# Virtual Zirconia Implants Replace Titanium Implants?
###### Abstract  
This review aims to discuss the advantages and disadvantages of zirconia implants compared with titanium implants. Moreover, it intends to review the relevant available long-term literature of these two materials regarding osteointegration, soft-tissue, microbiota, and peri-implantitis, focusing on clinical results. Briefly, titanium implants are a reliable alternative for missing teeth; however, they are not incapable of failure. In an attempt to provide an alternative implant material, implants made from ceramic-derivate products were developed. Owing to its optimal osseointegration competence, biocompatibility, and esthetic proprieties, zirconium dioxide (ZrO2), also known as zirconia, has gained popularity among researchers and clinicians, being a metal-free alternative for titanium implants with its main use in the anterior eshetic zones. This type of implant may present similar osseointegration as those noted on titanium implants with a greater soft-tissue response. Furthermore, this material does not show corrosion as its titanium analog, and it is less susceptible to bacterial adhesion. Lastly, even presenting a similar inflammatory response to titanium, zirconia implants offer less biofilm formation, suggesting less susceptibility to peri-implantitis. However, it is a relatively new material that has been commercially available for a decade; consequently, the literature still lacks studies with long follow-up periods.  
d 2021 21 July 2021 23 July 2021 23 July 2021 23 July 2021 23 July 2021 23 July 2021 23 July 2021 23 July 2021 23 July 2021 23 July 2021 23 chloride ion, resulting in the metal surface breakdown. Even in a passive environment, the basal implant corrosion rate is 0.02 mm/year to 0.13 mm/year [5]. Moreover, another drawback of titanium implants is their dark color. This can be an issue in a patient with a thin gingival phenotype, mainly in the esthetic area [6; 7; 8]. The grey shadow of titanium may be visible through the peri-implant mucosa, thus impairing the esthetic outcome [9].  
In order to overcome the drawbacks of titanium implants, zirconia implants were implemented. These implants have been used in Europe since the early 2000s and, subsequent to FDA approval in 2011, it has been more often used in the USA [10]. Furthermore, implants are a popular solution for dedentulous areas, and with the plethora of information available, patients search for different implant alternatives and come to dental offices requesting other options to the conventional titanium. In this matter, clinicians are raising questions such as whether the zirconia implants are reliable? Are they a better option compared with titanium implants? This narrative review aims to clarify these questions and review the long-term results of zirconia implants compared with titanium implants. Furthermore, this article offers a concise review of the literature regarding osteointegration, soft-tissue, microbiota, and peri-implantitis of the two materials, mainly focusing on clinical outcomes. Lastly, this review's ultimate objective is to provide qualified information to support the decision-making process of clinicians regarding implant material.