Comparison of Clinical Performance of Zirconia Implants and Titanium Implants in Animal Models: A Systematic Review

Purpose: This study aimed to compare the values of removal torque (RT) and bone-implant contact (BIC) reported in different animal studies for zirconia and titanium implants. Materials and Methods: A systematic review of the literature was performed to analyze BIC and RT of animal studies in which both zirconia and titanium dental implants were used. To identify the studies to include in this systematic review, an exhaustive search of PubMed was performed of animal studies published in English with reports on the quantification of the osseointegration of both titanium and zirconia implants by means of BIC and/or RT. The results were aggregated and analyzed within each of the animal models (pig, rabbit, rat, monkey, dog, and sheep). Results: The selection process resulted in a final sample of 16 studies. In general, no significant differences were found between titanium and zirconia. The significant differences in terms of BIC and RT reported by the authors were attributable to the different surface treatments and microporosities of the implant surfaces studied, not to the materials themselves. Only two articles reported significantly lower BIC for modified zirconia implants as compared to modified titanium implants. Four authors described statistically significant differences in terms of RT between zirconia and titanium implants in the different animal models, regardless of the surface treatment received by the implants. Conclusions: Within the limitations of this study, the values for the BIC and RT of zirconia implants in most of the studies analyzed did not show statistical differences compared with titanium implants. Modified-surface zirconia may have potential as a candidate for a successful implant material, although further clinical studies are necessary.