Nanotechnol Rev 2019; 8:396–404

Research Article

Cheng Hu, Jianxun Sun*, Cheng Long, Lina Wu, Changchun Zhou*, and Xingdong Zhang

Synthesis of nano zirconium oxide and its

application in dentistry
https://doi.org/10.1515/ntrev-2019-0035 dental materials are studied and develop to be used in re-
Received May 13, 2019; accepted May 28, 2019 building the curve, color, shape and function of teeth.
In the past few decades, dental materials have devel-
Abstract: Zirconium oxide (ZrO2 ) is the general mate-
oped rapidly, providing more personalized functions for
rial in dental area, with natural color, high toughness
dental treatment. The common materials application in
and strength. Recent years, small blocks of ZrO2 such
dental restorations and prosthesis are ceramic crown [6, 7]
as micro/nano powders have been studied and devel-
and implants [8]. Ceramic fused metal and all-ceramic
oped widely. Nano scale ZrO2 , which showsimproved me-
crown are often served to repair tooth defects. Compared
chanical characteristics and superior biocompatibility, are
with ceramic fused metal restorations, all-ceramic materi-
usually incorporated into different applications used in
als are preferred due to their natural color, wear resistance,
dentistry and tissue engineering. This review provides
biocompatibility and aesthetics [9]. Titanium implant is
an overview of nano-ZrO2 materials and its applications
the most frequently used in clinic nowadays [10], while re-
in dentistry. The synthesis of nano-ZrO2 powders were
cent developments of ZrO2 implants have attracted much
mainly prepared by coprecipitation, hydrothermal method
attention [11, 12]. Both in vivo and in vitro studied have
and sol-gel method. Then different applications of nano-
demonstrated that ZrO2 implants retain the similar or even
ZrO2 biomaterials in dental ceramics, implants, radio paci-
superior osseointegration than Ti implants [13–16].
fying agents, basement and tissue engineering fields were
High purity ZrO2 is the general material in dental area,
briefly introduced.
ZrO2 is a kind of biomaterial with good natural white
color, high toughness, excellent strength, steady chemical
properties, good corrosion resistance, which is a source
1 Introduction of high-performance ceramic material and especially bio-
compatible implant materials [17–20]. In fact, the high
Teeth are essential to oral and overall health, esthetics, strength of ZrO2 indicates that this material is hard to be
speaking, and quality of life. A large majority of the pop- processed and formed. Although CAD/CAM technique can
ulation is suffering from oral diseases, including caries, be used for solving such problems, however, it is hard to
pulpitis, and periodontal diseases, some of them may lead reach high accuracy demanded and the fabrication cost
to defect of teeth and functions [1, 2]. There is thereby an is high [21–23]. Hence, it is acceptable to introduced the
urgent need but it is still a significant challenge to recon- small blocks of ZrO2 such as micro/nano powders to re-
struct or regenerate the heterogeneous and dynamic den- solve the problems. Nano-ZrO2 provides more application
tal anatomical structure [3–5]. To solve this, the variety of scenarios, such as nano powders filling [24], nano coat-
ing [25, 26], sintering raw material [27] and so on. ZrO2
nanopowders are employed in promoting the bionics and
mechanical properties of dental ceramics and tissue engi-
*Corresponding Author: Jianxun Sun: State Key Laboratory of
neering scaffolds. Recent studies indicated that the coop-
Oral Diseases, West China Hospital of Stomatology, Sichuan Univer-
sity, Chengdu 610041, China; Email: [email protected]
eration of ZrO2 nanopowders can significantly strengthen
*Corresponding Author: Changchun Zhou: National Engineering the flexural strength, fracture toughness and shear bond
Research Center for Biomaterials, Sichuan University, 610064, strength of the materials [28, 29]. In another scenario,
Chengdu, China; Email: [email protected] nano-ZrO2 can served as a powerful porous coating of solid
Cheng Hu: State Key Laboratory of Oral Diseases, West China Hospi- surfaces to provide a nanostructured surface through the
tal of Stomatology, Sichuan University, Chengdu 610041, China
modification method that could improve the biocompati-
Cheng Long: Department of orthopedics, West China hospital,
Sichuan University, Chengdu 610041, China bility. For example, nano-ZrO2 coating on the surface of
Lina Wu, Xingdong Zhang: National Engineering Research Center Ti implants or the nano porous ZrO2 implants are able to
for Biomaterials, Sichuan University, 610064, Chengdu, China

Open Access. © 2019 C. Hu et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0
License
 Synthesis of nano zirconium oxide and its application in dentistry | 397

enhance the process of osseointegration [30]. It is consid- ple and the production is demonstrated to be nice, how-
ered that surface treatment and bioactivation accelerate ever, there are a few elements in the initial solution would
the new bone formation. residue, which could have effects on the sintering proper-
This review provides an overview of Nano-ZrO2 bioma- ties of the nanopowders.
terials and its applications in dentistry. Two aspects were Sol-gel method is extensively used to prepare solid ma-
discussed in detail. Firstly, the synthesis of nano-ZrO2 was terials from small molecules at the relatively lower temper-
introduced, and then the applications of nano-ZrO2 bio- ature. During the sol-gel process, the main step is the con-
materials on dental ceramics, implants, membranes, base- version of the precursors into the colloidal or polymeric so-
ment and tissue engineering are extensively reviewed. lution through hydrolysis and condensation reactions [38,
39]. The initial precursors are often metal alkoxides or
metal chlorides, which could have an effect on the proper-
ties of sol-gel, like drying or firing behavior. Huang and col-
2 Synthesis of nano-ZrO2 league [31] explored how the organic addition influenced
the characterization of ZrO2 nanocrystals. Zirconium oxy-
Among the metal oxide ceramics, ZrO2 has one of the best
chloride octahydrate (ZrOCl2 ) was used as precursor, while
high-temperature thermal stability and thermal insulation
glacial acetic acid (HAc) was applied as the chelating
performance. There are three different crystal structure of
agent during vigorous stirring. N,N-dimethylformamide
ZrO2 : cubic (c-ZrO2 ), tetragonal (t-ZrO2 ) and monoclinic
(DMF) as drying control chemical additives (DCCA) was
(m-ZrO2 ), with each crystal structure keeps stable in dif-
also added to reduce the cracks when stirring. After calci-
ferent range of rtemperature. Under certain condition, like
nation, the size of ZrO2 nanocrystals decreased to 13.94nm
pressure and temperature, each of the structure can be
by adding HAc and DMF. Shukale and Seal have suc-
transformed mutually, at the same time, their physical
cessfully synthesized nanocrystalline ZrO2 particles us-
properties, volume change in a way that t-ZrO2 holds the
ing the sol-gel method [40]. It is worthwhile to highlight
best performance while m-ZrO2 is the usually form at room
that the metastable t-ZrO2 is stabilized at normal temper-
temperature. Therefore, it is important to synthesis t-ZrO2
ature within pure ZrO2 displaying nonspherical morphol-
at moderate temperature to prevent expansion [31]. The ad-
ogy. The unique nature maybe result from the contribution
vanced application of nano-ZrO2 powders are containing
of the interfacial, and strain energies, which balance the
refractories, abrasives, ceramic pigments, oxygen sensors,
size and the shape, stabilizing the t-ZrO2 nanoparticles.
catalytic materials [32]. Nano-ZrO2 powders are mainly pre-
Hydrothermal method is an advanced technology for
pared by wet-chemical synthesis approaches, such as co-
preparing inorganic materials particularly particles with
precipitation [27, 33], hydrothermal synthesis [34], sol-gel
nano-sized to submicron crystals by chemical reaction in
preparation [35]. The physical method cannot meet the re-
aqueous solution under high temperature and pressure.
quirement of nano size, while gas-chemical method costs
Vapors or fluids acts as the tranformation agent for pres-
too high to repeat it in practical production.
sure, heat, and mechanical energy [41]. These character-
Coprecipitation is the primary means of wet-chemical
istics facilitate the formation of prepared powders that
precipitation for synthesis ZrO2 nanopowders. Coprecip-
have uniform microstructure, shape and components. Re-
itation technique is processing by adding precipitating
searchers think that hydrothermal method is considered to
agent into the mixture solution of water-soluble zirconium
be one of the most promising methods to prepare fine parti-
salts and stabilizers like Y2 O3 . After the precipitation reac-
cles with controlled forms [41]. Szepesi and colleagues [42]
tion, the insoluble precipitation as hydroxides is formed
have developed the high yield hydrothermal precipita-
which are then dried or calcined to obtain nano-ZrO2 pow-
tion procedure and synthesized zirconia or yttrium-doped
ders. The group of Wang and Zhai prepared the MgO-
tetragonal zirconia polycrystals (YTZP) with average size
Doped ZrO2 nanopowders with nanosize of 10 mol% [36].
of 8-10 nm. Bicine was served as the complexing solu-
A mixture of water and ethanol(ratio of 1: 1) served as the
tion to reducing the tendency of agglomeration in high-
precipiting and washing solvents. On the base of the capa-
yield batches. Another work built novel ZrO2 nanorods
bility ethanol holds to alleviate the hydrogen bond exist-
and nanoparticles from ZrO2 powders through hydrother-
ing inside of the formed zirconium hydroxide gels, the ho-
mal processing [43]. This long-drawn-out synthesis pro-
mogeneous nano-MgO-ZrO2 were formed, presenting sat-
cess was performed in autoclave with NaOH solution as
isfying sintering property. Another study investigated how
the mineralizer at a temperature of 200∘ C for totally 7 days.
pH value and residual NH4 Cl interfere crystallization of
The NaOH mineralizer had different concentrations of 15
nano-ZrO2 powders [37]. Coprecipitation technique is sim-
M, 20 M and 25 M. Under electron microscopy, the formed
398 | C. Hu et al.

Table 1: Different methods for synthesis of nano-ZrO2

Synthesis Advantages Disadvantages Size Morphology

approaches
coprecipitation simple in preparation; low low yield and purity of finished few nm to particles
equipment requirements; products; agglomeration; hundreds
commercialized influenced by many factors like nm
washing solvent, pH value, drying
method.
sol-gel handy operation; high purity; Time-consuming; poor sintering few nm to particles;
preparation homogeneous distribution; properties hundreds nanotubes
commercialized nm
hydrothermal high purity; time-saving; perfect equipments for stringent; high few nm to particles;
synthesis dispersion; various crystal shape; temperature several nanotubes;
controllable size; minimization of µm nanorods;
agglomeration. nanobars

block or powder form ZrO2 can be considered to gain more

formability.
Researchers have employed nano-ZrO2 for resistance
enhancement in diatomite-based ceramics. The method of
layer-by-layer (LBL) assembly modification was organized
in order to enhence the adsorption of electropositive nano-
ZrO2 [29]. The surface of diatomite-based ceramic powder
was modified using allylamine hydrochloride (PAH) and
sodium 4-styrenesulfonate (PSS), then nano-ZrO2 parti-
cles with positive electricity were absorbed to the ceramic
Figure 1: Bright field image of ZrO2 nanobars (20 M NaOH); HRTEM
powders. After PAH/PSS polyelectrolyte dispersants mod-
image of zirconia nanobar (25 M NaOH) [43]
ification, the size of diatomite particles decreased (from
0.12 to 35 µm); radius narrowed to 0.42 µm. The sintered
nanorods had diameters spanned from 25 to 200 nm and and shaped ceramics were prepared for further tests, and
lengths ranging several hundred nm to 2µm (Figure 1). the results suggested that addition of nano-ZrO2 has led to
the higher flexural strength, fracture toughness and shear
bond strength value with reduced porosity. The reasons
may lay in composite particles with a smaller wideness dis-
3 Application of nano-ZrO2 in
tribution and less aggregation; the addition of nano-sized,
dentistry uniform ZrO2 , which formed a dense unity with diatomite-
based ceramic powders [47, 48]. Another experiment [49]
3.1 Application of nano-ZrO2 as dental verified that the silica ceramics filled with nano-ZrO2
ceramics showed excellent heat shielding and high-temperature ab-
lation properties.
Over the past few decades, the increasing demand of func- As a biologically inert ceramic, ZrO2 need to combine
tional and aesthetics effect has hastened the development with other bioactive phase. Nano-ZrO2 can acts as the
of ceramic restoration crowns, which are of satisfying second phase to enhance the fatigue resistance to nano-
natural-tooth like color, bionics and mechanical proper- HA ceramics [50–54]. When compared with pure nano-
ties [44, 45]. Among the various dental ceramic materi- HA ceramics, the hybrid ceramics of nano-HA/nano-ZrO2
als, ZrO2 is of very superior strength and toughness. ZrO2 showed similar cytocompatibility. Besides, wettability of
is widely used as inlays, partial crowns, veneers and full the interfaces of ZrO2 -based dental ceramics seems to af-
ceramic crowns. Nevertheless, the high mechanical ZrO2 fect the adhesion properties. Marefati et al. have studied
dooms for the difficulty to machine [46]. To solve this, the the effect of different size yttria-stabilized tetragonal zir-
 Synthesis of nano zirconium oxide and its application in dentistry | 399

Figure 2: AFM pictures of nano-ZrO2 surface: (a) machining through common grinding method; (b) ultrasonic assistant grinding method [57]

conia polycrystals(Y-TZP) cores on wetting behaviour of tine treatment for tooth defect or missing. With their ex-
a molten feldspathic glass-ceramic [55]. There was an en- cellent mechanical strength and biocompatibility, Ti im-
hancement of wettability in nano-sized Y-TZP group. This plants are considered as the suitable substitutes for nat-
may be related with the diffusion-assisted atoms through ural teeth. The dense oxide film on the surface of Ti can
increased surface defects such as grain boundaries and form a chemical combination with bone tissue [58–60],
triple junctions. however, this level of osseointegration is not able to meet
In the midst of common processing, fracture among the requirements of the stresses [61, 62]. The close contact
the block material can be brought about. This is the between the implants material and alveolar bone tissue
main limitation when applying nano-ZrO2 . Therefore, the means that implant surface modification like roughness
impacts during consolidation process should be deeply and surface treatment play a role in the process of bone
studied. Park et al. [56] have explored the method that regeneration [63, 64]. Therefore, nano-ZrO2 can be served
combined application of magnetic pulsed compaction as the promising implants or coating material for better in-
(MPC) and subsequent sintering for densification of ZrO2 tegration.
nanopowders. The high density (98%) ZrO2 bulks were ob- Considerable research efforts have been devoted to
tained. At experiment condition, the authors have found that ZrO2 implants present the similar or even superior
that with increasing MPC pressure, the grain size of zirco- osseointegration than Ti implants. ZrO2 is particularly at-
nia block decreased, while the additional ratio of PVA did tractive as dental implants or coatings due to the highly
not have an obvious effect on the grain size. According to chemical stability, biocompatibility, suitable fracture re-
the paper, the optimum way was implemented as follow- sistance and flexural strength compared with alveolar
ing: MPC process (1 GPa compaction pressure and using 1.0 bone [65, 66]. Fabrication of ZrO2 basement including acid
wt. % PVA) and then two-step sintering (first at 1000∘ C and etching [67, 68], plasma spraying [69, 70] and deposition
then at 1450∘ C). A novel ultrasonic assistant grinding de- of bioactive layer [71–73] can further increase surface hy-
vice was designed by the group of Gao [57] to process nano- drophilic properties. An example of the application of
ceramics. The data and AFM picture (Figure 2) revealed the nano-technology treatment of ZrO2 implants is reported by
critical ductile depth of cut is deeper compared to whether the group of Lee [74]. The authors used micro-structured
common grinding or traditional ZrO2 engineering ceram- ZrO2 implants (ZiUnitet™) as substrate and chemical de-
ics. posited method was applied. ZiUnitet™were immersed
firstly into the phosphorous-rich solution then calcium-
rich solution to form the nano coating with a Ca/P ratio of
3.2 Application of nano-ZrO2 as dental 1.67. Nevertheless, 3-6 weeks in vivo healing study proved
implants there was no significantly difference between the groups,
given that it is hard to gain improvement on the base of
It is known that dental implants manufactured by tita- commercial implants with high level of osseointegration.
nium (Ti) and its alloys has gradually become the rou- Another group have used the creative selective infiltration-
400 | C. Hu et al.

Figure 3: The image of sintered nano-porous zro2 scaffolds and SEM image of a sintered zro2 scaffold with interconnectivity [85].

etching (SIE) technique to build a highly retentive nano- pare scaffolds presented a nano-porous structure with
porous surface beyond ZrO2 basement material. 4-6 weeks good interconnectivity (Figure 3). ZrO2 ceramic nanoparti-
in vivo research showed that SIE group had significantly cles can be an excellent filling material in composite scaf-
higher bone-implant contact and bone density compared fold for the satisfying cytocompatibility and high strength.
to Ti and control ZrO2 implant group [68]. Gaihre and collaborators functionalized chitosan scaf-
Electrochemical deposition is also a common used folds by adding nano-ZrO2 nanopowders [86]. They have
method for the preparation of metal oxide nano-structured found that the additional nano-ZrO2 can significantly en-
arrays [75]. Researchers have prepared a composite layer hance the compressive strength and modulus of original
consisting of nano-ZrO2 /hydroxyapatite coating on the porous chitosan, simultaneously the pre-osteoblasts (OB-
surface of Ti allay through the electrochemical method [76, 6) showed higher proliferation on the chitosan scaffolds
77]. The tensile test showed the combined strength be- filled with nano-ZrO2 .
tween uniformly nano-ZrO2 /hydroxyapatite coating and Bioactive factors are also the common way to increas-
titanium basement was 16.3 MPa, owing to the homo- ing bone regeneration ability of biomaterial scaffolds. Mi-
geneously distributed nano-ZrO2 were served as buffer croRNAs (miRNA) are small non-coding RNAs, which play
layer connecting the mismatching thermal expansion co- a role in RNA silencing and post-transcriptional up or
efficient of HA and Ti alloys. down regulation of gene expression. The group of Bala-
gangadharan have synthesized and characterized nano-
ZrO2 /chitosan scaffolds along with miR-590-5p [24], a
3.3 Application of nano-ZrO2 as bone tissue miRNA that can enhance Runx2 expression, which is a
engineering scaffolds vital signal pathway in osteogenic differentiation of cells.
In vitro osteogenic differentiation experiment showed that
Tissue engineering usually combines seed cells, engineer- ALP activity and calcium deposition had significantly in-
ing methods, biomaterial scaffolds and physical and chem- creased in miR-590-5p group. Thus, the presence of nano-
ical factors to restore, maintain, or improve function of or- ZrO2 enhanced the strength of the scaffolds so that they
gan. And bone tissue engineering method is recognized can be used in load-bearing bone defect area.
as the ideal approach to rebuild the bone defects [78, 79].
Biomaterial scaffolds need good mechanical strength to
meet the requirement stressed zone. Besides, these scaf- 3.4 Application of nano-ZrO2 as
folds are required to have certain osteoinductivity and cy- radiopacifying agent
tocompatibility properties, as well as the interconnection
structure to support the growth of osteoblasts, vessels and Root canal therapy is considered as the preferred method
new bone [80–84]. for treating pulpal and periapical diseases. It should be
Researchers have fabricated porous nano-ZrO2 scaf- pointed out that root canal obturation determine whether
folds through replication technique [85]. A coating the success of therapy. Within the process, X-ray film is the
polyurethane foam was employed as the template. Then primary path to evaluate the root canal obturation. And
a process of coating-drying-sintering was taken. The pre- thus the desired root filling material needs good radiopac-
 Synthesis of nano zirconium oxide and its application in dentistry | 401

ity [87, 88]. Some metal dioxides can be nominated as the ural strength was shown in 7.5 wt% nano-ZrO2 group. This
good candidates as the radiopacifiers in cement-base fill- may be related with that well-distributed nano-ZrO2 filled
ing material, like Bismuth oxide, Niobium oxide and ZrO2 . the minute space inside the repair resin matrix, arresting
Mineral trioxide aggregate (MTA) is a widely used the tiny crack propagation [95]. On the contrary, impact
dental material for root filling and pulp capping for its strength test implied that 2.5 wt% nano-ZrO2 group pro-
biocompatibility, seal ability, leading surrounding tissues vided the maximum impact strength, whereas the 5 wt%,
mineralization. MTA is mainly composed of Portland ce- and 7.5 wt% nano-ZrO2 group lowered the resin impact
ment(PC). Researchers have found that ZrO2 nanoparti- strength. The results was similar to Asopa’ s group [96].
cles can be the promising radiopacifier as supplement in This may be due to self-aggregation of high level ZrO2
PC for expediting hydration kinetics without weaken bio- nanoparticles, causing cluster structure formation.
compatibility [89]. The group of Tanamaru [90] evaluated Another group has explored the transverse strength
the properties of MTA and PC with micro-sized or nano- of autopolymerized acrylic resin reinforced with nano-
sized ZrO2 . The results indicated that both nano or micro ZrO2 [97]. Their experiment has demonstrated that nano-
ZrO2 can significantly aggrandize the radiopacity of origi- ZrO2 reinforcing denture repair resin can significantly en-
nal PC material, simultaneously, their radiopacity reached hance the transverse strength. They thought it was owing
the minimum standards by ISO/ADA of 3.0 mmAl. These to favourable distribution of nano-ZrO2 that allowed the
two researches have supported nano-ZrO2 could be proper nanoparticles fill into the space within polymeric chains.
alternative radiopacifier. In this case, the interfacial shear strength was increased.
Nevertheless, further studies need to be investigated to
know how nano-ZrO2 affect the denture resin mechani-
3.5 Application of nano-ZrO2 denture base cal properties and what section the best concentration lo-
material cates.

The desired denture repair requires accurate tissue fitting,

easy to make, matching the natural color, satisfying frac-
ture strength and aging resistance. Denture base is the
4 Conclusion and prospective
important branch of removable partial dentures and com-
With the excellent performance, ZrO2 has gradually be-
plete denture. It covers on the alveolar ridge and hard
come one of the widest used ceramic material in the fields
palate, providing the attachment for artificial teeth. Ac-
of oral prosthodontics. The nano scale of ZrO2 , including
cording to the curing methods, denture base resins can be
reinforcing fillings, nano-porous coating, noncrystalline
classified into the following three categories: heat-curing
powders, provide more opportunity in different applica-
resin, self-curing resin, light-curing resin. Among these
tion solutions. In this review, we focus on various syn-
denture base resins, polymethyl methacrylate (PMMA) is
thesis method of nano-ZrO2 and recent progress dental
the major constituent. Although PMMA can meet the most
field using nano-ZrO2 and related nano-composite. The
demand of the denture repair, the lack of flexural strength
outstanding properties of nano-ZrO2 such as natural color,
and impact strength limit its service life when it occurs to
high toughness and strength, steady chemical properties,
masticating accidents or suddenly drops [91–93].
good corrosion resistance determine the wide application
The incorporation of ZrO2 nanopowders into PMMA
prospect.
has been put forward in order to improve the performance.
As clearly highlighted in the paper, nano-ZrO2 can
The effect of different addition levels of ZrO2 nanopow-
be employed in dental ceramics, implants, radiopacifying
ders on the repair strength of PMMA has been investigated
agents, denture basement and tissue engineering. Nearly
by group of Mohammed and colleagues [28]. Prior to pre-
all the showed works have displayed the characteristics
pare ZrO2 /PMMA nanocomposite, a silanization process
improvement following adding nano-ZrO2 . Besides, nano-
of nano-ZrO2 particles was taken to active reaction area
ZrO2 exhibits the superior biocompatibility. Nevertheless,
on the surface so that there will be more firm adhesion
greater depth investigation about the interaction between
between nano-ZrO2 and the resin [94]. Different quantity
nano-ZrO2 and stem cells need to be explored, and more
of silanized nano-ZrO2 was added into autopolymerized
in vivo animal experiments are deserved to be carried out.
acrylic polymer powder to obtain the final concentration of
Overall, the role of nano-ZrO2 in dental field is essential.
2.5 wt%, 5 wt%, and 7.5 wt%. The results displayed that the
With more reliable trials, more of it will be seen.
addition of nano-ZrO2 increased flexural strength of resin
material with great significance. The highest value of flex-
402 | C. Hu et al.

Acknowledgement: This work was supported by the tomized zirconia and titanium implant abutments for canine and
National Key Research and Development Program of posterior single-tooth implant reconstructions: Preliminary re-
sults at 1 year of function, Clin. Oral Implants Res., 2010, 20,
China (No. 2018YFB1105600, 2018YFC1106800). Projects
219-225.
of Sichuan Province Science & Technology Department
[14] Zembic A., Sailer I., Jung R.E., Hämmerle C.H.F., Randomized-
(2018GZ0142, 2016CZYD0004, 2017SZ0001). Sichuan controlled clinical trial of customized zirconia and titanium im-
Province Science & Technology Department Interna- plant abutments for single-tooth implants in canine and pos-
tional Sci. & Tech. Innovation Cooperation Project terior regions: 3-year results, Clin Oral Implants Res. 2010, 20,
(2019YFH0079). The “111” Project (No. B16033). National 802-808.
[15] Brakel R.V., Noordmans H.J., Frenken J., Roode R.D., Wit GCD.,
Natural Science Foundation of China (31971251).
Cune M.S., The effect of zirconia and titanium implant abutments
on light reflection of the supporting soft tissues, Clin. Oral Im-
plants Res., 2011, 22, 1172-1178.
[16] Lops D., Bressan P.E., Chiapasco D.M., Rossi D.A., Romeo D.E.,
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