Clinical Performance Comparing Titanium and Titanium–Zirconium or Zirconia Dental Implants: A Systematic Review of Randomized Controlled Trials

Abstract

Objectives: This study aimed to compare clinical results between titanium (Ti), zirconia (Zr), or titanium–zirconium (TZ) dental implants and to analyze survival rate (SR), bleeding on probing (BoP), marginal bone loss (MBL), and/or probing depth (PD). Data source: Manual and electronic searches were conducted (PubMed and Web of Science) to identify randomized controlled trials that compared the outcomes of at least two implant types (control and test group) within the same study. The focused question was determined according to the PICOT strategy. Seven studies were included out of 202 research studies initially found. The follow-up periods ranged from 12 to 80 months, and the mean age was from 43.3 to 65.8 years old. The SR for Ti, TZ, and Zr implants ranged from 92.6% to 100%, 95.8% to 100%, and 87.5% to 91.25%, respectively; MBL for Ti, TZ, and Zr implants varied from −1.17 mm to −0.125 mm for Ti, −0.6 mm to −0.32 mm for TZ, and −0.25 mm to −1.38 mm for Zr. Studies showed a low incidence of mucositis and peri-implantitis; however, BoP for Zr was 16.43%, Ti ranged between 10% and 20%, and TZ from 10% to 13.8%. PD for Ti ranged from 1.6 mm to 3.05 mm, TZ was 3.12 mm (only one study), and Zr ranged from 2.21 mm to 2.6 mm. Conclusion: All three types of implants showed similar tissue behavior. However, the TZ group had better results when compared with Ti and Zr for SR, MBL, and BoP, except for PD. Furthermore, the worst SR was found in the Zr implants group.

Clinical performance of zirconium implants compared to titanium implants: a systematic review and meta-analysis of randomized controlled trials

“…Furthermore, this review may be the first to reveal that the PPD of Ti and Zr implants is comparable and significant under normal and experimental mucositis conditions, respectively. A recent systematic review failed to draw a definitive conclusion owing to the limitation in sample sizes of the included studies ( Fernandes et al, 2022 ). Under healthy conditions, a study revealed that the PPD was significantly greater around Ti implants than around teeth in the same patient (mean PPD difference = 0.8 mm, SD = 0.1 mm, P < 0.001) after 3-year follow-up ( Johnson & Persson, 2000 ), whereas the PPD around the Zr implants statistically significantly lower than around the control teeth at a 3-year follow-up time ( r = 0.56, P < 0.003) was observed in another trial ( Brüll, Van Winkelhoff & Cune, 2014 ).…”

“…A meta-analysis conducted in 2017 did not evaluate Zr and Ti implants in randomized controlled trials (RCTs) with a comparable baseline and has been outdated ( Elnayef et al, 2017 ). Furthermore, a recent systematic review did not quantitively analyze the differences between Zr and Ti implants ( Fernandes et al, 2022 ). As such, a novel systematic review and meta-analysis of RCTs is necessary to provide up-to-date evidence-based recommendations.…”

Stress Distribution Pattern in Zygomatic Implants Supporting Different Superstructure Materials

“…Dental implants remain the ideal treatment option for supporting prosthetic restorations in patients with partial and/or complete edentulism [ 1 ]. Unfortunately, in the atrophic edentulous maxilla, poor bone quantity and quality may inhibit the use of conventional dental implants [ 2 ].…”

Bisphosphonates and Their Influence on the Implant Failure: A Systematic Review

“…Over the years, studies have been carried out to find the most suitable material for the composition of the implants and the consequent success or failure of their osseointegration [3][4][5]. The most scientifically studied implants are titanium implants, and more recently, investigations and comparisons with zirconia material have emerged [3][4][5]. According to Hanawa (2020) [6], titanium has shown excellent biocompatibility, corrosion-resistance, and high fracture toughness based on high strength and elongation.…”