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A Randomised Controlled Trial Comparing a One-Piece Zirconia Tissue-Level Implant and Two-Piece Titanium Bone-Level
J H W de Beus1,2, M S Cune1,3, L Muijselaar1
1Department of Dentistry Orthodontics, Section of Restorative Dentistry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Clinical Oral Implants Research
|June 18, 2026
Summary
Zirconia and titanium dental implants show comparable marginal bone level changes after three years. Both implant types are viable options, with zirconia implants offering slightly better aesthetic outcomes and patient-reported measures.
Area of Science:
- Dental Implantology
- Biomaterials Science
- Prosthodontics
Background:
- Zirconia (ZrO2) and titanium (Ti) are commonly used materials for dental implants.
- Maxillary premolar region reconstruction presents unique clinical challenges.
- Long-term clinical performance data comparing these materials is essential for evidence-based practice.
Purpose of the Study:
- To compare the clinical performance of zirconia and titanium dental implants in the maxillary premolar region.
- To evaluate marginal bone level (MBL) changes, clinical parameters, aesthetic outcomes, and patient-related outcome measures (PROMs) over three years.
- To determine the viability of both zirconia and titanium implants for clinical application in this specific region.
Main Methods:
- A randomized controlled trial (RCT) involving 50 patients.
- Allocation of 25 patients to zirconia (ZrO2) one-piece implants and 25 to titanium (Ti) bone-level implants.
- Restoration with lithium disilicate crowns three months post-implant placement, with outcomes assessed three years after loading.
Main Results:
- No statistically significant difference in mean MBL change between zirconia (-0.02 mm) and titanium (-0.04 mm) implants after three years (p=0.635).
- One zirconia implant experienced osseointegration failure; survival rates were otherwise comparable.
- Favorable clinical parameters for both groups, with slightly higher bleeding scores for zirconia. Aesthetic outcomes and PROMs favored zirconia, though not statistically significant.
Conclusions:
- Zirconia and titanium implants demonstrate comparable marginal bone level changes after three years of function.
- Both implant materials showed favorable survival, clinical, and aesthetic parameters, along with comparable PROMs.
- These findings suggest that both zirconia and titanium implants are viable clinical options for the maxillary premolar region in the short term.