Comparative Evaluation of Titanium Versus Zirconia Implants for Their Clinical Outcomes: An Overview of Reviews

The use of dental implants has revolutionized dentistry, with titanium and zirconia being the most commonly utilized materials. This article presents a comparative evaluation of titanium and zirconia implants, focusing on their mechanical, biological, and clinical properties. Although the success of dental implant procedures depends on multiple variables, there is still insufficient literature documenting a comprehensive comparative evaluation of titanium and zirconia implants across their different properties. Therefore, this umbrella review aims to compare and evaluate various properties of titanium and zirconia implants. The intent of this article was to conduct an overview of systematic reviews (SRs) to provide a present review of different properties of titanium and zirconium implants; to analyze survival rate (SR), marginal bone loss (MBL), and/or probing depth (PD), bleeding on probing (BoP), pink esthetic score, and plaque index (PI); and to identify which has better clinical results among the titanium and zirconia implants. PubMed, Google Scholar, and Embase were used as literature databases. SRs, with or without meta-analysis, were included. A comprehensive search, both manual and electronic, was performed to identify SRs published between 2014 and March 2023 that aligned with the aims of this overview. The methodological quality of the selected reviews was evaluated using the A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) tool. Data were primarily presented descriptively and supported by detailed tables summarizing characteristics and findings at both the review and trial levels. The findings indicate that titanium implants demonstrate higher SRs (92.6%-100%) compared to zirconia implants (87.5%-91.25%), with zirconia associated with a greater risk of failure and lower overall success rates. MBL was comparable between the two groups (Ti: -1.17 to -0.125 mm; Zr: -1.38 to -0.25 mm), as were PDs (Ti: 1.6-3.05 mm; Zr: 2.21-2.6 mm), PI, and BoP (Zr: 16.43%; Ti: 10%-20%). Zirconia implants exhibited superior esthetic outcomes and greater early bone apposition at two weeks, whereas titanium implants showed a more favorable bone response at four weeks. Overall, titanium implants remain the gold standard for long-term predictability, while zirconia implants serve as a viable alternative in esthetically demanding cases.