Zirconia implants: low peri-implantitis rates, at least short-term

Zirconia implants (ZIs) are increasingly proposed as a metal-free alternative to titanium (TIs), marketed on esthetic and biological grounds, but solid prevalence data on peri-implantitis around ZIs — and whether implant material itself changes the risk — has been thin. This systematic review and meta-analysis searched four databases and grey literature through February 2026, including randomized controlled trials and cohort studies, and pooled 19 studies covering 687 patients and 995 implants with a mean follow-up of about 49 months.

The pooled implant-level prevalence of peri-implantitis around ZIs was low in the short-to-mid term: 2% (95% CI 0-6%) at ≤3 years, 2% (95% CI 0-8%) at >3-5 years, rising to 8% (95% CI 0-23%) beyond 5 years — though heterogeneity was substantial (I² 38.9-82.1%) and the long-term estimate carries a wide confidence interval. A separate comparative analysis restricted to five RCTs found no statistically significant difference in peri-implantitis prevalence between zirconia and titanium implants (RR 1.66, 95% CI 0.48-5.71, p=0.42) — meaning current evidence does not support material choice alone as a peri-implantitis risk modifier, in either direction.

The authors are candid about the limits: methodological heterogeneity, inconsistent peri-implantitis case definitions, sparse patient-level reporting, and a real shortage of long-term comparative data keep the certainty of evidence low. For clinicians already using or considering zirconia, the practical takeaway is that short-to-mid-term prevalence looks reassuringly low and roughly comparable to titanium — but the >5-year picture is still built on thin, wide-uncertainty data, so it is not yet a settled question for long-term risk counselling.