Two-Piece Zirconia Implants: An Office-Based Retrospective Study with up to 7 Years and Mean 3 Years of Follow-up

To evaluate the clinical outcomes of two different but identically designed two-piece zirconia implants (NobelPearl and Zeramex XT) in a private dental practice.

Between 2017 and 2024, 167 implants were placed in 106 patients and followed up to 88 months (mean: 39.1 months). In addition to the implant survival rate, marginal bone loss (MBL), clinical parameters, and surface properties were examined using 3D profilometry. The statistical analysis included descriptive evaluations and a survival analysis using the life-table method.

Three implants were lost (two fractures, one failed osseointegration), corresponding to an effective survival rate of 98.2%. The mean MBL varied between -0.14 mm and -0.58 mm. The surface roughness was minimal (Sa ~0.5 μm). No risk factor showed a significant association with implant loss in the univariate analysis.

Two-piece screw-retained zirconia implants showed a high survival rate and stable peri-implant tissue conditions over a period of up to 7 years. They represent a promising metal-free alternative to titanium implants. Further prospective long-term studies are needed to validate these results and to better understand potential risk factors.