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Clinical performance of immediately loaded zirconia implants: A systematic review with meta-analysis
Aline Pinheiro Alves1, Camila Gonçalves Jezini Monteiro1, Alice Maria de Oliveira Silva1
1Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
Objectives:
To evaluate the clinical performance of immediately loaded zirconia implants (ZIs) by analyzing survival and success rates, marginal bone loss (MBL), patient-reported outcome measures (PROMs), and the incidence of mechanical, biological, and esthetic complications.
Data Sources:
Electronic searches were conducted in four databases and non-peer-reviewed literature up to March 2025. Studies reporting clinical outcomes of immediately loaded ZIs supporting single crowns or fixed dental prostheses (FDPs) were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools. A random-effects meta-analysis was performed for survival rates, with adjustments for clustering effects and prediction intervals. Certainty of evidence was evaluated using the GRADE approach.
Study Selection:
Fifteen studies involving 508 patients and 691 zirconia implants were included. The pooled survival rate was 95.1 % over a mean follow-up of 44.2 months, with a prediction interval reaching up to 20 %. Success rates ranged from 73 % to 100 %. The mean MBL was 0.94 mm (SD: 0.66 mm), and mechanical complications were rare. Esthetic and biological complications were generally mild. PROMs were rarely assessed, but available data indicated high patient satisfaction with ZI treatment. The certainty of evidence was rated as low due to study heterogeneity and the predominance of non-randomized designs.
Conclusions:
Immediately loaded ZIs may achieve favorable clinical outcomes when properly indicated. However, due to variability among studies and a predominance of non-randomized data, further standardized, high-quality trials are necessary to confirm their long-term efficacy and safety.
Clinical Significance:
ZIs under immediate loading may be a viable option for selected cases with adequate bone and soft tissue conditions. Careful planning and patient selection are essential to optimize outcomes.
