Non-Surgical and Surgical Management of Peri-Implant Diseases and Defects in Zirconia Implants: A Scoping Review

The aim of this scoping review is to investigate the clinical, microbiological, and histological outcomes of non-surgical and surgical treatments for peri-implant diseases and experimentally induced peri-implant bone defects around zirconia implants.

An electronic search was performed up to May 2025 in three databases, including PubMed/MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials. Eligible studies included prospective or retrospective in vivo investigations, such as case series and comparative clinical trials, involving human or animal subjects with zirconia dental implants. Interventions comprised surgical and non-surgical treatments for peri-implant mucositis, peri-implantitis, or experimentally induced peri-implant bone defects. Outcomes assessed included changes in clinical, radiographic, microbiological and/or histological parameters following intervention. Reporting adhered to the PRISMA-ScR statement.

Ten studies met the inclusion criteria for this scoping review. Clinical investigations revealed comparable prevalence of peri-implant mucositis and peri-implantitis between zirconia and titanium implants, although some studies reported enhanced mucosal margin stability and reduced plaque accumulation around zirconia implants. In experimental models, zirconia implants elicited a milder inflammatory response and demonstrated greater resistance to bacterial colonization. Across peri-implantitis and buccal dehiscence models, both implant types achieved similar outcomes in bone regeneration and soft tissue healing.

Zirconia implants show clinical outcomes comparable to titanium implants regarding survival, peri-implant tissue health, and biological complication response. However, this observation is based on limited and heterogeneous data, predominantly derived from preclinical models and small clinical studies. Current evidence is insufficient to establish clinical equivalence between zirconia and titanium implants, particularly for peri-implant disease treatment and regenerative outcomes. Further well-designed, long-term clinical studies are required.