ABSTRACT Objectives This study aimed to prospectively investigate the long‐term clinical performance of a commercially available one‐piece zirconia dental implant system over 10 years. Material and Methods A multicenter, open‐label study was conducted at three clinical centers in Germany. Forty‐four patients with single‐tooth gaps meeting specific inclusion criteria received 44 yttria‐stabilized zirconia (Y‐TZP) implants featuring a sandblasted and acid‐etched (ZLA) surface. Clinical and radiographic follow‐ups were performed at 1, 3, 5, and 10 years to assess implant survival, success, peri‐implant bone levels, and esthetic outcomes using Pink Esthetic Score (PES) and White Esthetic Score (WES). Results At the 10‐year follow‐up, 35 patients with 35 implants were available for evaluation. The estimated 10‐year survival rate was 97.7% (95% CI: 97.27–98.13). Three implants (8.6%) showed biological complications, including peri‐implant mucositis in 2 implants (5.7%) and peri‐implantitis in 1 implant (2.9%), leading to a success rate of 91.4% (95% CI: 76.9–97.8). Peri‐implant bone loss was moderate, averaging 1.20 (±0.61) mm over 10 years, with stable bone levels observed after the initial remodeling phase. Esthetic outcomes revealed a slight increase in PES (7.4 to 7.8) and a minor decrease in WES (7.0 to 6.7) between years 5 and 10. Conclusions Zirconia implants demonstrated high long‐term survival and success rates, moderate bone loss, and favorable esthetic outcomes. These findings support their use as a clinically reliable and esthetically acceptable long‐term alternative to titanium implants. However, the limited sample size highlights the need for further confirmation in larger cohorts.
Roehling et al. (2026) studied this question.