Long‐Term Clinical, Radiographic and Esthetic Outcomes of Zirconia Dental Implants: A 10‐Year Prospective Multicenter Study

OBJECTIVES: This study aimed to prospectively investigate the long-term clinical performance of a commercially available one-piece zirconia dental implant system over 10 years. MATERIAL AND METHODS: A multicenter, open-label study was conducted at three clinical centers in Germany. Forty-four patients with single-tooth gaps meeting specific inclusion criteria received 44 yttria-stabilized zirconia (Y-TZP) implants featuring a sandblasted and acid-etched (ZLA) surface. Clinical and radiographic follow-ups were performed at 1, 3, 5, and 10 years to assess implant survival, success, peri-implant bone levels, and esthetic outcomes using Pink Esthetic Score (PES) and White Esthetic Score (WES). RESULTS: At the 10-year follow-up, 35 patients with 35 implants were available for evaluation. The estimated 10-year survival rate was 97.7% (95% CI: 97.27-98.13). Three implants (8.6%) showed biological complications, including peri-implant mucositis in 2 implants (5.7%) and peri-implantitis in 1 implant (2.9%), leading to a success rate of 91.4% (95% CI: 76.9-97.8). Peri-implant bone loss was moderate, averaging 1.20 (±0.61) mm over 10 years, with stable bone levels observed after the initial remodeling phase. Esthetic outcomes revealed a slight increase in PES (7.4 to 7.8) and a minor decrease in WES (7.0 to 6.7) between years 5 and 10. CONCLUSIONS: Zirconia implants demonstrated high long-term survival and success rates, moderate bone loss, and favorable esthetic outcomes. These findings support their use as a clinically reliable and esthetically acceptable long-term alternative to titanium implants. However, the limited sample size highlights the need for further confirmation in larger cohorts.