Ceramic implants have recently sparked the interest of the public and professionals alike. Despite titanium’s popularity as an implant material, decades of experience have shown a disquieting number of biological, technical, and esthetic complications (Jung et al. 2012, Mombelli et al. 2012, Pjetursson et al. 2012, Sailer et al. 2012). Titanium particles have been associated with peri-implant inflammation and bone loss (Pettersson et al. 2017, Safioti et al. 2017), leading to discussions of corrosion and metal allergies (Hosoki et al. 2016, Javed et al. 2013). Gingival recession and exposure of the metallic implant collar, or the appearance of a greyish shadow through thin peri-implant tissues may also lead to esthetic complications (Jung et al. 2007, Thoma et al. 2016b, Zucchelli et al. 2013). The relentless search for alternatives has steered us towards ceramic implants, and yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) in particular. Their color adaptability, adequate physical strength and resistance to wear and corrosion, make them promising surrogates for titanium implants (Osman & Swain 2015, Piconi & Maccauro 1999). Zirconia is a highly biocompatible material, comparable to titanium in its bone integration (Manzano et al. 2014, Stadlinger et al. 2010).

Zirconia oral implants have lately flooded the market. Different brands with various compositions, surface characteristics, designs and prosthetic connections are currently available for practitioners to purchase and directly utilize for patient treatment. Yet the questions remain: Are zirconia implants as great as advertised? Is there sufficient scientific and unbiased evidence to validate their use in routine clinical practice?