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Titanium vs zirconia implants

Zirconia (ceramic) implants are a metal-free option. Five-year data show high survival for one-piece zirconia implants, with far less long-term evidence than titanium.

The two materials

Most dental implant systems are made of titanium or zirconium oxide, also called zirconia.1 The ITI consensus groups zirconia with ceramic materials.3 Titanium implants have the longer research record: a 2019 systematic review of 18 prospective studies estimated 10-year survival of titanium implants at 96.4 percent.2

One-piece and two-piece designs

A one-piece implant has the implant body and abutment made as a single unit.3 A two-piece implant has a separate abutment joined to the implant.3 The ITI Group 2 consensus (2018) stated that one-piece zirconia implants can be recommended when clinical conditions are appropriate.3 The same consensus advised caution with two-piece zirconia implants because of insufficient data.3

Zirconia results at 5 years

A 2023 systematic review looked for studies of commercially available zirconia implants followed for at least 5 years.4

Measure at 5 yearsResult
Implant survival97.2 percent
Mean bone loss1.1 mm
Mean probing depth3.0 mm
Implants studied277
Patients studied221

Only 6 cohort studies met the review's criteria.4 The authors called for well-designed trials that compare titanium and zirconia implants directly.4

Comparing the evidence

TitaniumZirconia
Longest pooled follow-up in this library10 years25 years4
Pooled survival96.4 percent at 10 years297.2 percent at 5 years4
Consensus positionStandard material1One-piece recommended in appropriate conditions; two-piece with caution3

Abutments on titanium implants

Zirconia can also be used for the abutment on a titanium implant.5 A 2023 meta-analysis of randomized trials found no difference in bone level or gum pocket depth between titanium and zirconia abutments up to 5 years.5

General information about dental implants. Treatment decisions are made with a licensed dentist.

Sources

  1. U.S. FDA: Dental Implants, What You Should Know. fda.gov
  2. Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival. J Dent 2019. pubmed.ncbi.nlm.nih.gov
  3. Morton D et al. Group 2 ITI Consensus Report: Prosthodontics and implant dentistry. Clin Oral Implants Res 2018. pubmed.ncbi.nlm.nih.gov
  4. Roehling S et al. Clinical and radiographic outcomes of zirconia dental implants. Clin Oral Implants Res 2023. pubmed.ncbi.nlm.nih.gov
  5. Laleman I et al. Effect of different abutment materials on peri-implant tissues. Clin Oral Implants Res 2023. pubmed.ncbi.nlm.nih.gov

Evidence

Sourced facts

Each line links to the study or the specialty body it comes from.

  1. A 2023 systematic review found 97.2 percent survival of commercially available zirconia implants after 5 years (277 implants, 221 patients).

    Roehling S et al. Clinical and radiographic outcomes of zirconia dental implants: systematic review and meta-analysis. Clin Oral Implants Res 2023 · checked October 2, 2026

  2. The same review reported mean marginal bone loss of 1.1 mm at 5 years and called for more trials comparing titanium and zirconia.

    Roehling S et al. Clinical and radiographic outcomes of zirconia dental implants: systematic review and meta-analysis. Clin Oral Implants Res 2023 · checked October 2, 2026

  4. The ITI Group 2 consensus (2018) stated one-piece zirconia implants can be recommended when clinical conditions are appropriate, and two-piece zirconia implants should be used with caution due to insufficient data.

    Morton D et al. Group 2 ITI Consensus Report: Prosthodontics and implant dentistry. Clin Oral Implants Res 2018 · checked October 2, 2026

  5. Titanium implants have a 10-year survival estimate of 96.4 percent across 18 prospective studies.

    Howe MS, Keys W, Richards D. Long-term (10-year) dental implant survival: systematic review and sensitivity meta-analysis. J Dent 2019 · checked October 2, 2026

  6. The FDA states that most dental implant systems are made of titanium or zirconium oxide.

    U.S. FDA: Dental Implants, What You Should Know · checked October 2, 2026

  7. A meta-analysis of randomized trials found no difference in bone level or probing depth between titanium and zirconia abutments up to 5 years.

    Laleman I et al. Effect of different abutment materials on peri-implant tissues: systematic review and meta-analysis. Clin Oral Implants Res 2023 · checked October 2, 2026

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