Factor-specific clinical evidence for zirconia dental implants: A systematic review and evidence map

To map clinical evidence on implant-system factors and post-placement outcomes of zirconia dental implants and identify reporting and independent-replication gaps.

Human studies reporting an explicit within-zirconia factor comparison or continuous factor association were eligible. Clinical-context factors were mapped separately as a post hoc exploratory extension. Risk of bias was assessed through design-specific routes.

Five databases were searched through 30 August 2026; Embase reconciliation was completed on 31 August. The review was not prospectively registered.

Factor-stage decisions and numerical data were checked against source reports, and reports with possible participant overlap were grouped into families. Forty-five reports mapped to 24 families and yielded 230 results: 58 implant-system and 172 exploratory clinical-context results. Of 44 complete estimates, three were adjustment-only, leaving 41 exact comparison profiles (20 implant-system and 21 clinical-context), summarized in 28 broad certainty-display groups. No exact profile recurred in a second family with no documented overlap, precluding established independent replication and meta-analysis. Fifteen correlated diameter- and length-related coefficients arose from one longitudinal family, and every confidence interval included zero. No direct factor analysis evaluated peri-implantitis.

The retrieved evidence identifies substantial reporting and replication gaps and does not establish independently validated factor-specific associations. Lack of replication does not demonstrate absence of effects or equivalence between implant designs.

The evidence does not support a validated zirconia-specific factor rule for prognosis or treatment selection. Decisions still require assessment of the complete implant system, indication, anatomy, and established patient-, periodontal-, prosthetic-, and biomechanical risks.