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Prevalence of Peri-Implantitis Around Zirconia Implants: A Systematic Review and Meta-Analysis of Current Evidence
Vittorio Moraschini1, João Baptista de Moraes2, Alice Maria de Oliveira Silva1
1Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
Background:
Zirconia implants (ZIs) have emerged as a metal-free alternative to titanium implants (TIs) because of their favorable esthetic and biological properties. However, the prevalence of peri-implantitis associated with ZIs and the potential influence of implant material on peri-implant disease remain unclear.
Objective:
To estimate the implant-level prevalence of peri-implantitis associated with ZIs and to assess whether implant material influences peri-implantitis prevalence by comparing ZIs and TIs.
Methods:
Electronic searches were conducted in four databases and gray literature sources up to February 2026. Randomized clinical trials (RCTs) and cohort studies evaluating peri-implantitis associated with ZIs were included. The risk of bias was assessed using the RoB 2 and ROBINS-I tools. Random-effects meta-analyses were performed to estimate the pooled peri-implantitis prevalence at the implant level. Subgroup analyses according to follow-up duration and sensitivity analyses were additionally conducted.
Results:
Nineteen studies comprising 687 patients and 995 implants were included. The mean follow-up reported across studies was approximately 49 months. In studies with follow-up ≤ 3 years, the pooled prevalence of peri-implantitis associated with ZIs was 2% (95% CI: 0%-6%; I2 = 79.3%). Studies with follow-up > 3 to 5 years demonstrated a pooled prevalence of 2% (95% CI: 0%-8%; I2 = 38.9%), whereas studies with follow-up > 5 years showed a pooled prevalence of 8% (95% CI: 0%-23%; I2 = 82.1%). Comparative analysis of five RCTs demonstrated no statistically significant difference in peri-implantitis prevalence between ZIs and TIs (RR = 1.66; 95% CI: 0.48-5.71; p = 0.42). Sensitivity analyses did not identify studies with a critical risk of bias as the primary source of heterogeneity.
Conclusions:
Current evidence suggests a low short- to mid-term implant-level prevalence of peri-implantitis around ZIs, with higher estimates observed in studies with longer follow-up. However, the certainty of evidence remains limited because of methodological heterogeneity, variability in diagnostic definitions, inconsistent patient-level reporting, and the lack of long-term comparative studies. Limited comparative evidence did not demonstrate a statistically significant difference in peri-implantitis prevalence between ZIs and TIs.
