Over the first five years or so, zirconia implants and titanium implants appear to perform similarly in healthy patients. A 2026 systematic review prepared for the 2025 ZrO Summit, an international meeting on zirconia implants, found comparable survival and bone levels for the two materials over that period, while noting that long-term evidence for zirconia is still thin. Titanium remains the default because it has decades of follow-up behind it, and zirconia is an alternative worth understanding rather than an upgrade.
Two materials, two different histories
Titanium implants have been used for single teeth and full arches for many decades, and they come in a very wide range of shapes, sizes and connection types. Zirconia (zirconium dioxide) is a white, high-strength ceramic. It has been used for crowns and bridges for years, but as an implant material it is newer, and some early designs are no longer sold.
Both are designed to bond with the jawbone, a process called osseointegration. After healing, either can support a crown that looks like a natural tooth. The differences show up in the details: colour under the gum, how the parts connect, and how much long-term data exists.
What the survival figures say
For titanium, a widely cited systematic review by Jung and colleagues (Clinical Oral Implants Research, 2012) estimated that implants supporting single crowns survived at a rate of 97.2% after five years and 95.2% after ten years.
For zirconia, the numbers come from fewer and shorter studies. A meta-analysis by Roehling and colleagues (Clinical Oral Implants Research, 2023) pooled six cohort studies of commercially available zirconia implants with at least five years of follow-up and estimated survival at 97.2% after five years, based on 277 implants. A review of two-piece zirconia implants by Bazal-Bonelli and colleagues (Medicina Oral, Patología Oral y Cirugía Bucal, 2025) reported 96.3% survival across six studies, with follow-up ranging from under two years to just over nine, and the authors advised treating the result with caution because the designs are still new.
The 2026 consensus review (Pachiou and colleagues, International Journal of Oral and Maxillofacial Implants) compared the two materials directly. Survival and bone loss were similar at five years or more. In the first year, two-piece zirconia implants showed slightly lower survival than titanium in a subgroup analysis, which one-piece zirconia did not. The authors also pointed out that part of the available data comes from older systems no longer sold.
Survival also is not the same as success. An implant can remain in place while still having gum inflammation, bone loss or problems with the crown, so these percentages are only part of the picture.
Colour matters most where the gum is thin
The main practical reason to consider zirconia is appearance at the front of the mouth. Gum tissue is slightly translucent, so a grey metal part beneath thin gum can sometimes show through as a darker shade. A laboratory study by Ioannidis and colleagues (Clinical Oral Implants Research, 2017) measured the colour change caused by different restorative materials placed under pig gum tissue. All of the materials changed the colour of the tissue to some degree, the effect lessened as the tissue got thicker, and the least discolouration came from fluorescent zirconia and from gold alloy.
In practice, this means zirconia is most relevant for a front tooth in someone with thin gums or a high smile line. For back teeth, or where the gum is thick, the difference usually does not show. A titanium implant can also be paired with a tooth-coloured ceramic abutment, the connecting part between implant and crown, which reduces the chance of grey show-through without changing the implant itself.
Design limits that affect who can have zirconia
Many zirconia implants are one-piece, meaning the implant and the abutment are a single unit. That removes a joint where bacteria could gather, but it also means the angle of the abutment is fixed at the time of surgery. If the bone is not ideally positioned, a two-piece system, where the abutment is chosen and angled after healing, gives the dentist more room to adjust. Two-piece zirconia implants exist, and as the reviews above show, their evidence base is still developing.
Titanium systems also offer a wider choice of narrow, short and angled options and a larger range of compatible parts for later repairs. In more complex mouths, or where several implants will support a bridge, that flexibility often counts for more than colour.
Metal-free is a preference, not usually a medical need
Some people ask for zirconia because they prefer to avoid metal in the body. That is a reasonable personal choice. Titanium allergy, however, appears to be uncommon: in a study of 1,500 consecutive implant patients, Sicilia and colleagues (Clinical Oral Implants Research, 2008) found positive titanium allergy tests in 0.6%. If you have a history of metal reactions, mention it at your assessment so it can be discussed and, if needed, investigated with your GP.
Cost and planning
As a typical market range, a single implant with its crown costs about $4,000 to $7,000, and extra steps such as bone grafting add to that. This is a general guide, not a Lumi fee. Pricing for zirconia implants varies, so the only reliable figure is a written treatment plan with fees after an assessment. Our dental implant cost guide explains what makes up the total, and our comparison of implants, bridges and dentures covers the alternatives.
Whichever material is used, implants depend on healthy gums and bone around them. Peri-implantitis, an inflammatory condition that causes bone loss around implants, can affect zirconia as well as titanium. Daily cleaning and regular maintenance visits are part of the commitment, and our guides to cleaning around implants and peri-implantitis explain what is involved.
Common questions
Is zirconia stronger than titanium?
Zirconia is a very strong ceramic, but it is more brittle than titanium, which can bend slightly under load. Current zirconia implants perform well in studies up to about five years, and longer-term data is still being collected.
Will a zirconia implant look better than titanium?
It may, for a front tooth with thin gum, because there is no grey metal to show through. Where the gum is thicker, or for back teeth, the visible result is usually similar.
Can I choose zirconia for any missing tooth?
Not always. Bone position, gum thickness, bite forces and the number of teeth being replaced all affect which implant design is suitable. An examination with a 3D X-ray is needed before a material can be recommended.
If you are weighing up implant materials, the team at Lumi Dental in Melrose Park can assess the site and explain the options that suit it, and you will usually receive a written treatment plan, often by email. Free consults are available for implant treatment; see our current offers, read about dental implants at Lumi, or get in touch through our contact page.
