Consensus Statement 1: Based on the review, only zirconia was found to be a commercially available alternative material to titanium or titanium alloy implants.

Consensus Statement 2: The data after 5 years mainly applies to 1-piece zirconia implants for single crowns and 3-unit implant fixed dental prostheses (iFDP). Regarding 2-piece zirconia implants, only limited data is available. This statement is based on six clinical cohort studies (four prospective studies, two retrospective studies). A single retrospective study investigated 2-piece implants.

Consensus Statement 3: Zirconia implants show a mean survival rate of 97.2%, range: 93.8%– 100% at 5 years, comparable to published data for titanium-based implants. This statement is based on a meta-analysis (95% CI: 94.7%– 99.1%) of six clinical cohort studies (four prospective studies, two retrospective studies).

Consensus Statement 4: Over 5 years, zirconia implants show similar peri-implant tissue health compared to published data for titanium implants (mean MBL of 1.1 mm – range: 0.7–1.2 and mean PD of 3 mm – range: 2.2–3.3). Bleeding on probing could not be compared because of the heterogeneity of the used indices. This statement is based on a meta-analysis (95% CI: 0.9–1.3 mm for MBL and 2.5–3.4 mm for PD) on five clinical cohort studies.

Consensus Statement 5: Over 5 years, 1- piece zirconia implants for single crowns and 3-unit implant fixed dental prostheses (iFDP) do not show higher fracture risk than titanium implants. This statement is based on six clinical cohort studies (four prospective studies, two retrospective studies).

1) Can zirconia implants be recommended in daily practice?

Zirconia implants can be an alternative to titanium implants in selected indications. Based on available data for up to 5 years, 1- piece zirconia implants for single crowns and 3-unit implant fixed dental prostheses (iFDP) can be recommended as a treatment option. In clinical indications that require the positioning of the restoration margin submucosally, the cementation process has to be controlled. It has to be considered that various types and generations of zirconia implants exist today, exhibiting differences in mechanical properties and not all have been validated in clinical studies.

1) Are all implants made of titanium, or are there alternatives?

In addition to titanium implants, zirconia implants have been available for 20 years (2004).

2) What is the difference between titanium and zirconia implants?

Titanium is a metal and is gray. Zirconia is an oxide ceramic and has a tooth-like color. However, both materials integrate with bone and gums in the same way

3) Do zirconia implants perform as well as titanium implants?

Studies show that the performance of zirconia implants in terms of survival rate and integration with the bone and gum is the same as titanium implants for up to 5 years. These studies are, however, based on the first type of one-piece zirconia implants. Zirconia implants have evolved to offer us more options, but there are only limited studies to date on how these newer two-piece designs perform over time. This statement is based on six clinical cohort studies (four prospective studies, two retrospective studies). A single retrospective study investigated 2-piece implants.

4) I have an intolerance to various materials, including metals. Would you recommend that I have a ceramic rather than a titanium implant?

Intolerance to titanium is scarce. If you prefer a nonmetallic material, you can choose a zirconia implant instead. If you do so, you must know that an internal metal screw is needed in some of the newer two-piece zirconia implants to connect the different components. This metal screw will not come into contact with your bone or gums. This statement is based on six clinical cohort studies (four prospective studies, two retrospective studies). A single retrospective study investigated 2-piece implants.

5) I lost a titanium implant because of peri-implantitis. Is a ceramic implant a better solution to prevent these complications?

Currently, there is no clinical evidence that zirconia implants perform better than titanium implants to prevent peri-implantitis.