Advancing the clinical use of zirconia dental implants: a comprehensive review of outcomes, innovations and challenges

Zirconia dental implants have gained attention as an alternative to titanium implants. They offer superior aesthetics, biocompatibility, and appeal for metal-free restorations. This review examines zirconia implants’ clinical performance, mechanical properties, and design and surface treatment innovations. The analysis includes studies from 2008 to 2020, evaluating survival rates, bone loss, and challenges with osseointegration and mechanical fragility. Clinical evidence suggests that zirconia implants exhibit survival rates similar to titanium implants, with minimal marginal bone loss and favorable soft tissue outcomes. One-piece designs show better performance due to reduced mechanical failure risk. However, zirconia’s brittleness remains limited, especially in high-stress areas like the posterior mandible. Advances in zirconia formulations and surface treatments, such as sandblasting and acid etching, have improved osseointegration and clinical success. Although short-and medium-term studies are promising, the absence of long-term data raises concerns regarding the durability and performance of zirconia implants. Further research is needed to address osseointegration variability, refine surface modification techniques, and explore hybrid implant designs combining zirconia and titanium for enhanced mechanical strength. In conclusion, while zirconia implants offer significant potential as a titanium alternative, ongoing research, and long-term clinical trials are essential for their widespread acceptance in modern implantology.