Current status of ceramic coatings for dental implants.

There are various ceramic coatings available for dental implants. From a commercial standpoint, plasma-sprayed hydroxyapatite (HA) is the most popular. These coatings are typically partially amorphous after processing and contain crystalline phases other than HA. Plasma-sprayed HA and the other bioactive ceramic coating materials have been shown to enhance bone apposition as compared with uncoated metal implants. Some of the other available materials include the bioglasses, other calcium phosphates such as fluorapatite and tricalcium phosphate, and the inert ceramics such as alumina. The plasma-spray process is not optimum for all types of ceramic coatings, because it is not suitable for coating porous surfaces; the exact control of structure and chemistry is difficult with this process, and bond strength is not as high as is desired for some applications. Alternative methods for coating include sol-gel processing, ion beam and radio frequency (RF) sputtering, pulsed laser deposition, hot isostatic pressing, and electrophoretic deposition. The use of osteoinductive agents in conjunction with ceramic-coated implants is of current interest, and the degree and type of bonding of these agents appear to vary with the composition of the ceramic coating. Because there seems to be no satisfactory means of incorporating osteoinductive agents into ceramic coatings during any of the conventional coating procedures, the best approach seems to be to diffuse the agents into the coating after processing. Other possibilities include the tethering of the agents to the surface of the ceramic by suitable organic molecules or the placing of the agent in some carrier material such as a cement, which is placed around the implants.