The use of titanium dental implants versus zirconium dioxide dental implants in esthetic zone. Systematic review

Abstract

Background: The use of zirconium dental implants for esthetic purposes seems to have a promising future due to similar survival rates to titanium implants. Other added mentioned proprieties are white color, the small level of bacterial adherence and the high resistance of the material. Aim/Hypothesis: The main aim of this systematic review was to evaluate the zirconium oxide implants success and survival rates (ZrO2) versus the titanium implants (Ti) in the esthetic area. Material and Methods: This Systematic review was registered at PROSPERO with the reference CRD42015019546. Clinical trials that evaluated zirconium oxide implants were searched in seven electronic databases (PubMed, Lilacs, Science Direct, Cochrane Collaboration, Evidence Based Dentistry (EBD), Journal of Evidence-Based Dental Practice (JEBDP), NHS Evidence) till November 2016 and were included according to pre-established inclusion criteria. A manual search was performed on the bibliography of the collected articles, and the authors were contacted for additional references. Success and survival rate for titanium implants (Ti) was compared with the zirconium oxide implants success and survival rate (ZrO2). The quality of the included articles was evaluated using the Critical Appraisal Skills Programme (CASP) criteria, thus being analysed at both study and outcome level. Results: Seventeen articles were included and the results obtained after calculating the data from each study, in which the zirconium oxide dental implants (ZrO2) location (maxilla or mandible, anterior or posterior) is described. Number of patients: 1057. Number of implants of ZrO2: 1916. Survival: 95%. Follow-up Mean: 32 months (2.6 years). In order to analyze the information about the esthetic area, the studies which did not describe the placement of the zirconium oxide implants in the anterior area (ZrO2) were discarded, only implants placed from 14 to 24 and 34 to 44 (esthetic area) were accounted for: 486 ZrO2 implants, 94% survival, 29 months of follow-up (2.4 years). Of the included studies only two were randomized controlled trials, twelve prospective trials and three retrospective studies. Several methodological limitations on the collected articles and debated in this review. The overall survival rate of the zirconium oxide implants of one and two pieces resulted in 95%. Conclusions and Clinical Implications: Although the available scientific evidence base is and at considerable risk of bias, from the available data it is possible to conclude that zirconia dental implants could be used in esthetic zone with 94% survival. The different study designs and methodology make difficult to present an overall conclusion regarding the efficacy of ZrO2 implants in maintaining crestal bone levels and peri-implant soft tissue health. Further long-term, randomized controlled trials with a standard methodology are needed.