Ceramic or titanium implants? What the research on zirconia really shows

Many patients ask about a “metal-free” ceramic implant. Zirconia implants are a genuine option – but the evidence differs considerably from titanium. Here is what current research says.

Titanium has been used for dental implants for decades. Most long-term studies over 10 and 20 years concern titanium implants – see How long does a dental implant last?.

A meta-analysis by Roehling et al. (2018) of 18 studies found survival rates for zirconia implants of 98.3% after one year and 97.2% after two years. Bone loss in the first year was 0.7 mm.

A review for the ITI Consensus Conference (Roehling et al., 2023) of 6 studies and 277 implants found 5-year survival of 97.2%, no implant fractures and peri-implantitis in 0.4%. The authors describe zirconia implants as reliable for up to five years.

One-piece or two-piece?

Ceramic implants come as one-piece designs (implant and abutment in one) and two-piece systems. In the 2023 analysis, five of six studies concerned one-piece implants. The only study of a two-piece system showed 93.8% survival and most of the technical complications, such as abutment fractures. A statistical comparison of the two designs was not possible.

For planning this means that one-piece implants leave less flexibility in angle and position, which influences the choice of system in each case.

Allergy to titanium is a frequently cited reason for choosing ceramic. In a clinical study of 1,500 consecutive implant patients (Sicilia et al., 2008), titanium allergy was found in 9 people – a prevalence of 0.6%. Testing is suggested there only for patients who show allergy-type reactions after treatment.

Who might ceramic be suitable for?

• people with a proven intolerance to titanium
• very thin gum tissue in the visible front area, where a grey shimmer could be a concern – an aesthetic judgement made case by case
• patients who explicitly want a metal-free restoration, after being informed about the shorter evidence base

For most situations – especially multiple implants, bone grafting or fixed bridges – titanium remains the best-documented choice thanks to its long track record. Which material suits you belongs in a personal consultation.

About the authorDr. med. dent. Hasan CoşkunCo-founder of LHC Clinic, Istanbul

Dr. Coşkun studied dentistry at Charité – Universitätsmedizin Berlin (graduated 2000) and worked as a dentist in Germany for around 20 years. He has placed more than 10,000 implants and now practises in Istanbul with a focus on implant dentistry.

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This article is for general information and does not replace a personal examination. Whether and which treatment is suitable for you can only be assessed after examination and a consultation.