Study of the Month – June 2026: Zirconia Implants in Real-World Clinical Practice: Insights from 779 Implants
10.7.2026 · 7 min
How Strong Is the Evidence Beyond the Ideal Patient?'
Most clinical studies on dental implants focus on healthy individuals treated under controlled conditions. Everyday clinical practice, however, often involves patients who smoke, present with systemic conditions such as diabetes or cardiovascular disease, or require immediate placement and loading protocols.
This raises an important question:
How are zirconia dental implants reported in the available clinical literature involving local or systemic risk factors?
A recent scoping review conducted by the ZrO Summit 2025 Working Group provides a comprehensive overview of the available scientific evidence.
What Was Evaluated?
The review systematically analyzed published clinical evidence on zirconia implants placed in patients with systemic or local risk factors.
The evidence base included:
• 10 clinical studies
• 459 patients
• 779 zirconia implants
• Follow-up periods ranging from 1 to 5 years
The review was conducted according to PRISMA-ScR guidelines and the Joanna Briggs Institute (JBI) methodology, providing a structured evidence map currently available on this topic.
Which Risk Factors Were Included?
The studies reported outcomes for zirconia implants placed in patients with a variety of clinical conditions.
Systemic Factors
Available evidence included patients with:
• Well-controlled diabetes mellitus
• Controlled cardiovascular disease
• Controlled HIV infection
Local Factors
Studies also evaluated outcomes in cases involving:
• Moderate to heavy smoking
• Immediate implant placement
• Immediate loading
• Bone augmentation procedures
• Narrow-diameter or short implant designs
These patient populations more closely reflect routine clinical practice than the highly selected populations commonly included in traditional implant studies.
Immediate Loading Was Frequently Reported in the Reviewed Studies
One of the most noteworthy findings of the review was the frequent reporting of immediate loading protocols in the included studies.
Of the 779 zirconia implants included:
• 671 implants were immediately loaded
• 188 implants were conventionally loaded
These findings indicate that immediate loading protocols were frequently represented in the reviewed clinical evidence, while patient selection, implant design, surgical protocol, and primary stability remain important clinical considerations.
Marginal Bone Levels Remained Within Clinically Acceptable Limits
Across the included studies, reported marginal bone loss values were generally within accepted clinical thresholds during the available follow-up periods.
Despite differences in patient profiles, implant systems, and treatment protocols, the reported peri-implant bone levels were generally stable within the follow-up periods of the included studies.
What Does This Mean for Clinical Practice?
The primary value of this review is not that it provides definitive answers for every risk factor, but rather that it shows how zirconia implants have been reported in studies involving increasingly complex patient populations.
The available evidence suggests that:
• Controlled systemic conditions were represented in the reviewed literature and should be assessed through individualized clinical judgment.
• Local risk factors require case-specific clinical judgment.
• Immediate placement and immediate loading protocols are already well represented in the literature.
• Additional long-term prospective research remains necessary
While this review summarizes the currently available clinical evidence, treatment planning in risk-factor patients extends beyond individual study outcomes. Factors such as implant design, primary stability, soft tissue management, and biomechanical considerations remain important components of clinical decision-making.
For a broader discussion of treatment concepts and implant design considerations in compromised patients, read our article Ceramic Implants in Compromised Patients.
Where Does the Evidence Need to Grow?
The review highlights several areas where further research is needed, including:
• Osteoporosis
• Autoimmune disorders
• Head and neck radiotherapy patients
• Standardized surgical protocols
• Standardized prosthetic workflows
• Long-term outcomes beyond five years
• Direct comparisons of contemporary two-piece zirconia implant systems
These topics may inform future clinical recommendations as additional evidence becomes available.
Conclusion
This scoping review shows that zirconia implants are increasingly being studied beyond ideal patient populations, including in clinical scenarios involving selected local and systemic risk factors.
While additional long-term data are still needed, the available literature reports clinically acceptable outcomes in selected challenging treatment situations. As the evidence base continues to expand, it may more closely reflect the patients clinicians encounter in daily practice.
