ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title No Clinical Difference in the Osseointegration of Zirconia Dental Implants Compared to Titanium Dental Implants at 1 Year
Clinical Question Will dental implant surgery sites exhibit better osseointegration with zirconia implants as compared to traditional titanium implants?
Clinical Bottom Line Based on 1-year survival rates, zirconia implants have the potential to be an alternative to titanium implants; however, further studies are needed to establish how their long-term survival rates compare to titanium, as well as to establish the risk for technical/hardware and biological complications. 
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19663947Andreiotelli/200925 studiesSystematic review of nonrandomized trials
Key resultsThe systematic review identified histological animal studies that showed similar osseointegration between zirconia and titanium. Zirconia implant studies showed survival rates from 84% after 21 months up to 98% after 1 year. No randomized controlled clinical trials on zirconia implants could be found for this systematic literature review.
#2) 16137090Friberg/2005187 patients/478 titanium implantsProspective Clinical Study
Key resultsThis article, although not recent, provides 1-year survival rates for moderately rough surface titanium dental implants (TiUnite, Nobel Biocare AB, Göteborg, Sweden). This study had a patient group size of 187 and followed 478 titanium implants for 1 year. The cumulative survival rates were 98.6% (maxilla) and 100% (mandible).
#3) 27217032Hashim/201614 articles (meta-analysis: 13 articles/1,413 zirconia implants)Sytematic review and meta-analysis
Key resultsThis systematic review showed that the overall 1-year survival rate of zirconia dental implants was 92% (95% CI, 87%-95%) based on meta-analysis of 13 studies representing 1,413 zirconia implants.
Evidence Search Osseointegration, Zirconia Dental Implants, Titanium Dental Implants
Comments on
The Evidence
Validity: Andreiotelli/2009 compiled 881 articles and then narrowed them down to a final sample of 25 studies. Of these 25 studies, none were randomized controlled clinical trials. Animal experiments showed that there were no differences in the rate of osseointegration between Zirconia and Titanium dental implants. Zirconia implant studies showed good survival rate percentages, but were tested only after 1-2 years. Friberg/2005 included a reasonable number of patients (187), but the number of patients who withdrew from the study was very high (19.3%). Nonetheless, the 1-year survival rates for titanium dental implants were very high. Hashim/2016 was effective in presenting the overall 1-year survival rate of zirconia dental implants. It would be more beneficial to clinicians if the studies would test zirconia's survival over longer periods of time, but was a useful study for the comparison of titanium to zirconia at 1 year. Perspective: More clinical studies specifically comparing bone loss, osseointegration, longevity, and the overall success of zirconia as a dental implant material need to be done before considering this type of implant to be clinically acceptable. The last two studies form a basis of comparison between titanium dental implants and zirconia dental implants. Titanium showed better 1-year survival rates compared to zirconia, but zirconia showed promising results as an alternative dental implant material.
Applicability The results of the first study found there were no differences in the rate of osseointegration between zirconia and titanium dental implants. Zirconia dental implants have the potential to be successful, but more clinical studies are needed to confirm. Friberg/2005 and Hashim/2016 were used to compare survival rates of titanium vs. zirconia dental implants. Although this comparison showed that titanium dental implants have slightly higher survival rates than zirconia dental implants, sometimes it may be esthetically advantageous to use zirconia in certain clinical situations.
Specialty/Discipline (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords osseointegration, zirconia dental implants, titanium dental implants, implant survival
ID# 3198
Date of submission: 04/05/2017spacer
E-mail mcneillb@livemail.uthscsa.edu
Author Beau McNeill
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Jeffrey L. Hicks, BS, DDS
Faculty mentor/Co-author e-mail HicksJ@uthscsa.edu
Basic Science Rationale
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