Abstract
OBJECTIVES: To evaluate the clinical outcomes of zirconia dental implants over five years, considering the growing demand for metal-free alternatives to titanium due to aesthetic concerns and potential hypersensitivity reactions to metals. MATERIALS AND METHODS: This retrospective study analyzed 80 zirconia implants from an initial cohort of 95, with 15 excluded due to loss to follow-up or not meeting inclusion criteria. Both one-piece and two-piece designs were included, and some cases involved Guided Bone Regeneration (GBR). The primary outcome was implant survival. RESULTS: The overall survival rate was 83.8% (67/80) after a mean follow-up of 29.0 ± 16.6 months (maximum 62 months). Kaplan-Meier analysis estimated mean survival at 52.6 ± 2.38 months, with the median not reached due to censoring. Survival was significantly lower with immediate placement (p = 0.016). GBR was linked to higher survival, with all GBR implants surviving and failures only in non-GBR cases (p < 0.001). No significant differences appeared in implant design, loading protocol, diameter, jaw location, prosthesis, surface, zirconia brand, or patient sex. CONCLUSIONS: Zirconia implants showed 83.8% survival at five years, supporting their clinical applicability as metal-free implant systems. Immediate placement had significantly lower survival, favoring late placement. No significant differences were found between one-piece and two-piece implants, or between implants placed with and without GBR. Larger prospective studies with standardized clinical and radiographic assessments are needed to confirm these findings and refine zirconia implant protocols. CLINICAL RELEVANCE: Zirconia implants show good mid-term survival and can be an alternative to titanium. However, immediate placement should be approached cautiously due to potential impacts on success.