Studies & papers

Monzavi M, Masnavi M, Zraiqat A, Manesh A. Long-Term Clinical and Radiographic Outcomes of Ceramic Dental Implants: An 11-Year Retrospective Cohort Study. J Esthet Restor Dent. 2026 Jul 16. doi: 10.1111/jerd.70234. Epub ahead of print. PMID: 42464070.

Objective

The retrospective cohort study by Monzavi et al. (2026) evaluated the long-term clinical and radiographic outcomes of several ceramic dental implant systems, including Zeramex XT, with follow-up periods of up to 11 years.

A total of 275 ceramic implants were evaluated, including 83 Zeramex XT implants. For the overall cohort, the mean follow-up period was 4.6 years (median: 4 years; range: 4 months to 11 years). Kaplan-Meier analysis demonstrated an overall cumulative implant survival rate of 97.6% during the observation period.

Results

For the 83 Zeramex XT implants included in the study, the following outcomes were reported:

• Mean follow-up: 4.2 years
• First-year marginal bone loss (MBL), mean ± SD: 0.74 ± 0.30 mm (range: 0.20–1.50 mm)
• Kaplan–Meier survival rate: 98.8%
• Success rate: 95.1%
• mGI final, mean ± SD (range): 0.06 ± 0.24 (0–1)
• mPI final, mean ± SD (range): 0.02 ± 0.15 (0–1)

One implant failure occurred in the Zeramex XT group due to aseptic loosening, without clinical or radiographic signs of peri-implant inflammation. Three additional implants did not meet the study’s strict radiographic success criteria because of annual bone loss > 0.2 mm/year and/or excessive bone loss during the first year. This resulted in an overall success rate of 95.1% for Zeramex XT. Notably, no implant fractures were observed in the Zeramex XT group.

Conclusion

Within the observation period, Zeramex XT demonstrated a high implant survival rate (98.8%) and success rate (95.1%) along with stable peri-implant bone levels and favorable soft-tissue conditions.

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Tartsch J, Chrcanovic B, Wennerberg A, Kohal R, Albrektsson T. Two-piece Zirconia Implants: An Office-based Retrospective Study with up to 7 and mean 3-Year Follow-Up. Int J Oral Maxillofac Implants. 2025 Jul 30;0(0):1-36. doi: 10.11607/jomi.11469. Epub ahead of print. PMID: 40736783.

Objective

The objective of the retrospective study by Tartsch et al. (2025) was to evaluate the clinical outcomes of two identically designed two-piece zirconia (ATZ) implant systems Zeramex XT and NobelPearl™.

Between 2017 and 2024, a total of 167 implants were placed in 106 patients and followed for up to 88 months (mean: 39.1 months). In addition to implant survival rate, marginal bone loss (MBL), clinical parameters, and surface properties were evaluated using 3D profilometry. Statistical analysis included descriptive evaluations and survival analysis using the life table method.

Results

Zeramex XT and NobelPearl™ showed a survival rate of 98.2% as well as stable peri-implant tissue conditions over a period of up to 7 years. The mean marginal bone loss varied between -0.14 mm and -0.58 mm. The surface roughness was minimal (Sa ~0.5 µm). No risk factor showed a significant association with implant loss in the univariate analysis.

Conclusion

Two-piece, screw-retained zirconia implants demonstrated a high survival rate and stable peri-implant tissue conditions over a period of up to seven years. 

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Porporati, A. A. (2025). Zirconia in dentistry. In C. Picconi & M. Özcan (Eds.), Zirconia: Material properties and surgical principles for dental implants and restorations (pp. 25–33). Quintessence Publishing.

The author discusses the material properties of zirconia and its relevance in dentistry, with a focus on phase transformation behavior, mechanical performance, and processing.

The use of ceramics in medicine, including dentistry, has increased due to their favorable biological behavior and resistance to corrosion in the oral environment.

Zirconia, in particular, has gained relevance following the discovery of phase transformation toughening, which enabled broader applications of ceramic materials. Zirconia exists in monoclinic, tetragonal, and cubic crystal structures depending on temperature, and its properties can be modified through stabilization with oxides such as yttria, resulting in yttria-stabilized tetragonal zirconia polycrystal (Y-TZP).

The transformation from tetragonal to monoclinic phase is associated with a volume increase and shear strain, which can generate compressive stresses that slow crack propagation and improve toughness. The effectiveness of this mechanism depends on factors such as stabilizer concentration, grain size, and microstructural constraints.

The processing of zirconia, particularly sintering, plays a critical role in determining its microstructure and mechanical behavior. Material modifications, including the addition of alumina, can improve resistance to aging and alter mechanical properties. Furthermore, developments in CAD/CAM zirconia materials have enhanced optical properties through changes in composition and microstructure.

Conclusion

Zirconia has established itself in dental implantology, where its properties meet clinical requirements and have produced results comparable to titanium. 

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Mangkorn W, Kamonkhantikul K, Homsiang W, Arksornnukit M. Brushing effect on retentive force and surface roughness of three overdenture attachment patrices: An in vitro study. J Prosthodont. 2025 May 21. doi: 10.1111/jopr.14075. Epub ahead of print. PMID: 40400095.

Objective

The objective of the study was to investigate the brushing effect on retentive force and surface roughness of titanium, coated titanium, and zirconia patrices in several implant-retained overdenture attachments, including Zeramex Docklocs® attachment system.

Conclusion

The patrices in the denture attachment system Zeramex Docklocs® could provide retention and maintain surface characteristics after simulated brushing for up to 150,000 cycles, which is equivalent to approximately 15 years of clinical use.

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Sagheb, K., Yildirimturk, S., Kaya, S. et al. Ex vivo comparison of drilling techniques for optimizing primary stability of zirconia dental implants in different bone densities. Int J Implant Dent 11, 28 (2025). https://doi.org/10.1186/s40729-025-00603-z

Objective

The objective of the study by Sagheb et al. (2025) was to investigate the primary stability of zirconia implants using different drilling protocols, focussing on the effects of thread cut on insertion torque in both mixed (D2/D3) and soft (D4) bone types.

Conclusion

Within the limitations of this study, the authors concluded that reducing the thread cut enhances primary stability, as indicated by insertion torque. Reducing thread cutting demonstrated improved stability of Zeramex XT in soft bone D4. In contrast, in D2/D3 bone, Zeramex XT required a full thread cut to remain within the manufacturer’s torque range of 20–45 Ncm.

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Kohal RJ, Schikofski T, Adolfsson E, Vach K, Patzelt SBM, Nold J, Wemken G. Fracture Resistance of a Two-Piece Zirconia Implant System after Artificial Loading and/or Hydrothermal Aging-An In Vitro Investigation. J Funct Biomater. 2023 Dec 15;14(12):567. doi: 10.3390/jfb14120567. PMID: 38132821; PMCID: PMC10743638.

Objective

The objective of this study was to investigate the fracture resistance of the two-piece Zeramex XT implant system. For this purpose, 32 implants with screw-retained zirconia abutments were divided into four groups of eight samples each. Group 0 (control group) was neither loaded nor aged in a chewing simulator; group H was hydrothermally aged; group L was loaded with 98 N; and group HL was subjected to both hydrothermal ageing and loading in a chewing simulator. One sample from each group was analysed for t-m phase transformation, the others were loaded until fracture. A one-way ANOVA was performed to assess the differences between the groups.

Results

No implant fracture occurred during the simulation of artificial mastication. Furthermore, there were no statistically significant differences (p > 0.05) between the groups in terms of fracture strength (group 0: 783 ± 43 N; group H: 742 ± 43 N; group L: 757 ± 86 N; group HL: 740 ± 43 N) and bending moment (group 0: 433 ± 26 Ncm; group H: 413 ± 23 Ncm; group L: 422 ± 49 Ncm; group HL: 408 ± 27 Ncm).

Conclusion

In the context of the present study, it can be concluded that the artificial load and hydrothermal ageing do not reduce the fracture strength of the Zeramex XT implant system investigated.

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Mohseni P, Soufi A, Chrcanovic BR. Clinical outcomes of zirconia implants: a systematic review and meta-analysis. Clin Oral Investig. 2023 Dec 23;28(1):15. doi: 10.1007/s00784-023-05401-8. PMID: 38135804; PMCID: PMC10746607.

The meta-analysis included 25 studies that provided information on the failure rate of implants in any group of patients with zirconia implants.

The studies reported on 4017 zirconia implants (including 49 Zeramex T implants) in 2083 patients. The patients were 851 (42.4%) men and 1,157 (57.6%) women, with no gender information available for 75 patients. Patients received an average of 1.91 ± 1.51 (range: 1-14) implants. 7 of 25 studies had a follow-up period of more than 60 months.

Results

The cumulative 10-year survival rate of zirconia implants is 95.1 %. The mean MBL fluctuated between 0.632 and 2.060 mm over long observation periods (up to 132 months).

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Romanos GE, Fischer GA, Rahman ZT, Delgado-Ruiz R. Spectrometric Analysis of the Wear from Metallic and Ceramic Dental Implants following Insertion: An In Vitro Study. Materials (Basel). 2022 Feb 4;15(3):1200. doi: 10.3390/ma15031200. PMID: 35161144; PMCID: PMC8838065.

Objective

The objective of this study was to analyse the wear of titanium and zirconia implants at the time of insertion using X-ray fluorescence spectrometry (XRF) and an in vitro protocol with artificial bovine bone plates. Five groups were analysed using XRF spectrometry: Groups 1-4 (titanium implants) and Group 5 (Zeramex XT zirconia implants). The implants were placed in two bone blocks held together by a vice. The blocks were separated and the insertion sites were analysed for titanium (Ti) and zirconium (Zr). Statistical descriptive analyses of Ti and Zr concentrations in the coronal, middle and apical bone interface were performed. A comparative analysis confirmed differences between the surface stability of the implant and Ti accumulation at the insertion sites of the bone block. There was a direct correlation between the implant length and the amount of titanium found on the bone block. Titanium is abraded from the implant surface at the time of implant placement.

The results of the study confirm the wear of metallic, but not ceramic implants such as Zeramex XT at the time of insertion.

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Tartsch J, Blatz MB. Ceramic Dental Implants: An Overview of Materials, Characteristics, and Application Concepts. Compend Contin Educ Dent. 2022 Sep;43(8):482-488; quiz 489. PMID: 36170627.

In addition to the theoretical basics, including an overview of the material, the composition of zirconia implants and modern manufacturing technologies, the article discusses various implant concepts and their clinical advantages.  

The advantages of the two-piece and reversibly screw-retained (carbon fibre-reinforced screw made of PEEK) ceramic implant concept are also illustrated using an anterior tooth case and its 3-year follow-up (stable, good aesthetic soft tissue conditions and a stable bone situation without bone loss).

Conclusion

The data currently available show that dental implants made of high-performance zirconium dioxide have come closer to titanium implants in terms of material stability, surface design and success rates thanks to continuous further development. The known surgical and prosthetic protocols can largely be adopted for zirconia implants.

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Jank, Siegfried PhD, MD, DMD; Hochgatterer, Gregor DMD. Success Rate of Two-Piece Zirconia Implants: A Retrospective Statistical Analysis. Implant Dentistry 25(2):p 193-198, April 2016. | DOI: 10.1097/ID.0000000000000365 

The aim of the study was to evaluate the clinical success of two-piece Zeramex implants with regard to osseointegration using the manufacturer's warranty data.

Results

Data from 15,255 implants sold between 2010 and 2014 were analysed retrospectively. Zeramex T had an average success rate of 96.7 %, while the Zeralock implants had an average success rate of 98.5 %.

Conclusion

The results of the study show that two-piece zirconia implants have competitive success rates that have improved from >96.7 % to >98.5 % over three product generations.

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