Comparative Osseointegration Outcomes of Titanium vs. Zirconia Implants: A Schematic Assessment with Meta-Analysis of Bone-Implant Contact and Clinical Longevity
DOI:
https://doi.org/10.36283/ziun-pjmd14-3/067Keywords:
Titanium Implants, Zirconia Implants , Osseointegration , Bone-Implant Contact , Marginal Bone Loss , Implant SurvivalAbstract
Background: Previously, titanium implants were the most widely chosen option because they bond very well with the jawbone and have good strength. On the other hand, zirconia implants are now being used, giving patients improved appearance, better tissue compatibility, and fewer chances of bacterial infection. The review discusses how titanium and zirconia implants perform when placed in human subjects compared to each other in terms of osseointegration, survival rate, bone loss, and clinical outcomes.
Methods: A PRISMA-aligned systematic review and meta-analysis were set up following specified protocols, but were not registered on PROSPERO. Until April 2025, study databases such as PubMed, Scopus, Web of Science, and Cochrane Library were searched for human studies. Some of the key outcomes assessed were BIC and bone level changes. The study evaluated the risk of bias using the Newcastle-Ottawa Scale and the Cochrane RoB tool. Using random effects, a meta-analysis reported the pooled odds ratios (OR) along with their confidence intervals (CI).
Results: The review included 12 studies, which were randomized trials, cohorts, or case reports. When all the studies were pooled, it was found that there was no difference between titanium and zirconia implants in terms of BIC and clinical longevity (OR 1.09, 95% CI 0.84–1.41). Results revealed that zirconia implants were similar to titanium in terms of survival and surrounding bone support.
Discussion: Overall, zirconia implants can give good outcomes and are a smart alternative to titanium, especially when aesthetics or sensitivity matter. Nonetheless, additional well-designed trials lasting for an extended time are needed to fully assess zirconia implants’ benefits and efficacy.
References
1. Abd El-Ghany OS, Sherief AH. Zirconia based ceramics, some clinical and biological aspects: Review. Future Dent J. 2016;2(2):55-64. doi:10.1016/j.fdj.2016.10.002
2. Abouel Maaty FAN, Ragab MA, El-Ghazawy YM, Elfaiedi FI, Abbass MMS, Radwan IA, et al. Peri-implant soft tissue in contact with zirconium/titanium abutments from histological and biological perspectives: A concise review. Cells. 2025;14(2):129. doi:10.3390/cells14020129
3. Albanchez-González MI, Flores JG, Reuss JM, Martínez RM, Lobato Peña DM, Cortés-Bretón Brinkmann J. Fixed dental prostheses on six zirconia implants for an anterior maxillary rehabilitation: Case report with 10-year follow-up. Int J Prosthodont. 2024;3:349-351. doi:10.11607/ijp.8479
4. Alqahtani SM, Chaturvedi S, Alkhurays M, Al Mansoori MA, Mehta V, Chaturvedi M. Clinical effectiveness of zirconia versus titanium dental implants in anterior region: An overview of systematic reviews. Eur J Med Res. 2025;30:290. doi:10.1186/s40001-025-02488-5
5. Apratim A, Eachempati P, Krishnappa Salian KK, Singh V, Chhabra S, Shah S. Zirconia in dental implantology: A review. J Int Soc Prev Community Dent. 2015;5(3):147-156. doi:10.4103/2231-0762.158014
6. Arefnia B, Fakheran O, Jakse N, Payer M. Patient-reported outcomes of zirconia dental implants: A systematic review and future directions. J Patient Rep Outcomes. 2025;9(1):7. doi:10.1186/s41687-025-00839-8
7. Barfeie A, Wilson J, Rees J. Implant surface characteristics and their effect on osseointegration. Br Dent J. 2015;218(5):E9. doi:10.1038/sj.bdj.2015.171
8. Beus JHW de, Cune MS, Meijer HJA, Raghoebar GM, Schepke U. Metal-free custom-made zirconia implants—A prospective 5-year follow-up single-arm clinical trial. Clin Implant Dent Relat Res. 2025;27(1):e13404. doi:10.1111/cid.13404
9. Bienz SP, Hilbe M, Hüsler J, Thoma DS, Hämmerle CHF, Jung RE. Clinical and histological comparison of the soft tissue morphology between zirconia and titanium dental implants under healthy and experimental mucositis conditions—A randomized controlled clinical trial. J Clin Periodontol. 2021;48(5):721-733. doi:10.1111/jcpe.13411
10. Borgonovo AE, Censi R, Vavassori V, Savio M, Re D. A possible relationship between peri-implantitis, titanium hypersensitivity, and external tooth resorption: Metal-free alternative to titanium implants. Case Rep Dent. 2021;2021:8879988. doi:10.1155/2021/8879988
11. Borys J, Maciejczyk M, Antonowicz B, Sidun J, Świderska M, Zalewska A. Free radical production, inflammation and apoptosis in patients treated with titanium mandibular fixations—An observational study. Front Immunol. 2019;10:2662. doi:10.3389/fimmu.2019.02662
12. Chile J, Dolores A, Espinoza-Carhuancho F, Alvitez-Temoche D, Munive-Degregori A, Barja-Ore J, et al. Zirconia dental implants as a different alternative to titanium: A literature review. J Int Soc Prev Community Dent. 2023;13(5):357-364. doi:10.4103/jispcd.JISPCD_104_23
13. Cionca N, Hashim D, Mombelli A. Two-piece zirconia implants supporting all-ceramic crowns: Six-year results of a prospective cohort study. Clin Oral Implants Res. 2021;32(6):695-701. doi:10.1111/clr.13734
14. Daou EE. The zirconia ceramic: Strengths and weaknesses. Open Dent J. 2014;8:33-42. doi:10.2174/1874210601408010033
15. Depprich R, Zipprich H, Ommerborn M, Naujoks C, Wiesmann HP, Kiattavorncharoen S, et al. Osseointegration of zirconia implants compared with titanium: An in vivo study. Head Face Med. 2008;4:30. doi:10.1186/1746-160X-4-30
16. Donos N, Akcali A, Padhye N, Sculean A, Calciolari E. Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome? Periodontol 2000. 2023;93(1):26-55. doi:10.1111/prd.12518
17. Elias CN. Factors affecting the success of dental implants. In: Implant Dentistry—A Rapidly Evolving Practice. IntechOpen; 2011. doi:10.5772/18746
18. Giacon TA, Giancola F, Paganini M, Tiengo C, Camporesi EM, Bosco G. Hyperbaric oxygen therapy and A-PRF pre-treated implants in severe periodontitis: A case report. Int J Environ Res Public Health. 2021;18(2):413. doi:10.3390/ijerph18020413
19. Gulati K, Chopra D, Kocak-Oztug NA, Verron E. Fit and forget: The future of dental implant therapy via nanotechnology. Adv Drug Deliv Rev. 2023;199:114900. doi:10.1016/j.addr.2023.114900
20. Hossain N, Islam MA, Shakib Ahmed MM, Chowdhury MA, Mobarak MH, Rahman MM, et al. Advances and significances of titanium in dental implant applications. Results Chem. 2024;7:101394. doi:10.1016/j.rechem.2024.101394
21. Huang YC, Huang YC, Ding SJ. Primary stability of implant placement and loading related to dental implant materials and designs: A literature review. J Dent Sci. 2023;18(4):1467-1476. doi:10.1016/j.jds.2023.06.010
22. Kohal RJ, Dennison DK. Clinical longevity of zirconia implants with the focus on biomechanical and biological outcome. Curr Oral Health Rep. 2020;7(4):344-351. doi:10.1007/s40496-020-00289-9
23. Koller M, Steyer E, Theisen K, Stagnell S, Jakse N, Payer M. Two-piece zirconia versus titanium implants after 80 months: Clinical outcomes from a prospective randomized pilot trial. Clin Oral Implants Res. 2020;31(4):388-396. doi:10.1111/clr.13576
24. Laumbacher H, Strasser T, Knüttel H, Rosentritt M. Long-term clinical performance and complications of zirconia-based tooth- and implant-supported fixed prosthodontic restorations: A summary of systematic reviews. J Dent. 2021;111:103723. doi:10.1016/j.jdent.2021.103723
25. Pandey C, Rokaya D, Bhattarai BP. Contemporary concepts in osseointegration of dental implants: A review. Biomed Res Int. 2022;2022:6170452. doi:10.1155/2022/6170452
26. Peláez J, Gelfo-Flores J, Albanchez-González MI, Bazal-Bonelli S, López-Suárez C, Comino-Garayoa R, et al. Long term follow-up of a full-arch rehabilitation with an implant-supported overdenture on four zirconia implants and a zirconia bar. A case report. J Clin Exp Dent. 2022;14(4):e371-e375. doi:10.4317/jced.59362
27. Poli PP, de Miranda FV, Polo TOB, Santiago Júnior JF, Lima Neto TJ, Rios BR, et al. Titanium allergy caused by dental implants: A systematic literature review and case report. Materials. 2021;14(18):5239. doi:10.3390/ma14185239
28. Roehling S, Ghazal G, Borer T, Thieringer F, Gahlert M. Implant supported fixed dental prostheses using a new monotype zirconia implant—A case report. Dent J. 2015;3(3):79-92. doi:10.3390/dj3030079
29. Ruiz Henao PA, Magrin GL, Caneiro-Queija L, Benfatti CAM, Leira Y, Liñares-González A, et al. Single-piece zirconia versus single-piece titanium, narrow-diameter dental implants in the anterior maxilla: 5-year post-loading results of a randomized clinical trial. Clin Oral Implants Res. 2024;35(10):1310-1323. doi:10.1111/clr.14319
30. Silva NRFA, Sailer I, Zhang Y, Coelho PG, Guess PC, Zembic A, et al. Performance of zirconia for dental healthcare. Materials. 2010;3(2):863. doi:10.3390/ma3020863
31. Singh PV, Reche A, Paul P, Agarwal S. Zirconia facts and perspectives for biomaterials in dental implantology. Cureus. 2023;15(10):e46828. doi:10.7759/cureus.46828
32. Su G, Zhang Y, Jin C, Zhang Q, Lu J, Liu Z, et al. 3D printed zirconia used as dental materials: A critical review. J Biol Eng. 2023;17(1):78. doi:10.1186/s13036-023-00396-y
33. Swalsky A, Noumbissi SS, Wiedemann TG. The systemic and local interactions related to titanium implant corrosion and hypersensitivity reactions: A narrative review of the literature. Int J Implant Dent. 2024;10(1):58. doi:10.1186/s40729-024-00578-3
34. Szczęsny G, Kopec M, Kowalewski ZL. Toxicity, irritation, and allergy of metal implants: Historical perspective and modern solutions. Coatings. 2025;15(3):361. doi:10.3390/coatings15030361
35. Nicholson JW. Titanium alloys for dental implants: A review. Prosthesis. 2020;2(2):11. doi:10.3390/prosthesis2020011
36. Zarone F, Di Mauro MI, Ausiello P, Ruggiero G, Sorrentino R. Current status on lithium disilicate and zirconia: A narrative review. BMC Oral Health. 2019;19:134. doi:10.1186/s12903-019-0838-x
37. Zuercher AN, Balmer M, Brügger LV, Thoma DS, Jung RE, Bienz SP. Clinical, radiographic and patient-reported outcomes of zirconia and titanium implants in the posterior zone after 1 year of loading—A randomized controlled trial. Clin Oral Implants Res. 2024;35(11):1428-1439. doi:10.1111/clr.14329
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