Impact of Laser Surface Modification on Zirconia Implants: A Systematic Review of In Vitro Evidence

Zirconia implants have emerged as a viable alternative to titanium due to their superior aesthetics, chemical stability, and biocompatibility. However, their inherently low surface bioactivity has resulted in the development of advanced surface modification techniques to improve osseointegration and biological performance. This systematic review evaluated in vitro studies investigating the effects of laser surface treatment on zirconia implants. A comprehensive electronic and manual search was conducted in PubMed, Cochrane Library, Google Scholar, Scopus, ScienceDirect, and EBSCOhost, including studies published after 2005. Nine in vitro studies met the inclusion criteria. The results demonstrated that laser irradiation significantly enhanced surface roughness, wettability, and protein adsorption while promoting osteoblastic adhesion, proliferation, and differentiation. Femtosecond and Nd:YAG lasers produced well-defined micro- and nano-topographies without inducing deleterious phase transformation or compromising mechanical integrity. Additionally, laser-treated zirconia exhibited reduced bacterial adhesion, suggesting improved antimicrobial potential. Despite methodological variations, all studies indicated positive biological and structural outcomes associated with laser modification. Laser surface modification thus represents a precise, reproducible, and contamination-free approach for enhancing zirconia implant performance.