Clinical performance of zirconia implants: A meta-review

Statement of problem: The clinical effectiveness of zirconia implants as an alternative to titanium implants is still controversial. Purpose: The purpose of this analysis was to identify and evaluate systematic reviews reporting on the clinical outcomes of zirconia implants for oral rehabilitation. Material and methods: An electronic search was undertaken on MEDLINE, Embase, and the Cochrane Oral Health Reviews databases up to December 24, 2018, without language restriction. Eligible reviews were screened and assessed. The eligibility criteria were systematic reviews or meta-analyses, implant survival rate, implant success, marginal bone loss, peri-implant soft tissue status, and biologic and functional complications of zirconia implants. Two review authors independently evaluated the quality assessment of the secondary studies by applying the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. Results: Nine reviews fulfilled the inclusion criteria and were evaluated. Seven reviews were classified as moderate and 2 as high quality. The overall AMSTAR's quality of these reports was moderate. In the primary studies contained in these reviews, zirconia implant clinical outcomes were found to be similar or inferior to those for titanium implants. The few primary clinical studies contained in these reviews were not homogeneous among each other, presented poor methodology, and only offered promising short-term outcomes due to the lack of long-term follow-ups. Conclusions: Based on this meta-review, in spite of short-term promising results of zirconia implants, evidence with long term is lacking.