Long-Term Clinical and Radiographic Outcomes of Ceramic Dental Implants: An 11-Year Retrospective Cohort Study.
TL;DR
Ceramic implants may represent a viable metal-free treatment option for appropriately selected patients, particularly in esthetically demanding situations, when careful case selection, system-specific training, and adherence to surgical and restorative protocols are applied.
Abstract
Objective
Evidence on zirconia dental implants remains limited. This retrospective study evaluated clinical and radiographic outcomes of contemporary ceramic implant systems placed in private practice with variable follow-up of up to 11 years.
Materials And Methods
This retrospective cohort evaluation included 174 patients receiving 275 zirconia implants (one-piece systems and a two-piece tissue-level screw-retained system) placed between 2013 and 2025 with a minimum one-year follow-up. Implant survival and success rates were assessed. Standardized periapical radiographs were analyzed using ImageJ to measure marginal bone levels at placement and annually thereafter. Peri-implant soft tissue health was evaluated using the modified Plaque Index and modified Gingival Index.
Results
Kaplan-Meier cumulative implant survival was 97.6%, and overall success was 95.3%. Mean first-year marginal bone loss ranged from 0.25 to 0.74 mm, with a pooled mean of 0.49 mm. Mean annual bone loss after year 1 was low at 0.12 mm/year. Soft tissue indices remained low, and no suppuration was observed. Two implant fractures occurred (0.73%); remaining failures were associated with lack of osseointegration or aseptic loosening.
Conclusions
Within the limitations of this retrospective study, contemporary ceramic implant systems demonstrated high survival and success with stable peri-implant bone levels and favorable soft tissue conditions. CLINICAL
Significance
This study provides real-world clinical and radiographic data on contemporary ceramic implant systems, including one-piece ceramic implants and ATZ two-piece ceramic implants with carbon fiber screws. These findings may help clinicians contextualize the observed performance of ceramic implants in daily practice. Ceramic implants may represent a viable metal-free treatment option for appropriately selected patients, particularly in esthetically demanding situations, when careful case selection, system-specific training, and adherence to surgical and restorative protocols are applied.