Zirconia vs PMMA

Understanding The Facts

This information is summarised from a number of independent and respected sources including the National Library of Medicine, the National Institute of Health, and many more. We have used publicly available information and made it easier for you to understand.

If you would like to read the full version of any of the studies we have added links to every piece of information to take you to the source. You can also find an additional list of Zirconia related clinical studies at the bottom of this page.

At New Life Teeth we believe that Zirconia is a far superior material for your final fixed teeth and this is based on the many years of combined experience of our surgeons and laboratory staff.

We provide every patient with our Prettau Unbreakable Zirconia teeth and here is why…

Dr Stuart Lutton talking to a full mouth dental implant patient

Biocompatibility

1. Zirconia exhibits excellent biocompatibility in the oral environment[1]. It interacts well with fibroblasts, osteoblasts, dental pulp cells, and macrophages, demonstrating good biocompatibility in the mouth.

2. Zirconia prosthetics offer superior aesthetics (see below), resistance to staining, and are less prone to breakage compared to PMMA acrylic prosthetics[2]. The smooth, polished surface of Zirconia is less likely to attract bacteria, ensuring long-term cleanliness and reduced maintenance.

3. Zirconia prosthetics do not attract bacteria or plaque, thus lowering the chances of developing gum disease, tooth decay, or bad breath[3]. In contrast, PMMA can become discoloured over time and is more prone to bacterial buildup.

4. Zirconia retains the strength of a metal-like substance while providing a completely metal-free, biocompatible base for implants[3]. This makes it highly suitable for dental prosthetics.

5. PMMA acrylic prosthetics, while cost-effective for companies, have some drawbacks including potential breakage, wear and tear over time, and issues like staining and bacterial buildup[2].

In conclusion, zirconia demonstrates superior biocompatibility, durability, and resistance to bacterial adhesion compared to PMMA for prosthetic teeth. Its excellent biomechanical properties and interaction with the oral environment make it a highly recommended material for definitive implant-supported prostheses[1][2][3].

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839238/
[2] https://northtexasdentalsurgery.com/choosing-the-right-all-on-four-prosthesis-zirconia-vs-pmma-options-explained/
[3] https://ariadentalcare.com/blog/acrylic-vs-zirconia-dental-implants/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360736/
[5] https://www.sciencedirect.com/science/article/abs/pii/S0928493118325839

Aesthetics

1. Zirconia offers superior aesthetics compared to PMMA[1]. Zirconia prosthetics can provide a more natural and lifelike appearance, closely mimicking the look of natural teeth.

2. Zirconia can be manufactured with varying degrees of translucency, allowing it to more accurately mimic the light-transmitting properties of natural teeth[4]. PMMA, while it can look beautiful, may not have the same level of translucency.

3. Both materials can be customised for individual patients, and Zirconia offers more options for shade matching and characterisation to achieve a highly natural look[4].

4. Zirconia maintains its aesthetic qualities for longer periods due to its durability and resistance to wear[1]. PMMA may require more frequent replacements or repairs, which can affect its long-term aesthetic appeal.

5. When it comes to simulating gum tissue, PMMA can be more flexible in creating natural-looking gum areas. However, advancements in Zirconia prosthetics have also made it possible to achieve excellent gum aesthetics with this material[5].

While both materials can provide attractive results, Zirconia is generally considered the premium choice for aesthetics in Full Mouth Dental Implants prosthetic teeth due to its superior properties in terms of appearance, durability, and stain resistance[1][3].

Citations:
[1] https://northtexasdentalsurgery.com/choosing-the-right-all-on-four-prosthesis-zirconia-vs-pmma-options-explained/
[2] https://www.youtube.com/watch?v=aoEFc45G22M
[3] https://drsehmi.co.uk/all-on-4-materials-what-is-better-zirconia-pmma-or-acrylic/
[4] https://www.bunkerhilldentistry.com/2019/01/18/all-on-4-tooth-materials/
[5] https://www.oralhealthgroup.com/features/an-alternative-prosthetic-design-for-lower-full-arch-implant-restorations/

Maintenance

There are several key differences in the long-term maintenance requirements for Zirconia versus PMMA prosthetics:

1. Zirconia prosthetics maintain their surface properties better over time compared to PMMA resin. This means Zirconia prosthetic teeth are easier for patients to maintain with self-care and require less professional intervention[1].

2. Zirconia's smoother, more polished surface is less prone to plaque adhesion and calculus formation compared to that of PMMA. This results in reduced maintenance needs for Zirconia prosthetic teeth[1].

3. Zirconia is highly resistant to staining, while PMMA is more prone to discolouration over time. This means PMMA prosthetics may require more frequent professional cleaning or replacement to maintain aesthetics[2].

4. Zirconia prosthetics are more durable and resistant to wear compared to PMMA. PMMA prosthetics may require more frequent repairs or replacements, typically every 3-5 years, while Zirconia prosthetic teeth can last much longer with proper care[2].

5. While regular maintenance appointments are recommended for both types of prosthetic teeth, patients with PMMA prosthetics may need more frequent professional care due to the material's less durable properties. Zirconia prosthetic teeth generally require less frequent professional intervention[1][2].

6. With most providers Zirconia prosthetic teeth have a higher initial cost, however at New Life Teeth we offer Zirconia prosthetic teeth in our fixed competitive pricing and we offer a 15-year warranty on our teeth. If you choose PMMA teeth the provider will offer a 3-5 year warranty on the teeth. This means that in the long run, you will need to pay for breakages and repairs to your PMMA teeth. Zirconia is, therefore, a more cost-effective material in the long run compared to PMMA, which may require more frequent replacements and maintenance[2].

In conclusion, while both materials may require ongoing maintenance, Zirconia prosthetics however generally offer lower long-term maintenance requirements. They are easier to maintain, more resistant to staining and wear, and typically require less frequent professional intervention compared to PMMA prosthetics.

Citations:
[1] https://decisionsindentistry.com/article/maintaining-implant-supported-hybrid-prostheses/
[2] https://northtexasdentalsurgery.com/choosing-the-right-all-on-four-prosthesis-zirconia-vs-pmma-options-explained/
[3] https://www.nature.com/articles/s41405-024-00214-7
[4] https://www.youtube.com/watch?v=aoEFc45G22M
[5] https://www.sciencedirect.com/science/article/pii/S0022391321002651

Mechanical Properties

Zirconia generally exhibits superior mechanical properties compared to PMMA for dental prosthetic applications:

1. Zirconia has significantly higher flexural strength (900-1200 MPa) and fracture toughness compared to PMMA[1]. This makes Zirconia more resistant to breakage and wear over time.

2. Zirconia has a much higher hardness ratio (1200 HV) over PMMA[1]. This contributes to better wear resistance and longevity of Zirconia prosthetic teeth.

3. In 3D finite element analysis, Zirconia shows less deformation (0.168 mm) under load compared to PMMA (1.035 mm)[3]. This indicates better dimensional stability for Zirconia prosthetics.

4. Zirconia prosthetics are significantly heavier than PMMA (6.34 g vs 1.33 g for a 4-unit fixed dental prosthesis)[3]. However, the higher weight does not negatively impact its mechanical performance.

While PMMA has some advantages such as lower weight and costs to the provider, Zirconia's superior strength, hardness, wear resistance, and long-term stability make it generally preferable for permanent full mouth dental implant prosthetics. However, the optimal choice may depend on the specific clinical situation and patient needs.

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515448/
[2] https://northtexasdentalsurgery.com/choosing-the-right-all-on-four-prosthesis-zirconia-vs-pmma-options-explained/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670660/
[4] https://iopscience.iop.org/article/10.1088/1757-899X/987/1/012031
[5] https://www.sciencedirect.com/science/article/abs/pii/S0928493118325839

How Does The Cost Compare?

1. Zirconia prosthetics generally have a higher upfront cost compared to PMMA or metal-acrylic hybrids. One study estimated the difference to be around £7,829 higher for Zirconia prosthesis fabrication[2][4]. However, there are some clinics which offer Zirconia at a more affordable cost than PMMA, at New Life Teeth we provide Full Mouth Dental Implants (both jaws) with our Prettau Zirconia teeth for £16,500

2. PMMA prosthetics tend to require more frequent replacements and maintenance. They can break, experience wear and tear, and are prone to staining and bacterial buildup. This leads to higher long-term costs for repairs and replacements[1].

3. Studies have shown that zirconia fixed implant prostheses have reduced overall complication rates compared to metal-acrylic hybrids. This leads to lower costs associated with treating complications over time[2].

4. Zirconia prosthetics demonstrate significantly higher survival rates (93.7% ± 5.5% at 5 years) compared to metal-acrylic prostheses (83.0% ± 11.1%). Higher survival rates translate to a less frequent need for complete replacement, therefore reducing long-term costs[2].

In conclusion, while Zirconia prosthetics may require a higher upfront investment, their superior durability, lower maintenance requirements, and reduced complication rates make them more cost-effective over the long term compared to PMMA options. Patients and clinicians should consider these long-term cost benefits when choosing between zirconia and PMMA prosthetics.

Citations:
[1] https://northtexasdentalsurgery.com/choosing-the-right-all-on-four-prosthesis-zirconia-vs-pmma-options-explained/
[2] https://pubmed.ncbi.nlm.nih.gov/32142577/
[3] https://stomadentlab.com/denture-services/zirconia-pmma/
[4] https://core.ac.uk/works/124658353
[5] https://www.youtube.com/watch?v=aoEFc45G22M

Durability

Zirconia prosthetics generally offer superior durability and longer lifespan compared to PMMA prosthetics:

1. Zirconia exhibits remarkable wear resistance, making it a long-term solution for dental prosthetic needs. It is less prone to breakage and wear over time compared to PMMA[2][3].

2. PMMA prosthetics, especially hybrid options with acrylic components, often require more frequent maintenance and replacement. The teeth in hybrid prostheses may need replacement every five to seven years[3].

3. A study comparing zirconia and metal-acrylic prostheses found higher survival rates for zirconia prosthetics. At 5 years, Zirconia prostheses had a survival rate of 93.7% ± 5.5%, while metal-acrylic prostheses had a survival rate of 83.0% ± 11.1%[1].

4. Zirconia prostheses showed lower rates of both minor and major complications compared to metal-acrylic prostheses. Major prosthetic complications requiring lab work were reported in 25.8% of zirconia cases versus 41.9% in metal-acrylic cases[1].

5. Due to its superior mechanical properties, zirconia prosthetics offer better long-term durability and reduced need for replacement or maintenance compared to PMMA options[3].

6. Zirconia's smooth, polished surface is more resistant to staining and bacterial buildup compared to PMMA, contributing to better long-term aesthetics and cleanliness[2][3].

While PMMA prosthetics may have lower initial costs, the durability and longer lifespan of zirconia prosthetics generally make them more cost-effective in the long run. Zirconia's superior wear resistance, higher survival rates, and lower complication rates contribute to its extended lifespan and reduced need for replacements or repairs over time.

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10297443/
[2] https://stomadentlab.com/denture-services/zirconia-pmma/
[3] https://northtexasdentalsurgery.com/choosing-the-right-all-on-four-prosthesis-zirconia-vs-pmma-options-explained/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515448/
[5] https://www.youtube.com/watch?v=aoEFc45G22M

Resistance To Stains and Bacteria

Zirconia generally exhibits superior resistance to stains and bacteria compared to PMMA in dental prosthetics:

1. Zirconia restorations are far superior in stain resistance compared to PMMA (acrylic) teeth[1]. Zirconia can better endure staining from substances like coffee, wine, and nicotine, maintaining its appearance over time.

2. Fewer bacteria attach to the zirconia surface compared to PMMA[1]. This property helps prevent gum discolouration and reduces the risk of bacterial buildup, which is a common issue with PMMA prosthetics.

3. Zirconia's smooth, polished surface contributes to its resistance to both staining and bacterial adhesion[5]. This makes it easier to maintain cleanliness and freshness of the prosthetic over time.

4. The superior stain and bacterial resistance of zirconia contributes to its long-term durability and aesthetic appeal. PMMA, on the other hand, is more prone to discoloration and bacterial accumulation over time[1][5].

5. While both materials require regular cleaning, zirconia's resistance to stains and bacteria makes it easier to maintain its appearance and hygiene with standard oral care practices[1][5].

6. The reduced bacterial adhesion on zirconia surfaces can contribute to better overall oral health for the wearer, potentially reducing the risk of gum inflammation and other oral health issues associated with bacterial buildup[5].

In conclusion, zirconia demonstrates significantly better resistance to stains and bacteria compared to PMMA. This property contributes to zirconia's superior long-term performance, easier maintenance, and potential benefits for oral health in dental prosthetics.

Citations:
[1] https://www.dentaprme.co.uk/dental-blog/what-you-need-to-know-about-dental-crowns-made-from-zirconia/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503455/
[3] https://www.researchgate.net/publication/344212884_Effect_of_Cleansers_on_the_Colour_Stability_of_Zirconia_Impregnated_PMMA_Bio-Nanocomposite
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558324/
[5] https://stomadentlab.com/denture-services/zirconia-pmma/

Photo of our Zirconia Dental Implants in our belfast lab

Conclusion

In the comparison between Zirconia and PMMA for dental implants, Zirconia emerges as the superior choice for long-term, high-quality dental restorations. Its excellent biocompatibility, superior aesthetics, durability, and resistance to stains and bacteria make it an ideal material for patients seeking optimal results.

While PMMA remains a viable option for temporary restorations or budget-conscious patients, Zirconia's long-term benefits often outweigh its higher initial cost. The material's ability to provide natural-looking, long-lasting restorations with reduced maintenance needs and lower complication rates makes it a preferred choice for many dental professionals.

Ultimately, the decision between Zirconia and PMMA should be based on individual patient needs, considering factors such as long-term oral health, aesthetic expectations, and overall value. As dental technology continues to advance, Zirconia's role in dental implants and prosthetics is likely to grow, offering patients increasingly refined solutions for their restorative dental needs.

If you want to read even more clinical studies we have listed even more below…

Clinical Studies on Zirconia

Zirconia: Established facts and perspectives for a biomaterial in dental implantology:
‍https://onlinelibrary.wiley.com/doi/10.1002/jbm.b.31147

‍Performance and outcome of zirconia dental implants in clinical studies: A meta-analysis:
‍https://onlinelibrary.wiley.com/doi/10.1111/clr.13352

‍Zirconia Implants and Marginal Bone Loss: A Systematic Review and Meta-Analysis of Clinical Studies:
‍https://pubmed.ncbi.nlm.nih.gov/32724922/

‍Long-term survival and success of zirconia screw-retained implant-supported prostheses for up to 12 years: A retrospective multicenter study:
‍https://www.thejpd.org/article/S0022-3913(21)00265-1/fulltext

‍Prosthetic Materials Used for Implant-Supported Restorations and Their Biochemical Oral Interactions: A Narrative Review:
‍https://www.mdpi.com/1996-1944/15/3/1016

‍Zirconia: Established facts and perspectives for a biomaterial in dental implantology:
‍https://onlinelibrary.wiley.com/doi/10.1002/jbm.b.31147

‍Zirconia in dental implantology: A review:
‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515795/

‍Clinical Success of Zirconia in Dental Applications:
‍https://onlinelibrary.wiley.com/doi/10.1111/j.1532-849X.2009.00513.x

‍Implant Supported Fixed Dental Prostheses Using a New Monotype Zirconia Implant—A Case Report:
‍https://www.mdpi.com/2304-6767/3/3/79

‍Zirconia in dental implantology: A review:
‍https://pubmed.ncbi.nlm.nih.gov/26236672/

‍Zirconia as a Dental Biomaterial:
‍https://www.mdpi.com/1996-1944/8/8/4978