Implantes de titânio e zircônia na reabilitação oral: um panorama geral das evidências científicas – revisão de literatura

Miqueias Santos Bispo
Mestrando em Implantodontia SLM
ORCID: 0009-0004-2609-7231

Matheus Menezes da Silva
Mestrando em Implantodontia SLM
ORCID: 0000-0002-2389-3601

Rafael Fidêncio de Lima
Mestrando em Implantodontia SLM
ORCID: 0009-0006-7757-731X

Natallia Cristina Roberto Tiago
Mestranda em Implantodontia SLM
ORCID: 0009-0002-0359-7001

Erika Larissa Andrade Martinez Venâncio
Mestranda em Implantodontia SLM
ORCID: 0009-0005-8037-0187

José Carlos Felix
Mestrando em Implantodontia SLM
ORCID: 0009-0001-7790-1400

Lucia Beatriz Belluomini
Mestranda em Implantodontia SLM
DOI: 0009-0008-3013-9325

Lilian Hasimoto
Mestranda em Implantodontia SLM
ORCID: 0009-0004-3399-9268

Julia Lima Sidaoui
Mestranda em Implantodontia SLM
ORCID: 0009-0000-6743-7141

Paulo Victor Guedes de Carvalho Peleteiro
Mestrando em Implantodontia SLM
ORCID 0000-0002-2634-5221

Julia de Almeida Smanio
Mestre e Doutora em Implantodontia – USP
ORCID: 0009-0009-3352-4066

Rafael Ortega Lopes
Mestre e Doutor em Implantodontia – UNICAMP
ORCID: 0000-0003-0028-611X

DOI: https://doi.org/10.71440/2675-5610.10.4.25.490-495.art

RESUMO

Objetivos: Verificar quais sao as principais evidencias cientificas disponiveis sobre as características e desfechos dos implantes dentarios de titanio e zirconia. Material e Métodos: Uma busca eletronica, utilizando bases de dados como PubMed, SciELO e LILACS, realizada entre 2015 e 2025, com trabalhos em língua portuguesa e inglesa, priorizando ensaios clínicos, revisões e metanálises, foi realizada. Os descritores utilizados na busca booleana incluíram termos como: “implantes dentários”, “titanio”, “zirconia”, “osseointegracao”. Escalas de qualidade foram aplicadas para cada desenho de estudo na determinação dos possíveis vieses. Resultados: Dos 112 estudos selecionados, apenas 28 (4 revisoes sistemáticas com metanálise, 5 revisoes sistematicas sem metanálise, 11 revisoes narrativas, 1 estudo clinico controlado, 4 estudos laboratoriais, 1 estudo laboratorial ex vivo e 2 estudos de coorte) foram incluídos. A qualidade geral foi considerada boa. Implantes de titanio com formato cônico e macrogeometria de rosca robusta favorecem a estabilidade primaria, além dos tratamentos de superficie aditivos/ subtrativos que melhoram a osseointegracao. Entretanto, a hipersensibilidade imunológica ao titanio ainda e controversa pela evidencia escassa e pelos testes disponiveis com potencial diagnostico não totalmente conclusivo. Os implantes de zircônia adquirem grande potencial de osseointegração quando recebem algum tipo de tratamento superficial, como o ataque ácido ou o laser, favorecendo a proliferação de células osteogênicas. Embora o fenômeno de degradação hidrotérmica seja preocupante, ele não afeta a rugosidade superficial da zirconia, o que traria um bom desempenho mecânico ao longo do tempo. Conclusão: A escolha entre implantes de titânio e zircônia deve considerar fatores como estética, resistência e a resposta do tecido ósseo. As modificações na superfície dos implantes de titanio e zirconia demonstram ser um fator determinante para o sucesso clinico. A pesquisa sugere que ambos os tipos de implantes têm seu lugar na pratica clínica.

Palavras-chave: Implantes dentarios; titanio; zirconia; osseointegracao.

Titanium and zirconia dental implants: an overview of the scientific evidence – literature review

ABSTRACT

Objectives: To verify the main scientific evidence on the characteristics and outcomes of titanium and zirconia dental implants. Material and Methods: An electronic search of PubMed, SciELO, and LILACS identified studies published from 2015 to 2025 in Portuguese and English, prioritizing clinical trials, reviews, and meta-analyses. The Boolean search used the descriptors “dental implants,” “titanium,” “zirconia,” and “osseointegration.” Risk-of-bias and methodological quality assessment tools were applied. Results: Of 112 records screened, 28 studies were included (4 systematic reviews with meta-analysis, 5 systematic reviews without meta-analysis, 11 narrative reviews, 1 controlled clinical trial, 4 laboratory studies, 1 ex vivo laboratory study, and 2 cohort studies). Overall methodological quality was considered good. Tapered titanium implants with robust thread microgeometry favored primary stability, and additive/subtractive surface treatments improved osseointegration. However, immunologic hypersensitivity to titanium remains controversial due to limited evidence and the non-definitive diagnostic performance of available tests. Zirconia implants exhibit strong osseointegration potential when subjected to surface treatments (e.g., acid etching or laser), which promote osteogenic cell proliferation. Although hydrothermal degradation is a concern, it does not appear to affect zirconia surface roughness, suggesting favorable mechanical performance over time. Conclusions: The choice between titanium and zirconia implants should consider esthetics, mechanical strength, and host bone response. For both materials, surface modification is a key determinant of clinical success. Current evidence indicates that both implant types have defined indications in clinical practice.

Keywords: dental implants; titanium; zirconia; osseointegration

Referências

Beaumont J, McManus G, Darcey J. Differentiating success from survival in modern implantology – key considerations for case selection, predicting complications and obtaining consent. Br Dent J. 2016 Jan 15;220(1):31-8. https://doi.org/10.1038/sj.bdj.2016.26

Kligman S, Ren Z, Chung CH, Perillo MA, Chang YC, Koo H, Zheng Z, Li C. The impact of dental implant surface modifications on osseointegration and biofilm formation. J Clin Med. 2021 Apr 12;10(8):1641. https://doi.org/10.3390/jcm10081641

Bosshardt DD, Chappuis V, Buser D. Osseointegration of titanium, titanium alloy and zirconia dental implants: current knowledge and open questions. Periodontol 2000. 2017 Feb;73(1):22-40. https://doi.org/10.1111/prd.12179

Wen G, Zhang Y, Xie S, Dong W. The influence of two distinct surface modification techniques on the clinical efficacy of titanium implants: a systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2024 Sep;125(5S1):101855. https://doi.org/10.1016/j.jormas.2024.101855

Cionca N, Hashim D, Mombelli A. Zirconia dental implants: where are we now, and where are we heading? Periodontol 2000. 2017 Feb;73(1):241-258. https://doi.org/10.1111/prd.12180

Sridhar S, Wilson TG Jr, Palmer KL, Valderrama P, Mathew MT, Prasad S, Jacobs M, Gindri IM, Rodrigues DC. In vitro investigation of the effect of oral bacteria in the surface oxidation of dental implants. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e562-75. https://doi.org/10.1111/cid.12285

Hashim D, Cionca N, Courvoisier DS, Mombelli A. A systematic review of the clinical survival of zirconia implants. Clin Oral Investig. 2016 Sep;20(7):1403-17. https://doi.org/10.1007/s00784-016-1853-9

Heimes D, Becker P, Pabst A, Smeets R, Kraus A, Hartmann A, Sagheb K, Kämmerer PW. How does dental implant macrogeometry affect primary implant stability? A narrative review. Int J Implant Dent. 2023 Jul 5;9(1):20. https://doi.org/10.1186/s40729-023-00485-z

Romanos G, Damouras M, Veis AA, Hess P, Schwarz F, Brandt S. Comparison of histomorphometry and microradiography of different implant designs to assess primary implant stability. Clin Implant Dent Relat Res. 2020 Jun;22(3):373-379. https://doi.org/10.1111/cid.12915

McCullough JJ, Klokkevold PR. The effect of implant macro-thread design on implant stability in the early post-operative period: a randomized, controlled pilot study. Clin Oral Implants Res. 2017 Oct;28(10):1218-1226. https://doi.org/10.1111/clr.12945

Ibrahim A, Heitzer M, Bock A, Peters F, Möhlhenrich SC, Hölzle F, Modabber A, Kniha K. Relationship between implant geometry and primary stability in different bony defects and variant bone densities: an in vitro study. Materials (Basel). 2020 Sep 30;13(19):4349. https://doi.org/10.3390/ma13194349

Jemat A, Ghazali MJ, Razali M, Otsuka Y. Surface modifications and their effects on titanium dental implants. Biomed Res Int. 2015;2015:791725. https://doi.org/10.1155/2015/791725

Sun XD, Liu TT, Wang QQ, Zhang J, Cao MS. Surface modification and functionalities for titanium dental implants. ACS Biomater Sci Eng. 2023 Aug 14;9(8):4442-4461. https://doi.org/10.1021/acsbiomaterials.3c00183

Kim MJ, Yun PY, Chang NH, Kim YK. The long-term evaluation of the prognosis of implants with acid-etched surfaces sandblasted with alumina: a retrospective clinical study. Maxillofac Plast Reconstr Surg. 2020 Apr 8;42(1):10. https://doi.org/10.1186/s40902-020-00255-6

Kim HK, Lee EY, Kim JJ. Five-year retrospective radiographic follow-up study of dental implants with sandblasting with large grit, and acid etching-treated surfaces. J Korean Assoc Oral Maxillofac Surg. 2015 Dec;41(6):317-21. https://doi.org/10.5125/jkaoms.2015.41.6.317

Watanabe M, Liu L, Ichikawa T. Are allergy-induced implant failures actually hypersensitivity reactions to titanium? A literature review. Dent J (Basel). 2023 Nov 9;11(11):263. https://doi.org/10.3390/dj11110263

Comino-Garayoa R, Cortés-Bretón Brinkmann J, Peláez J, López-Suárez C, Martínez-González JM, Suárez MJ. Allergies to titanium dental implants: what do we really know about them? A scoping review. Biology (Basel). 2020 Nov 18;9(11):404. https://doi.org/10.3390/biology9110404

Mombelli A, Hashim D, Cionca N. What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review. Clin Oral Implants Res. 2018 Oct;29 Suppl 18:37-53. https://doi.org/10.1111/clr.13305

Müller-Heupt LK, Schiegnitz E, Kaya S, Jacobi-Gresser E, Kämmerer PW, Al-Nawas B. Diagnostic tests for titanium hypersensitivity in implant dentistry: a systematic review of the literature. Int J Implant Dent. 2022 Jul 11;8(1):29. https://doi.org/10.1186/s40729-022-00428-0

Swalsky A, Noumbissi SS, Wiedemann TG. The systemic and local interactions related to titanium implant corrosion and hypersensitivity reactions: a narrative review of the literature. Int J Implant Dent. 2024 Nov 22;10(1):58. https://doi.org/10.1186/s40729-024-00578-3

Hanawa T. Zirconia versus titanium in dentistry: a review. Dent Mater J. 2020 Jan 31;39(1):24-36. https://doi.org/10.4012/dmj.2019-172

Glauser R, Schupbach P. Early bone formation around immediately placed two-piece tissue-level zirconia implants with a modified surface: an experimental study in the miniature pig mandible. Int J Implant Dent. 2022 Sep 14;8(1):37. https://doi.org/10.1186/s40729-022-00437-z

Ciszyński M, Chwaliszewski B, Simka W, Dominiak M, Gedrange T, Hadzik J. Zirconia dental implant designs and surface modifications: a narrative review. Materials (Basel). 2024 Aug 25;17(17):4202. https://doi.org/10.3390/ma17174202

Hafezeqoran A, Koodaryan R. Effect of zirconia dental implant surfaces on bone integration: a systematic review and meta-analysis. Biomed Res Int. 2017;2017:9246721. https://doi.org/10.1155/2017/9246721

Cunha W, Carvalho O, Henriques B, Silva FS, Özcan M, Souza JCM. Surface modification of zirconia dental implants by laser texturing. Lasers Med Sci. 2022 Feb;37(1):77-93. https://doi.org/10.1007/s10103-021-03475-y

Pereira GKR, Venturini AB, Silvestri T, Dapieve KS, Montagner AF, Soares FZM, Valandro LF. Low-temperature degradation of Y-TZP ceramics: A systematic review and meta-analysis. J Mech Behav Biomed Mater. 2015 Mar;55:151-163. https://doi.org/10.1016/j.jmbbm.2015.10.017

Yang H, Xu YL, Hong G, Yu H. Effects of low-temperature degradation on the surface roughness of yttria-stabilized tetragonal zirconia polycrystal ceramics: a systematic review and meta-analysis. J Prosthet Dent. 2021 Feb;125(2):222-230. https://doi.org/10.1016/j.prosdent.2020.01.005

Gil J, Delgado-García-Menocal JA, Velasco-Ortega E, Bosch B, Delgado L, Pérez-Antoñanzas R, Fernández-Fairén M. Comparison of zirconia degradation in dental implants and femoral balls: an X-ray diffraction and nanoindentation study. Int J Implant Dent. 2021 Oct 18;7(1):103. https://doi.org/10.1186/s40729-021-00383-2