Long‐Term Clinical and Radiographic Outcomes of Ceramic Dental Implants: An 11‐Year Retrospective Cohort Study

OBJECTIVE: Evidence on zirconia dental implants remains limited. This retrospective study evaluated clinical and radiographic outcomes of contemporary ceramic implant systems placed in private practice with variable follow-up of up to 11 years. MATERIALS AND METHODS: This retrospective cohort evaluation included 174 patients receiving 275 zirconia implants (one-piece systems and a two-piece tissue-level screw-retained system) placed between 2013 and 2025 with a minimum one-year follow-up. Implant survival and success rates were assessed. Standardized periapical radiographs were analyzed using ImageJ to measure marginal bone levels at placement and annually thereafter. Peri-implant soft tissue health was evaluated using the modified Plaque Index and modified Gingival Index. RESULTS: Kaplan-Meier cumulative implant survival was 97.6%, and overall success was 95.3%. Mean first-year marginal bone loss ranged from 0.25 to 0.74 mm, with a pooled mean of 0.49 mm. Mean annual bone loss after year 1 was low at 0.12 mm/year. Soft tissue indices remained low, and no suppuration was observed. Two implant fractures occurred (0.73%); remaining failures were associated with lack of osseointegration or aseptic loosening. CONCLUSIONS: Within the limitations of this retrospective study, contemporary ceramic implant systems demonstrated high survival and success with stable peri-implant bone levels and favorable soft tissue conditions. CLINICAL SIGNIFICANCE: This study provides real-world clinical and radiographic data on contemporary ceramic implant systems, including one-piece ceramic implants and ATZ two-piece ceramic implants with carbon fiber screws. These findings may help clinicians contextualize the observed performance of ceramic implants in daily practice. Ceramic implants may represent a viable metal-free treatment option for appropriately selected patients, particularly in esthetically demanding situations, when careful case selection, system-specific training, and adherence to surgical and restorative protocols are applied.