Zirconia implant surfaces showed a statistically significant reduction in human plaque biofilm formation after 72 hours of incubation in an experimental anaerobic flow chamber model compared with titanium implant surfaces.

Objectives: To evaluate implant survival, peri-implant marginal bone loss, technical, and biological complications as well as aesthetic outcomes of zirconia implants in clinical studies. Material and Methods: Electronic (Medline, Embase) and hand searches were perinvestigating zirconia dental implants with a mean follow-up of at least 12 months. Primary outcomes were implant survival and peri-implant marginal bone loss. Secondary outcomes included technical and biological complications as well as aesthetic outcomes. Meta-analyses were performed to estimate implant survival and marginal bone loss. Results: From 943 titles, 264 abstracts were selected. Subsequently, 80 full-text articles were screened, and 18 studies were included for data extraction. One-(14 studies) and 2-piece zirconia implants (4 studies) were investigated. Commercially available (CA) (510 implants, 398 patients) and not commercially available (NCA) zirconia implants (618 implants, 343 patients) were identified. For CA implants (followup: 12-61.20 months), technical complications (1.6%), implant fractures (0.2%) and biological complications (4.2%) were reported. Meta-analyses estimated 1-and 2-year survival rates of 98.3% (95% CI: 97.0%-99.6%) and 97.2% (95% CI: 94.7%-99.7%), respectively, and a mean 1-year marginal bone loss of 0.7 mm (95% CI: 0.4-1.0 mm). Conclusions:Since 2004, the survival rates of CA implants significantly improved compared with NCA implants. CA 1-piece zirconia implants showed similar 1-and 2year mean survival rates and marginal bone loss after 1 year compared with published data for titanium implants. However, more clinical long-term data are needed to confirm the presently evaluated promising short-term outcomes.

First-generation zirconia implants showed low overall survival and success rates. The evaluated clinical and radiographic parameters were consistent with healthy peri-implant tissues. Additionally, nonfractured failures were not associated with peri-implant infections.

Objectives To evaluate whether zirconia implants demonstrate differences in hard and soft tissue integration compared to titanium implants in preclinical studies. Material and Methods In March 2017, electronic (MEDLINE, EMBASE) and hand search was performed to identify preclinical studies comparing zirconia and titanium implants. Primary outcomes were bone‐to‐implant contact (BIC) and removal torque out (RTQ), respectively, push‐in (PI) measurements. Secondary outcomes included biologic width (BW) dimensions. Results A total of 37 studies were included for data extraction after screening of 91 from 1,231 selected titles. Thirty‐seven experimental studies using six different species were identified. The follow‐up periods ranged between 0.4 and 56 weeks. For titanium, mean values of 59.1% (95% CI: 53.3 – 64.8), 102.6 Ncm (95% CI: 81.5 – 123.6), and 25.1 N (95% CI: 20.2 – 30.0) for BIC, RTQ, and PI were estimated, respectively. The mean values for zirconia were 55.9% (95% CI: 51.6 – 60.1), 71.5 Ncm (95% CI: 51.1 – 91.9), and 22.0 N (95% CI: 13.2 – 30.7) for corresponding parameters. Confounding factors such as animal species, implant material, loading protocol, and study or loading duration significantly influenced the outcomes. Similar qualitative soft tissue integration was reported for zirconia and titanium implants. However, faster maturation processes of epithelial and connective tissues around zirconia implants were assumed. Quantitatively, similar BW dimensions were evaluated for titanium (3.5 mm; 95% CI: 2.9 – 4.2) and zirconia (3.2 mm; 95% CI: 2.7 – 3.7), whereas the loading protocol significantly influenced the outcomes. Conclusions Zirconia and titanium implants demonstrate a similar soft and hard tissue integration capacity. However, titanium tended to show a faster initial osseointegration process compared to zirconia. Importantly, not only material characteristics but predominantly animal species and study protocols can significantly influence the outcomes.

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