Zirconia Materials Market to Exceed $297.7 Million This Year, and Here's Why

Experts predict that the worldwide zirconia dental material market will be worth nearly $300 million this year. Per Coherent Market Insights, a market research and business-to-business consulting firm, the estimated value will be $292.7 million and will grow to over $510 million by 2030.¹ So, what is it about zirconia that is driving such growth in gross revenue and market share?

Zirconia is a type of ceramic, specifically zirconium oxide, that is known for providing strength and causing less wear on the opposing teeth when compared to other dental materials.² Per 360 Market Updates, a market-research firm, there are a few key players in the global zirconia dental materials market:³

• 3M ESPE
• Aidite
• Aurident
• Dentsply Sirona
• CRYSTAL Zirconia
• GC
• Glidewell Laboratories
• Huge Dental
• Ivoclar
• Kuraray Noritake Dental
• Pritidenta
• Sagemax Bioceramics
• Upcera Dental
• Zirkonzahn

Zirconia is Gaining Popularity for Many Reasons

So, why is zirconia so popular for restorative work? Nathaniel Lawson, DMD, PhD, Division Director, Division of Biomaterials at the UAB School of Dentistry, says it is advantageous from both the clinical and laboratory perspectives. From a clinical standpoint, Dr Lawson says zirconia is attractive as it has higher strength than any other ceramic material clinicians use.

"Due to its strength, we can do more minimal tooth preparations. For example, some manufacturers recommend as little as 0.6mm occlusal reduction for zirconia. Additionally, its high strength allows it to be conventionally cemented with resin-modified glass ionomer cement," Dr Lawson explains.

From the laboratory perspective, zirconia has several advantages, per Dr Lawson. It is milled from large discs with the consistency of chalk. These large discs allow multiple restorations to be milled from 1 disc, unlike glass ceramics, where a single restoration is milled from an individual block. As a result, he says that the cost and efficiency of producing restorations from zirconia are improved over glass ceramics.

Also, milling the zirconia from the chalk-like disc is easier on the machines than milling the harder glass-ceramic blocks. Additionally, Dr Lawson says the size of the zirconia discs allows more extensive restorations to be milled, such as full-arch implant prostheses. Dr Lawson says there are various types of zirconia—3Y, 4Y, and 5Y— where the y stands for Yitria. The more Yitria there is, the more translucent the crown will be, but with lower the flexural strength.⁴ Dr Lawson says the different types allow a laboratory to use one workflow to fabricate anterior and posterior units.

"It's important to know that not all zirconia is the same. There is 3Y zirconia, which is the strongest but most opaque, 5Y zirconia, which is the most translucent but the weakest, and 4Y, which is in-between," Dr Lawson says. "I use zirconia when I need strength. For example, I use it for posterior crowns, and it's the only ceramic material that I would use for a posterior bridge."

Rolando Nunez, DDS, MSc, Clinical Research Manager at BISCO, Inc, agrees that labs prefer zirconia materials because they are friendly for processing. Plus, it's affordable; he says labs can get a lot of restorations from an inexpensive puck of material.

"Now, from a clinical perspective, zirconia is probably as versatile as metal and even more because you can do a single-unit restoration with zirconia, but you can also do a large span, something you can't do with lithium disilicate or any other ceramic material. You can make suprastructures that will go on top of implants. You can create dentures with zirconia," Dr Nunez explains.

Greg Campbell, DDS, a private-practice dentist in Long Beach, CA, says one reason zirconia is growing in popularity is dentists do not have to reduce as much with the preps. Some materials require a 1.5 mm reduction, whereas most zirconia only needs a .8 mm. Dr Campbell says that most dentists are conservative about removing tissue, so they under reduce. Unfortunately, this leads to more breaking and fracturing of the restoration.

"Years ago, when zirconia entered the market, one of the biggest selling points is you don't have to reduce as much. You can be more conservative, and it's more forgiving in that sense. You don't have to be aggressive with your preps if you feel like you're being aggressive," Dr Campbell explains. "So, it's very accommodating to the clinician and especially for those clinicians that under reduce, which some say up to 70% of all restorations are under reduced."

Zirconia also allows dentists to bond or seat restorations with conventional cement. Dr Campbell loves bonding with zirconia, but he knows not every dentist likes bonding their restorative work. Nevertheless, the versatility is appealing, he says.

Also, Dr Campbell says zirconia has a lot of biocompatibility. In some cases, the material achieves reattachment. In addition, zirconia is forgiving with margins, avoiding the chipping and pitting that can happen when milling some ceramics.

"The margins can be knife-edge, chamfer, or shoulder, and the marginal integrity is equivalent to that of a gold restoration, which you can't always get with other ceramics," Dr Campbell says. "The marginal integrity is unbelievable."

Where Does Zirconia Do Best?

Dr Campbell would use zirconia anywhere in the mouth, which he wouldn't have back in the early days of the materials. However, improvements in esthetics have changed that.

For example, he likes the new KATANA™ Zirconia ONE block with his CEREC. The material has a flexural strength of 933MPa after a 5-minute milling time and sinters in 18-minutes. He also likes how it is a multi-layer block, using four layers in graduated shades. Dr Campbell says that dentists can now choose their finish from either a pre-sinter polish, post-sinter polish, or glaze. He uses zirconia for all types of restorative work, from full or partial coverage to onlays and more.

"With this high-translucent zirconia and the multi-layer, it opens up the ability to do a lot of nice-looking dentistry that doesn't look pearly. It doesn't look opaque," Dr Campbell says, adding that early versions of the material were too opaque. "Zirconia also causes less stress and damage on the opposing teeth if it's polished and you always polish your contacts. So, I love that you're putting something very friendly to the opposing arch."

"At the beginning, zirconia was not pretty. It was very opaque. The main selling points were strength, fracture, toughness, face transformation, crack-propagation-stopper, and all these wonderful properties that interest people doing restorative dentistry. But the demand for a more esthetic material allows the industry to evolve rapidly and develop a more esthetically pleasant material so clinicians can expand the treatment horizon," Dr Nunez says. "Now you can use zirconia for something that you couldn't do ten years ago or even 5 years ago."

For example, Dr Nunez says with the new "ultra-translucent" 5Y materials, clinicians are no longer limited to doing posterior crowns. Instead, they can do anterior crowns and even veneers. Dr Nunez also says that zirconia is interesting regarding shade stability.

"I know a lot of clinicians that are using for single-match," Dr Nunez says, adding that he thinks new, highly trained restorative dentists might discover they are zirconia lovers. "This dentist can practice using just zirconia for everything that has to do with indirect restorations. You can do anything from an onlay, crown, short and long bridges, Maryland bridge, structures over implants, dentures, and now veneers. You can use a zirconia structure and a more esthetic ceramic on top of it. The possibilities are endless."

How to Get the Most Out of Zirconia Materials

Dr Campbell says the prep is essential no matter what material clinicians use.

For example, if clinicians do not round off their axial walls, they can have failures. Dr Campbell says rounding this part of the prep means less tension put on the tooth. So, understanding the proper prep metrics, prepping for the material, and then delivering that material properly will set up zirconia restorations for success.

"It's all about the prep for the material. You don't have one standard prep for every material, so you will need to know the prep metrics. For example, if second plane reduction calls for .8, you need to do .8; if it calls for 1mm, then do 1mm," Dr Campbell says. "Many dentists miss the second plane of reduction and rounding from the occlusal surface to the axial wall."

Dr Nunez says the first thing anyone should know before working with zirconia is to understand that it is a temperamental, reactive material. For example, the contamination from the try-in causes a chemical reaction on the surface of zirconia, which decreases the surface's bondability. Therefore, the restoration will fail if the clinician does not fix the contamination.

Unlike lithium disilicate, zirconia needs clinicians to create mechanical retention, which you do by sandblasting. The sandblast will expose a pristine, clean zirconia surface for primer application. Dr. Nunez says the lab usually takes care of the sandblast for the clinician. However, if the clinician does not have a sandblaster after the try-in, they need to clean it. Bisco has ZirClean® cleaning gel for these cases. However, other manufacturers do, too, like IvoClean for Ivoclar and KATANA™ Cleaner from Kuraray.

Dr Nunez says once the surface is clean, it is essential to use a primer with MDP (10-Methacryloyloxydecyl dihydrogen phosphate). For example, Bisco's Z-Prime™ Plus contains MDP and BPDM (biphenyl dimethacrylate) to enhance the bond strength of zirconia. Dr Nunez says that Z-Prime has been proven, documented, and published that it will bond to zirconia. However, any product with MDP would work in this situation.

"MDP will bond to zirconia, but it needs to be sandblasted first, and it has to be clean and pristine," Dr Nunez explains, adding that cements containing MDP will not need a primer because the MDP works as well as the priming. "So, there are differences amongst products, but the procedure is the same."

Following this procedure for bonding will create a strong adhesion that lasts. Dr Nunez says there is much to learn and expect from manufacturers, materials, and protocols. However, he says that the bond to zirconia is stronger than the bond to lithium disilicate over time per their tests, due to its chemical nature.

"There is this perception that you can bond zirconia, but it's not as good as lithium disilicate. And it's not from an immediate bond strength perspective. But over time, there are the ways the bond degrades, and with zirconia, it is more stable," Dr Nunez says.

Dr Campbell says you can get excellent esthetic outcomes with the material. Esthetics from zirconia was something many clinicians would have never guessed when the material first entered the market.

"It's cool that there are options that we never thought were possible early in my career," Dr Campbell says. "There's a new sheriff in town."

References

1. Insights C. Zirconia Based Dental Materials Market to Surpass US$ 510.5 Million by 2030 - Coherent Market Insights. Prnewswire.com. Published 2022. Accessed October 5, 2022. https://www.prnewswire.com/news-releases/zirconia-based-dental-materials-market-to-surpass-us-510-5-million-by-2030--coherent-market-insights-301612420.html

2. What Is a Zirconia Crown? WebMD. Published 2022. Accessed October 5, 2022. https://www.webmd.com/oral-health/what-is-a-zirconia-crown#:~:text=Zirconia%20is%20a%20newer%20material,tear%22%20that%20happens%20over%20time

3. 2022-2029 GLOBAL ZIRCONIA DENTAL MATERIAL PROFESSIONAL MARKET RESEARCH REPORT, ANALYSIS FROM PERSPECTIVE OF SEGMENTATION. 360 Market Updates. Published 2022. Accessed October 5, 2022. https://www.360marketupdates.com/2022-2029-global-zirconia-dental-material-professional-market-19809044

4. Greatimps.com. Published 2022. Accessed October 5, 2022. https://www.greatimps.com/single-post/what-s-the-difference-between-3y-4y-and-5y-zirconia