Title	Zirconia Implants Provide Highly Esthetic Restorations in the Anterior Maxilla
Clinical Question	In patients seeking implant therapy in the esthetic zone, do zirconia-based implants provide an esthetic restoration?
Clinical Bottom Line	For patients seeking implant therapy in the esthetic zone, zirconia implants provide esthetic outcomes. This is supported by a retrospective study evaluating zirconia implant-based restorations 1 year after placement and rating them on the Pink Esthetic Score (PES) and White Esthetic Score (WES) measures. This is compared to a similarly designed study examining titanium implants using the same measures.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 29897352 Kniha/2018 52 patients with zirconia implant restorations in the esthetic zone Cohort Study Key results For 53 zirconia implants restored in the esthetic zone, mean PES was 8.8 and mean WES was 8.6. These rankings were provided by 12 examiners (3 OMFS, 3 orthodontists, 3 prosthodontists, and 3 dental students). 19228100 Belser/2009 45 patients with titanium implant restorations in the esthetic zone Cohort Study Key results For 45 titanium implants restored in the esthetic zone, mean PES was 7.8 and mean WES was 6.9. Rankings were provided by 2 prosthodontists.
Evidence Search	Zirconia OR Titanium AND Dental Implant AND White Esthetic Score
Comments on The Evidence	53 zirconia implants placed in the esthetic zone received a mean score of 8.8 on the PES and 8.6 on the WES 1 year after placement. Given that the commonly acceptable clinical threshold of esthetic clinical success is 6.0 on both measures, these zirconia restorations were comfortably regarded as being esthetically acceptable. Other studies support these findings, showing that zirconia implants tend to create less peri-implant mucosal discoloration when compared to titanium implants (Thomas, 2016). Similarly designed studies evaluating titanium implant-based restorations on the PES and WES found them to also be predictably clinically acceptable in the esthetic area. The authors in both provided studies listed no conflicts of interest.
Applicability	When making clinical decisions regarding restorations in the esthetic area, zirconia implants may provide clinically acceptable restorations in a predictable manner similar to titanium implants. The author of the study discusses that zirconia implants may provide esthetic outcomes superior to titanium implants, but due to lack of standardization between the comparable studies, such claims are currently unsubstantiated. Additional data is needed for long-term esthetic outcome for zirconia implant restorations. Implant restorations are also not recommended for all patients due to potential systemic limitations, restorative complications, or financial considerations. Other highly esthetic restorations are available and should be considered in these situations.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords	Zirconia Implant, Ceramic Implant, Titanium Implant, Esthetic Zone, Pink Esthetic Score, White Esthetic Score
ID#	3485
Date of submission	12/01/2021
E-mail	esplin@uthscsa.edu
Author	Kaleb C. Esplin, DDS
Co-author(s)	Ellen Piehl, DMD
Co-author(s) e-mail	piehl@uthscsa.edu
Faculty mentor	Dr. Georgios Kotsakis, DDS, MS
Faculty mentor e-mail	kotsakis@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available