Are monolithic zirconia complete arch implant-supported prostheses reliable? A systematic review and meta-analysis

Despite the increasing use of monolithic zirconia for complete arch implant-supported prostheses, evidence regarding their long-term survival, complication rates, and clinical predictability remains limited and heterogeneous.

The purpose of this systematic review was to evaluate the survival and overall performance of monolithic zirconia complete arch implant-supported prostheses.

An electronic search was conducted in 9 databases following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO (CRD: 42025640173). Meta-analyses were performed using random-effects models (α=.05). Subgroup analyses evaluated the pooled proportion of prosthetic failures, implant longevity, and technical complications. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool, and the certainty of evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Thirteen studies comprising 2841 prostheses and 3940 implants were included in this systematic review. The pooled proportion rate of monolithic zirconia complete arch prostheses in function at the last follow-up (12 to 62 months) was 99% (95% confidence interval [CI]): 97% to 100%; I²=72%, while implant longevity reached 100% (95% CI: 99% to 100%; I²=75%). The pooled technical complication rate was 14% (95% CI: 4% to 27%; I²=96%). Subgroup analyses revealed higher complication rates in veneered designs (up to 27%) compared with monolithic configurations (1% to 3%). Most studies presented a moderate to serious risk of bias according to ROBINS-I, mainly due to retrospective designs and confounding. The certainty of evidence was rated as low by GRADE, primarily because of methodological limitations and heterogeneity.

Monolithic zirconia complete arch implant-supported prostheses demonstrated high cumulative proportions of prostheses remaining in function and low rates of technical and biological complications within the reported follow-up periods.