Ceramic (Zirconia) Dental Implants: What Is Known and What Is Not

What a ceramic implant is

A ceramic dental implant is made of zirconia (zirconium dioxide), a white ceramic, instead of titanium. Like a titanium implant, it is a post in the jawbone that fuses with the bone and carries a crown or a bridge. Titanium is regarded as the international standard¹ for implants and has a much longer record.

Ceramic implants come in two designs:

• One-piece. The part in the bone and the part that carries the crown are a single piece, so it heals with that part showing through the gum. Because the crown-carrying part is built in, there is little room to correct its angle or position afterwards, which calls for precise planning and an experienced team².
• Two-piece. The connector (abutment) is a separate part fixed later. The German guideline notes that this allows bone to be added at the same time and the implant to heal without load.

Most of the research is on one-piece implants; the evidence for two-piece implants is limited³. The early signals are mixed. In the 2026 review described below, two-piece ceramic implants had slightly lower one-year survival than titanium⁴ in a subgroup analysis, which the authors called a potential difference. A 2023 review that pooled studies of different designs and product generations counted more losses with two-piece than with one-piece implants⁵ (7.5 against 4.1 per cent); those studies were not built to compare the two, so this is a signal, not a proven difference.

How ceramic and titanium implants compared in studies

A 2026 review pooled 9 studies that compared the two materials directly, with 435 implants, and found no significant difference in implant survival⁴ at one year, three years and five years or more. Bone level on X-rays differed by a fraction of a millimetre: about 0.16 mm more loss around ceramic implants at one year, a gap that shrank when the less reliable studies were set aside, and no clear difference at five years or more. The authors limit their conclusion to healthy patients, follow-up of up to five years and older implant systems, part of which are no longer sold.

A trial in several centres, published after that review's literature search, placed 61 two-piece ceramic and 61 titanium implants, each carrying one crown. One year after the crowns were fitted, 100 per cent and 96.5 per cent were in place⁶, a difference that was not significant, and bone levels were similar. The authors found no clinical superiority for either and called the ceramic implant a viable alternative for a single tooth. The trial tested one screw-retained design for one year, and its authors declared grants from the manufacturer.

'No significant difference' does not mean 'just as good'. These studies are small and short, so they cannot show that ceramic implants last as long as titanium.

What studies of ceramic implants alone show

Most studies of ceramic implants have no titanium group. Their figures describe ceramic implants only and cannot be set against titanium figures from other studies.

• Five years. A review prepared for an international implant consensus pooled 6 groups of patients with 277 implants from systems currently on the market. About 97 in 100 were still in place after five years⁷, with about 1.1 mm of bone loss on average. Still in place is not the same as trouble-free.
• When losses happen. A review of 25 studies with 4,017 implants counted 172 losses (4.3 per cent). 124 of the 172 happened in the first year⁵.
• Older products. Implants from systems no longer sold, or used only in studies, were lost more often than those on the market: 11.3 against 2.5 per cent. This is an association.
• Fracture. A ceramic implant can break, but in this review it was uncommon: 26 of 4,017 implants. 18 of the 26 came from one study, and 15 of those were very narrow implants (3.25 mm). Implants whose top had been reshaped with a drill were also lost more often. This is not a fracture rate for today's implants of standard width.

The same review also gives a ten-year survival estimate. It is a statistical (life-table) estimate from studies with different lengths of follow-up; most implants were followed for less than ten years, so it is not the observed ten-year result of everyone in the review. The German guideline notes that frequent product changes make it impossible to judge ceramic implants beyond five years¹.

Which missing teeth ceramic implants are used for

Expert groups say ceramic implants can be an alternative to titanium in selected cases³. The European Association for Osseointegration found comparable evidence for one-piece implants replacing one to three missing teeth with fixed crowns or a small bridge².

• Small bridges. A 2025 review of 13 studies reported about 93 in 100 implants in place under three-unit bridges⁸ after about four years on average. The authors considered them favourable where appearance matters and biting forces are low.
• Removable dentures held by implants. Results were weaker. In the same review about 70 in 100 implants (69.5 per cent) were in place after an average of 12 months, and the authors called this less predictable. In the one randomised trial, 71.2 per cent of ceramic and 82.1 per cent of titanium implants⁹ were in place after 12 months, and three ceramic implants fractured in the first year against none of the titanium ones.
• Crowns and bridges on top. The EAO paper reported more chipping of the veneering porcelain² on layered crowns and bridges. That is a problem with the crown or bridge, which may need repair or replacement, not the loss of the implant.

How implant treatment runs, stage by stage, is explained on the dental implants page.

Gum health and appearance

Inflammation of the gum around an implant (peri-implant mucositis) and peri-implantitis, inflammation with loss of the supporting bone, occur around ceramic implants as they do around titanium. A review of comparative studies found no difference in biological complications¹⁰, with moderate certainty. At one year the gum bled more often when gently probed around ceramic implants; this finding has low certainty and was not matched by differences in plaque or pocket depth. A 2026 review of 19 studies found peri-implantitis affecting about 2 in 100 ceramic implants in studies of up to five years and about 8 in 100 in longer ones¹¹. The statistical uncertainty was wide (for the longer studies, anywhere from 0 to 23 per cent), definitions differed, and the comparison with titanium showed no significant difference. A ceramic implant does not prevent peri-implantitis and needs the same daily cleaning and regular reviews.

Ceramic implants are often presented as looking more natural. In the comparative review there was no significant difference at one year⁴ in the pink aesthetic score, which rates the gum around the crown, or in what patients reported. An international consensus suggests, as expert opinion, that ceramic parts passing through the gum might be preferred where appearance matters most. A better appearance with ceramic implants has not been shown in studies.

Titanium allergy and healthy titanium implants

Some people ask for a ceramic implant because they worry about a metal allergy. The German guideline on titanium hypersensitivity says a ceramic implant may be considered when titanium intolerance is suspected¹²; that recommendation rests on low-level evidence. The same guideline notes that titanium intolerance is not adequately documented and that other metals must be considered too. Skin patch tests and blood (lymphocyte) tests do not help to assess it, and patch testing people before treatment just in case is advised against.

If you have titanium implants that are working well, no source supports removing them to replace them with ceramic. The guideline says that removing an implant for suspected intolerance should be decided on very strict grounds.

What is not known

• How ceramic implants compare with titanium after five years.
• Whether two-piece ceramic implants hold up as well as one-piece ones over the years. The German guideline says a two-piece ceramic implant should be used only after the patient has been told in detail¹ that long-term data are missing.
• How ceramic implants do in people who smoke, have diabetes, take bone-strengthening medicines or have had radiotherapy. The comparative studies were in healthy patients. Choosing ceramic does not replace the usual assessment before any implant: gum disease, smoking, diabetes, the medicines you take and past radiotherapy are discussed as they would be for titanium.
• Results with a temporary tooth fitted straight away, with narrow implants for back teeth or under a fixed bridge across a whole jaw. The sources used here give no figures for these.
• Any benefit for general health. No source we used supports it.

If a ceramic implant is proposed to you, ask why it suits your case rather than titanium, whether it is one-piece or two-piece, how often the team places this system and what would happen if it failed.

When to see a dentist

Contact your dentist if an implant or the tooth on it feels loose, if a crown chips or cracks, or if the gum around an implant bleeds, swells, recedes or releases pus. Do not wait for your next planned review. After surgery, call your dental team the same day if bleeding does not stop with pressure or if numbness lasts after the anaesthetic should have worn off.

Emergencies. Heavy bleeding that will not stop, difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, high fever or swelling around the eye are serious signs. Do not wait for the clinic's reply: go to the nearest emergency department or call 112.

Frequently asked questions