Introduction

Titanium (Ti) is regarded as the “gold standard” for dental implants due to its durability. However, it poses challenges in biocompatibility and aesthetics, with reports of Ti particle release, hypersensitivity in some patients, and a notable link to peri-implantitis despite high survival rates. Zirconia (ZrO₂) implants exhibit comparable or even more favourable biofilm formation, immunological parameters, peri-implant inflammation, and probing depths compared to Ti implants.

Aim

To compare ZrO₂ and Ti dental implants in the maxillary premolar region, in terms of marginal bone level (MBL) changes, clinical parameters, aesthetic outcomes, and patient related outcome measures (PROMs) 1 year after prosthetic loading.

Patient Profile

• Patients requiring single tooth implant therapy in the maxillary premolar region (n=50).
• All the study subjects had a bone height ≥10 mm beneath the maxillary sinus.

Methods

Study Design

• A randomized-controlled trial.

Treatment Strategy

• Following 3 months of the toot extraction, patients were randomized to receive either a ZrO₂ implant (n=25) or a Ti (n= 25) bone-level implant.
• Patients in both groups received a lithium disilicate crown 2 weeks later.
• Patients in the Ti-group were fitted with a screw-retained implant prosthesis on a Ti-base abutment.
• Follow-up visits were scheduled at 1 month (T1) and after 1 year (T12)

Outcomes

Primary Outcome

• Changes in MBL

Secondary Outcomes

• Implant survival, peri-implant tissue health, aesthetics, and PROMs.

Results

• The mean MBL change after 1 year did not differ significantly between the study groups (Table 1).

Table 1: Change in MBL in 1 year

• The implant survival rates after 1 year were 96% for the ZrO₂-group and 100% for the Ti-group.
• Overall, the scores for the other clinical outcome parameters were generally favorable, with no significant group differences. Nevertheless, the aesthetic outcomes varied significantly for two criteria: (a) level of facial mucosa (p = .022), in favor of Ti, and (b) root convexity/soft tissue color and texture (p = .005) in favor of ZrO₂.
• Patients in both the study groups had high PROMs with no significant group differences, indicating similar level of patient satisfaction.

Conclusions

• The ZrO₂ and Ti implant types used for replacing a single missing maxillary premolar, had comparable outcomes in terms of MBL change after 1 year.
• Clinical and aesthetic parameters, and PROMs, were favorable and similar between both implant types after 1 year of prosthetic loading.
• The findings of this short-term study suggest that both the types of implants are suitable for clinical use.

Clin Oral Impl Res. 2024;35:630–640.