Abstract

Oral rehabilitation of fully or partially edentulous patients remains a major clinical challenge due to functional, esthetic, and biological demands. The introduction of osseointegration in the twentieth century established the biological foundation of modern implant dentistry and enabled predictable long‑term outcomes with titanium implants. Continuous advances in implant design, surface characteristics, loading protocols, and biomaterials have expanded clinical possibilities, including the development of zirconia implants as a metal‑free alternative. To critically analyze the historical, biological, and technological evolution of dental implants, with particular emphasis on the current clinical role of zirconia implants in evidence‑based oral rehabilitation. This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Electronic searches of PubMed/MEDLINE, Scopus, and Web of Science were performed for English‑language publications from January 2000 to March 2026. Clinical trials, cohort studies, and systematic reviews evaluating titanium and zirconia dental implants were included. Data regarding implant survival, osseointegration, marginal bone loss, loading protocols, and biological, technical, and esthetic outcomes were qualitatively synthesized. Methodological quality was assessed using RoB 2, ROBINS‑I, and AMSTAR‑2 tools. Titanium implants consistently demonstrated high long‑term survival rates (>90–95%), confirming their status as the gold standard. Zirconia implants showed comparable short‑ and medium‑term survival and marginal bone stability, particularly in one‑piece designs. Immediate and early loading protocols achieved outcomes similar to conventional loading when appropriate clinical criteria were respected. Zirconia implants exhibited favorable soft‑tissue responses and superior esthetic outcomes in anterior regions, although mechanical limitations were noted in specific designs. Titanium implants remain the most extensively validated option for implant therapy. Zirconia implants represent a viable alternative in selected clinical situations, especially when esthetic demands are prioritized; however, long‑term randomized controlled trials are still required to confirm their biological and mechanical predictability.

Keywords

dental implants, titanium, zirconium oxide, implant survival