when torque removal fails or fragments remain. | Creates a larger defect and requires precise diameter and depth control. |
| Fragment behavior | Titanium may deform; zirconia tends to remain rigid until fracture. | Material knowledge guides retrieval tools and force. | A small apical fragment can be difficult to visualize or engage. |
Material behavior under force
Titanium is a metal with ductility and the capacity for plastic deformation before fracture. Zirconia is a high-strength ceramic with limited plastic deformation. Its strength depends on composition, manufacturing, surface condition, geometry, and cyclic loading. When a zirconia implant fails, it can fracture abruptly rather than bend.
These differences affect removal. A titanium implant may tolerate some deformation during retrieval and can be sectioned with carbide instruments. A zirconia implant requires diamond or specialized cutting approaches and careful irrigation, and attempts to create a slot for a driver can initiate cracks.
Reverse torque and engagement
Reverse torque is attractive because it can separate the implant-bone interface without removing a circumferential ring of bone. Success depends on a stable connection between the removal device and implant. For a titanium implant, the internal connection or external body may accept dedicated tools. For zirconia, one-piece geometry, bonded abutments, or a fractured neck can limit engagement.
Applying more torque is not always the answer. If ceramic begins to crack, the case can convert from removal of an intact implant to retrieval of a buried fragment. The surgeon should define a stopping point and have a trephine or alternative plan available.
Surface modification and implantoplasty
In selected titanium peri-implantitis cases, implantoplasty smooths exposed threads to reduce roughness and improve cleansability. The procedure releases titanium particles and changes implant dimensions, so it remains a considered surgical choice rather than a routine step.
Zirconia implantoplasty is not an equivalent procedure. Grinding can create microcracks, alter transformation behavior, reduce cross-section, and increase fracture risk. A ceramic fixture that would require extensive surface removal to become maintainable may be better evaluated for explantation.
Cutting around the implant
Trephines, burs, and piezosurgery remove bone around either material. The selected diameter should be as conservative as safely possible. Heat control is essential, and the proximity of nerve, sinus, roots, and cortical plates must be mapped. Ceramic hardness can complicate accidental contact between the instrument and implant.
If an implant has fractured below the crest, a circular trephine may be the most direct method, but it creates a cylindrical defect. Selective troughing on one or more surfaces can sometimes permit luxation with less bone loss. The surgeon needs three-dimensional access and should avoid chasing a fragment blindly near vital anatomy.
What the evidence can and cannot say
Systematic reviews of explantation techniques include predominantly titanium implants. They support reverse torque as a frequently successful bone-preserving technique, but they do not establish the same success rate for every zirconia design. Published zirconia removal evidence is more often case-based and linked to fracture or malposition.
Therefore, patients should receive a material-specific but not alarmist explanation. Ceramic implants are removable, yet an integrated fractured zirconia implant may require more invasive retrieval than a mobile fixture or an intact titanium implant. The exact anticipated defect should guide consent and graft planning.
Frequently asked questions
Is zirconia impossible to drill?
No, but it is very hard and requires appropriate diamond or specialized instruments, irrigation, and control. Cutting can also introduce cracks.
Is reverse torque always safer for zirconia?
It can preserve bone when successful, but a damaged ceramic implant may fracture under torque. The surgeon needs a backup removal strategy.
Can implantoplasty be performed on zirconia?
Routine titanium implantoplasty principles should not be transferred to zirconia. Material damage and fracture risk require a different analysis.
Does titanium removal always preserve more bone?
No. A fractured or deeply integrated titanium implant may also require trephination. Integration, position, and anatomy often matter more than material alone.
Should I choose an implant material based on future removability?
Retrievability is one factor, but system identification, component availability, clinical evidence, position, and restorative design are also important.
Questions to discuss with your implant team
- What implant material, system, design, and dimensions are present?
- Can a dedicated reverse-torque device engage the implant safely?
- What is the fracture risk if torque is applied?
- How much bone is expected to be removed with the backup technique?
- Will the defect be grafted immediately or after healing?
What this means for patients
The principles of implant removal are shared, but zirconia and titanium respond differently to torque and cutting. Zirconia can fracture rather than bend, so engagement, backup instruments, and bone-preservation planning are especially important.
Selected references
- Roy M, Loutan L, Garavaglia G, Hashim D. Removal of osseointegrated dental implants: a systematic review of explantation techniques. Clin Oral Investig. 2020;24(1):47-60. doi:10.1007/s00784-019-03127-0.
- Stajcic Z, Stojcev Stajcic L, Kalanovic M, Dinic A, Divekar N, Rodic M. Removal of dental implants: review of five different techniques. Int J Oral Maxillofac Surg. 2016;45(5):641-648. doi:10.1016/j.ijom.2015.11.003.
- Bethke A, et al. Fracture resistance of zirconia oral implants in vitro: a systematic review and meta-analysis. Materials. 2020;13(3):562.
- Attard L, Lee V, Le J, et al. Mechanical Factors Implicated in Zirconia Implant Fracture Placed within the Anterior Region: A Systematic Review. Dent J. 2022;10(2):22. doi:10.3390/dj10020022.
- Schwarz F, John G, Mainusch S, Sahm N, Becker J. Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. J Clin Periodontol. 2012;39(8):789-797.
- Roehling S, et al. Performance and outcome of zirconia dental implants in clinical studies: A meta-analysis. Clin Oral Implants Res. 2018;29 Suppl 16:135-153.