## 1 Introduction  
Ossoeintegration is defined as a connection between the living bone and the implant surface in a stable and functional way. This involves anchoring the implant by forming bone tissue around the implant without fibrous tissue growth at the bone-implant interface [1]. This direct contact between the implant surface and the bone is decisive for the success of the implant, since it decreases the risk of failure, improves stability, and promotes implant longevity. In order to enhance osseointegration, it is possible to change the roughness of the implant surface [2]. Over the years, studies have been carried out to find the most suitable material for the composition of the implants and the consequent success or failure of their osseointegration [3; 4; 5]. The most scientifically studied implants are titanium implants, and more recently, investigations and comparisons with zirconia material have emerged [3; 4; 5]. According to [PERSON] (2020) [6], titanium has shown excellent biocompatibility, corrosion-resistance, and high fracture toughness based on high strength and elongation. Compared to titanium, zirconia reported a significantly reduced bacterial biofilm formation and increased microcirculation in the peri-implant soft tissues [3]. Regarding peri-implant soft tissues, both materials have similar integration properties. However, titanium appears to have a faster initial osseointegration process when compared to zirconia. Survival rates of more than 96% for titanium implants with microrough surfaces have been reported after being followed for 10 years [3]. On the other hand, [PERSON] et al. (2018) [7] reported higher success rates (95.8%) for titanium and zirconia implants (90.9%) in the mandible compared to the maxilla, at 71.9% and 55%, respectively. Nevertheless, the use of bisphosphonate (BP) may impair the osseointegration. It is a class of drugs that are frequently selected when there is an alteration in the bone metabolism, which are utilized to prevent bone loss [8]. It can be administered orally (e.g., daily, weekly, or monthly) for treatment of osteoporosis and Paget's disease, or intravenously (every 3 months or annually) to treat malignant skeletal oncological diseases [9]. BPs can also be classified according to generations, with the first generation being non-nitrogenous and including drugs such as Clodronate, Etidronate, and Tiludronate. The second and third generation, on the other hand, contain nitrogen. Regarding the second generation, it includes drugs such as Alendronate, Neridronate, and Pamidronate and the third generation includes drugs such as Risedronate, Mindronate, Zoledronate, and Ibandronate [9]. Despite the fact that they increase the quality of life of the patients, there is an elevated risk that BPs can cause osteonecrosis of the jaw. This is characterized by an exposure of necrotic bone in the mandibular region that normally persists for 8 or more weeks [10]. Patients who have been treated with BPs intravenously have shown a greater chance of developing medication-related osteonecrosis of the jaw (MRONJ) or implant loss compared to oral-intaking therapy [11]. In a study developed by [PERSON] et al. [10], patients taking BPs who were treated intravenously lost 6 implants out of 68, which yielded an 8.82% for failure rate; patients treated with intraoral therapy had a failure of 5 implants in 423 (1.18%), which was more than 7-fold less. They considered the dental implant a failure if the implant had mobility, active inflammation for more than 8 weeks without healing with antibiotic therapy, drainage of purulent secretion near the implant, the presence of necrotic bone or unheated soft tissue, or implant loss [10]. A study by [PERSON] et al. [12] showed that Zoledronate (the third generation of BPs) and Alendronate (the second-generation BPs) improved titanium implant osseointegration in ovariectomized rats.