Clinical behavior of two-piece zirconia implants. A systematic review.

Background: This systematic review aimed to evaluate the clinical behavior of two-piece zirconia implants (T-PZI) in terms of overall implant survival and success rates, marginal bone loss (MBL) complication rates, and others biological parameters.

Material and methods: PRISMA guidelines were followed, and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An automated search was conducted in four databases (Medline/PubMed, Scopus, Web of Science, and Cochrane Library), as well as a manual search for relevant clinical articles published until 18 May 2024. The review included human studies with at least five patients in which T-PZI were placed. Quality of evidence was evaluated using the Newcastle-Ottawa Quality Assessment Scale and the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2).

Results: Six studies met the inclusion criteria and were included for analysis, with a total of 298 T-PZI. A survival rate of 96.31% was recorded with follow-up periods ranging from 18.4±10.4 months to 111.1±2.2 months. The success rate ranged from 63 to 100% and MBL ranged from 0.130.6 to 1.38±0.81mm Conclusions: T-PZI may offer a reliable alternative to titanium dental implants, achieving a survival rate of 96.31%, acceptable rates of MBL and adequate biological parameters. However, the findings of the review must be treated with caution, as the data obtained are derived from the early stages of this new development in ceramic dental implants. More comparative studies are needed in order to determine the viability of T-PZI in different clinical situations.