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

Duan, Chengchen; Li, Ye; Zhang, Mengyun; Yang, Lei; Li, Chunjie; Pan, Jian; Wu, Yingying; Cao, Yubin

doi:10.7717/peerj.15010

Cited by 3 publications

(2 citation statements)

References 46 publications

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“…Compared to the MBL change with the findings reported in the literature, the patients in our study in general presented with less MBL change for both types of implant (Duan et al, 2023;Neugebauer et al, 2023). Allthough some meta-analyses report more favorable results for Ti implants compared to ZrO 2 implants (Elnayef et al, 2017;Sales et al, 2023), short-term differences were small, which were also seen in the present study.…”

Section: Discussionsupporting

confidence: 55%

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A randomized clinical trial on zirconia versus titanium implants in maxillary single tooth replacement

de Beus,

Cune,

Slot

et al. 2024

Clinical Oral Implants Res

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ObjectivesThis RCT aimed to compare zirconia and titanium dental implants in the maxillary premolar region. The comparison was based on marginal bone level (MBL) changes, clinical parameters, aesthetic outcomes, and patient related outcome measures (PROMs) 1 year after prosthetic loading.Materials and MethodsFifty patients were randomly assigned to receive either a zirconia (ZrO2, n = 25) implant or a titanium (Ti, n = 25) bone‐level implant. Implants were provided with a lithium disilicate crown 3 months after placement. Follow‐up was at 1 month and after 1 year. The primary outcome pertained to changes in MBL. Reported secondary outcomes consisted of implant survival, peri‐implant tissue health, aesthetics, and PROMs.ResultsMean MBL change after 1 year was 0.01 mm (SD = 0.45; min = 0.72, max = 0.86) for ZrO2 and −0.09 mm (SD = 0.34; min = 0.53, max = −1.06) for Ti (p = .439). Scores for the other clinical outcome parameters and PROMs were generally favorable, with no significant differences. However, significant differences were found for the aesthetic outcomes regarding two criteria: (a) level of facial mucosa (p = .022), in favor of Ti, and (b) root convexity/soft tissue color and texture (p = .005) in favor of ZrO2.Conclusion and clinical implicationsThe ZrO2 and Ti implant types used in this study, replacing a single missing maxillary premolar, show a comparable outcome in terms of MBL change after 1 year. Clinical and aesthetic parameters, as well as PROMs, are favorable and similar between both implant types after 1 year of prosthetic loading. These short‐term study results suggest that both are suitable for clinical use.

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Section: Discussionsupporting

confidence: 55%

“…Currently, there is a scarcity of studies that directly compare ZrO 2 and Ti implants within the same study design (Duan et al, 2023; TA B L E 2 Case mix variables.…”

Section: Discussionmentioning

confidence: 99%

A randomized clinical trial on zirconia versus titanium implants in maxillary single tooth replacement

de Beus,

Cune,

Slot

et al. 2024

Clinical Oral Implants Res

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Local antimicrobial delivery systems for prophylaxis and treatment of periprosthetic traumatological infections

Aparicio-Blanco,

López-Torres,

Alonso-Berenguel

et al. 2025

European Journal of Pharmaceutical Sciences

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Comparative Clinical Behavior of Zirconia versus Titanium Dental Implants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Morena,

Leitão-Almeida,

Pereira

et al. 2024

JCM

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Objective: The goal of this systematic review and meta-analysis was to assess whether there were clinically relevant differences in the treatment of edentulous areas comparing zirconia (Zr) and titanium (Ti) dental implants. The null hypothesis is that no differences can be observed in terms of the clinical parameters; the positive hypothesis I is that Zr implants have generally better results compared to Ti implants; and the positive hypothesis II is that Ti implants have a generally superior result than Zr implants. Methods: This review work was registered on the PROSPERO platform, and its development was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The electronic search process was conducted on three databases (PubMed/Scopus/Web of Science), including randomized controlled trials (RCTs) from the past 10 years (up to April 2024). Identified articles were analyzed and included/excluded based on pre-defined selection and exclusion criteria. The quality assessment and risk of bias were evaluated using a Cochrane risk-of-bias assessment tool specifically designed for randomized trials (RoB2). A meta-analysis was conducted to correlate different treatment options based on the described outcomes; a random-effects model was used in the analysis of the variables. The analysis of heterogeneity was conducted by means of Cochran’s Q-test and Higgins’ I2 statistic. Results: Six RCTs were enrolled; 152 patients (90 males and 62 females) and 448 implants (267 Zr and 181 Ti) were included. Dental implant placement involved both the maxillary and mandibular arches. The implant sites showed heterogeneity in receiving Zr and Ti dental implants; in particular, 22 dental implants were placed in the mid-palatal region and 426 dental implants in the alveolar region (255 were in Zr and 171 in Ti). Regarding the success rate, it was better for Zr but with no statistical difference (p > 0.05); bleeding on probing had slight differences between Ti with 0.34% ± 0.42 and Zr with 0.26% ± 0.36 (p > 0.05); plaque score showed 0.46 ± 0.47 for Ti compared to 0.44 ± 0.49 for Zr (p > 0.05); no statistically significant difference was observed for pink esthetic score (PES). Statistically significant results were found for survival rate, which favored Ti implants (77.6%) compared to Zr (70.3%) (p < 0.05), and for marginal bone loss, which showed less loss in Ti implants (0.18 mm ± 0.47) compared to 0.42 mm ± 0.40 in Zr at 12 months (p < 0.001). Conclusions: The present systematic review and meta-analysis identified the positive hypothesis I and rejected the null and positive hypothesis II; it was possible to conclude that Ti dental implants have a better survival rate and less marginal bone loss than Zr dental implants after 1-year follow-up.

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

Cited by 3 publications

References 46 publications

A randomized clinical trial on zirconia versus titanium implants in maxillary single tooth replacement

A randomized clinical trial on zirconia versus titanium implants in maxillary single tooth replacement

Local antimicrobial delivery systems for prophylaxis and treatment of periprosthetic traumatological infections

Comparative Clinical Behavior of Zirconia versus Titanium Dental Implants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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