Zirconia compared to titanium dental implants in preclinical studies—A systematic review and meta‐analysis

Abstract

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.

Current status on lithium disilicate and zirconia: a narrative review

“…As regards zirconia implants, the literature reports controversial, short-term and mainly anecdotal data [165,[170][171][172][173][174]. A recent systematic review with metaanalysis has evidenced similar potentialities of hard-and soft-tissue integration between zirconia and titanium implants, although with a slower initial osseointegration process detected in zirconia ones.…”

Future prospects of zirconia for oral implants —A review

“…Zirconia, tetragonal zirconia polycrystal (TZP) in particular, gained increasing importance due to their mechanical, esthetic and biocompatible performance for dental implants. In the recent reviews, it is reported that zirconia implants are a promising alternative to Ti with comparable osseointegration, a superior soft-tissue response in short-term outcomes [4][5][6][7] . However, more evidence data are needed to confirm the presently evaluated outcomes.…”

Biofunctionalization of zirconia with cell-adhesion peptides via polydopamine crosslinking for soft tissue engineering: effects on the biological behaviors of human gingival fibroblasts and oral bacteria

“…The use of zirconia as implant abutment material is rapidly increasing, since it is regarded as being more aesthetic and biologically friendly compared with traditional abutment material, titanium. 9 However, because it is bioinert and has low reactivity, the use of zirconia is challenging when it comes to fast integration with the surrounding tissue. 10 To address this issue, several surface modication approaches have been proposed to improve the biological performance of zirconia in terms of tissue responses: (i) modifying the surface topography by grinding, sand blasting, 11 or etching; 12 (ii) application of ultraviolet irradiation, 13 plasma spraying, 14 or laser treatment; 15 and (iii) coating of the surface with bioactive agents such as hydroxyapatite, 16 calcium phosphate, 17 chitosan, 18 type I collagen, 19 and bone morphogenetic protein 2.…”