The Truth About Ceramic Implants | 医療法人社団EPSDC

This study answers a common question with real data from 11 years and 275 implants: “Are ceramic (zirconia) implants really long-lasting and safe?”

Bottom line (in one sentence)

If you choose the right case and follow the correct protocol, ceramic implants can be as durable and reliable as titanium.

Six surprising takeaways (easy summary)

97.6% survival over 11 years (95.3% success)

Only 6 out of 275 implants failed.
Most failures were not due to the material itself but to factors like difficult surgical sites, not following instructions (e.g., wearing retainers), or improper force control.

“Brittle” worries are much smaller than you think (fracture rate 0.73%)

Only 2 implants fractured. Causes: too much insertion torque at placement, or using a too-narrow implant for a heavy-bite molar.
In short, with proper handling and size selection, fractures are very rare.

After year 1, the bone is very stable (only about 0.12 mm loss per year)

Year 1 shows normal “remodeling” with an average 0.49 mm bone change.
After year 2, bone levels barely change and remain stable when osseointegration is good.

Very friendly to the gums (zero suppuration reported)

Pus-related complications were 0%.
Gum inflammation scores stayed very low, and plaque scores even improved.
Zirconia surfaces attract fewer bacteria, helping maintain a healthy seal around the implant.

Two-piece systems are advancing (more flexibility with screw-retained restorations)

The two-piece, tissue-level system “Zeramex XT” (with carbon fiber–reinforced polymer screws) showed a 98.8% Kaplan–Meier survival (up to 7 years, average 4.2).
Slightly more early bone change in year 1 can occur, but prosthetic flexibility and strength improve.
Strictly follow the recommended screw torque—this is crucial.

Insertion depth “rules” differ from titanium

For ceramics, placing the platform slightly above the bone crest (0.6–1.6 mm supracrestal) gives the best bone stability.
At bone level (or deeper), year-1 bone loss can reach up to 1.6 mm.
Don’t copy titanium habits; follow ceramic-specific protocols for success.

Who is it for?

People who prefer metal-free options and care about gum color/appearance.
For clinics: proper case selection, surgical/prosthetic workflows, and torque control training are essential.

Visual analogy

Think of the implant as a “support post,” bone as the “ground,” and gums as the “grass.”
Place the post at the right position and depth, and don’t apply excessive force. Then both the ground (bone) and grass (gums) stay healthy for a long time.

Final note

Ceramic implants are no longer just an “alternative for metal allergy.” With proper indications and protocols, they can be a first-line option.

Reference

Monzavi et al. 2026 Long- Term Clinical and Radiographic Outcomes of Ceramic Dental Implants: An 11- Year Retrospective Cohort Study. Journal of Esthetic and Restorative Dentistry, 2026; 38:2074–2088

Well, the problem of this study is not the comparative study. We cannot draw any conclusion if the zirconia implant is better than the titanium implant. At lease there are cases suitable for the zirconia implant. Hiroshi

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