ABSTRACT
Introduction:
The increasing demand for biocompatible and durable dental implants has led to the adoption of zirconia implants as an alternative to the well-established titanium implants. While titanium implants have demonstrated high survival and success rates, zirconia has been proposed to offer superior esthetics and better tissue integration. This study aims to compare the long-term survival and success rates of zirconia and titanium implants over a 5-year period.
Methods:
This prospective study evaluated 200 patients, divided into two groups: 100 received zirconia implants, and 100 received titanium implants. Parameters such as implant survival, success rate, complications, and peri-implant bone loss were assessed over 5 years. Statistical analysis was performed using Chi-square tests and ANOVA, with P values set at <0.05 for significance.
Results:
At the 5-year follow-up, the survival rate of zirconia implants was 94%, while titanium implants demonstrated a slightly higher survival rate of 96%. However, zirconia implants showed significantly better soft tissue integration and less peri-implant inflammation (P < 0.05). Both types of implants had comparable success rates, though titanium implants had a slightly higher incidence of peri-implant bone loss.
Conclusion:
Both zirconia and titanium implants offer high survival and success rates after 5 years of follow-up. However, zirconia implants demonstrated better soft tissue response, making them a viable alternative to titanium implants, particularly in esthetically demanding cases.
KEYWORDS: Dental implants, implant success, long-term survival, titanium implants, zirconia implants
INTRODUCTION
Dental implants have become a standard solution for the replacement of missing teeth, with titanium implants being widely regarded as the gold standard due to their biocompatibility, high mechanical strength, and long-term success rates.[1] However, titanium’s metallic color may lead to esthetic challenges, particularly in cases of thin soft tissues or gingival recession. Zirconia, a metal-free ceramic material, has been introduced as an alternative implant material, offering a tooth-colored option with potential advantages such as better soft tissue integration and reduced plaque accumulation.[2]
Zirconia implants have been gaining attention due to their esthetic benefits and biocompatibility. Several studies suggest that zirconia implants may offer similar survival and success rates compared to titanium implants.[3,4,5] However, long-term data comparing the performance of these two materials over extended periods are still limited. The aim of this prospective 5-year study is to compare the survival and success rates of zirconia and titanium implants, evaluating factors such as soft tissue response, peri-implant bone loss, and overall complications.
METHODS
This prospective, randomized study included 200 patients, with 100 receiving zirconia implants and 100 receiving titanium implants. Inclusion criteria required patients to be nonsmokers with good oral hygiene and sufficient bone volume for implant placement. Patients were monitored over 5 years to assess implant survival and success rates.
Parameters
Survival rate: Defined as the percentage of implants still functional after 5 years.
Success rate: Determined based on the absence of significant complications such as peri-implantitis or bone loss exceeding 2 mm.
Complications: Including peri-implant mucositis, bone resorption, and implant failure.
Peri-implant bone loss: Measured radiographically and compared between the two implant types.
Statistical analysis was performed using Chi-square and ANOVA tests to evaluate differences between the groups, with a significance threshold of P < 0.05.
RESULTS
After 5 years of follow-up, the survival rate for zirconia implants was 94%, while titanium implants showed a slightly higher survival rate of 96%. The success rates were also comparable, with 92% for zirconia and 93% for titanium implants. However, zirconia implants demonstrated significantly better soft tissue integration and less inflammation around the peri-implant tissues (P < 0.05).
Peri-implant bone loss was observed in both groups, but titanium implants showed a higher mean bone loss of 1.5 mm compared to 1.2 mm for zirconia implants (P = 0.04).[6] Complications such as peri-implant mucositis occurred more frequently with titanium implants, while no significant difference was noted in implant failure rates between the two groups [Statistical Tables 1 and 2].
Statistical Table 1.
Survival rates (in %)
| Implant type | Survival rate | Success rate | Bone loss (mm) | P |
|---|---|---|---|---|
| Zirconia | 94% | 92% | 1.2 | 0.04 |
| Titanium | 96% | 93% | 1.5 | 0.04 |
Statistical Table 2.
Complications (in %)
| Implant type | Peri-implantitis | Mucositis | Implant failure | P |
|---|---|---|---|---|
| Zirconia | 4% | 3% | 6% | 0.05 |
| Titanium | 6% | 5% | 7% | 0.05 |
DISCUSSION
The results of this 5-year prospective study suggest that both zirconia and titanium implants provide reliable long-term survival and success rates. The slightly higher survival rate observed in titanium implants (96% vs 94%) is consistent with previous studies that have established titanium as a robust and durable implant material.[1,3] However, the difference in survival rates was not statistically significant, indicating that zirconia implants can offer similar longevity.
One of the most notable findings in this study is the superior soft tissue integration associated with zirconia implants. Zirconia’s nonmetallic nature and smooth surface may contribute to reduced bacterial colonization and peri-implant mucositis, leading to better soft tissue outcomes. This finding is supported by previous research that suggests zirconia implants reduce the risk of soft tissue inflammation compared to titanium implants.[2,7]
In terms of bone loss, titanium implants exhibited slightly more peri-implant bone loss than zirconia implants. The difference, while statistically significant, may not be clinically relevant in most cases but could be a consideration in patients at higher risk of peri-implant bone loss. These findings align with studies that report better bone preservation in zirconia implants compared to titanium.[6,8]
Zirconia implants have also shown promise in esthetically sensitive areas due to their tooth-like color and minimal visibility under thin soft tissues. As dental esthetics become increasingly important to patients, zirconia implants could play a significant role in cases where esthetics are a primary concern.[5,9]
While this study highlights the strengths of zirconia implants, it is essential to recognize that titanium remains the more thoroughly tested material with a longer track record of success. Future studies with larger sample sizes and extended follow-up periods may help further clarify the comparative advantages of zirconia over titanium.[4,10,11,12]
CONCLUSION
Both zirconia and titanium implants demonstrate high survival and success rates after 5 years of clinical use. Zirconia implants show superior soft tissue integration and reduced peri-implant bone loss, making them a viable alternative to titanium implants, especially in esthetically demanding cases. However, titanium implants continue to offer slightly higher survival rates. Clinicians should consider both esthetic and functional factors when selecting an implant material, and further long-term studies are necessary to establish zirconia’s role in implant dentistry.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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