Study of the Month – March 2026: Long Term Outcomes of Zirconia Implants After Titanium Implant Failure

Zirconia dental implants are gaining increasing attention in implant dentistry research after titanium implant failure. In this month’s Study of the Month, presented at the IADR Congress, Prof. Dr. Etyene Schnurr summarizes the results of a large retrospective clinical study evaluating the longterm performance of tissuelevel zirconia implants placed after the failure of titanium implants

These findings provide clinically relevant insights for implant dentistry, particularly for the management of compromised implant sites and for patients seeking metal-free implant rehabilitation.

Background: Why Consider Zirconia Implants After Titanium Implant Failure?

Titanium implants remain the gold standard in dental implantology, with 10year survival rates exceeding 95%. However, there are clinical scenarios in which alternative materials may be advantageous.

• Esthetic limitations due to gray discoloration through thin peri implant mucosa

• Biological concerns related to titanium particle or ion release

• Rare cases of titanium hypersensitivity

• Growing patient demand for metal free dental implants

The current study investigated whether zirconia implants can provide long-term outcomes when placed at sites previously affected by titanium implant failure.

Study Aim

This retrospective clinical study aimed to evaluate the long-term outcomes of zirconia implants placed in the same anatomical site following the removal of a failed titanium implant.


The primary outcome measures included:

• Cumulative survival rate (CSR)

• Marginal bone loss (MBL)

• Vertical bone changes after functional loading

• Pink Esthetic Score (PES)

• Peri implant clinical parameters (plaque accumulation, bleeding on probing, PSR)

Study Design and Methods

This study analyzed 284 zirconia implants placed in 121 patients. All implants were inserted after the explantation of a titanium implant in the same region.


The indications for titanium implant removal included:

• Previous peri implantitis

• Prosthetic or implant failure

• Indication for metal free rehabilitation

Immediate versus delayed implant placement protocols were compared.

The study received ethical approval from the Ethics Committee of Eastern Switzerland (BASEC No. 2025 01811).

Key Study Results

✅ High LongTerm Implant Survival

• High cumulative survival rate up to 9.24 years across all indications

• 2 Implants loss only in the previous peri-implantitis group at 7 and 8 years after functional loading

• These results demonstrate that zirconia implants exhibit high long-term survival, even when placed after titanium implant failure, a scenario that represents a clinically complex initial management situation.

🦷 Stable Peri Implant Bone Levels


• Overall stable marginal bone levels across all indication groups

• Immediate and late implantation of zirconia implants showed no significant differences.

• No clinically relevant differences related to implant design (one piece vs. two piece)

👉 Clinical relevance: Early replacement with zirconia implants may contribute to the preservation of peri-implant bone and improved aesthetic outcomes.

🎨 Improved Aesthetics and PeriImplant Soft Tissue Health

• The Pink Esthetic Score (PES) increased significantly across all groups

• Significant improvements were observed in peri-implant health parameters, including:

o Reduced plaque accumulation

o Reduced bleeding on probing

o Improved periodontal screening indices

Zirconia implants demonstrate a favorable soft tissue response, supporting long-term peri-implant health.

Summary of Clinical Findings

• Zirconia implants perform predictably after titanium implant failure

• They represent a metal-free favorable alternative even in compromised implant sites

• Early implant placement may support marginal bone and softtissue stability

• High long term survival rates (>5 years) across all clinical indications

• Significant improvements in esthetic outcomes and peri implant health indices

Conclusion: Zirconia Implants as a Reliable Alternative in Implant Dentistry

This study provides strong clinical evidence that tissue-level zirconia implants are a reliable, esthetically advantageous, and biologically favorable alternative to titanium implants following implant failure, even in challenging clinical situations.

For patients with high esthetic demands or a preference for metal free implant solutions, zirconia implants offer promising long term outcomes in contemporary implant dentistry.

📌 Study of the Month – At a Glance

• Study type: Retrospective clinical study

• Implants analyzed: 284 zirconia implants

• Maximum follow up: 9 years

• Survival rate: 98-100%

• Key takeaway: Early zirconia implant placement may support long term bone and soft tissue stability

Prof. Dr. med. dent. E. Schnurr (Scientific Advisor, SDS)

Provides scientific guidance for SWISS DENTAL SOLUTIONS. She researches the oral microbiome, biofilm infections, and their impact on overall health: from clinical research and data analysis to drug development.

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