Three‐Year Follow‐Up of Clinical, Radiographic, and Patient‐Reported Outcomes for Zirconia and Titanium Implants in the Posterior Region: A Randomized Controlled Trial

OBJECTIVE: To compare the 3-year clinical, radiographic, esthetic, and patient-reported outcomes of zirconia (Zr) and titanium (Ti) implants placed in posterior sites in a randomized, controlled within-subject design. MATERIALS AND METHODS: Forty-two patients each received one Zr and one Ti implant. Clinical and radiographic outcomes were evaluated at baseline, 1, and 3 years after crown delivery. Marginal bone levels (MBL), peri-implant soft-tissue parameters, technical complications, esthetic outcomes (ΔE values, VAS scores), and patient-reported measures were assessed. Thirty-nine patients (37 Zr; 39 Ti implants) were available at 3 years. RESULTS: The 3-year survival rate was 100% for Ti and 94.9% for Zr implants. MBL remained stable after the initial remodeling phase, with no clinically relevant differences between materials. Peri-implant soft-tissue conditions (BOP, plaque presence, PD, KT) were similar for Zr and Ti. Two zirconia implants were lost during the observation period. Peri-implantitis was diagnosed in 7.9% of the implants, affecting three titanium and three zirconia implants. Technical complications differed between groups: chipping occurred significantly more often at Zr implant-supported crowns. Ti implants showed two screw-loosening events, while Zr implants showed two cases of decementation. Esthetic and patient-reported outcomes were comparable, with low perceived mucosal color differences and a slight preference for Zr sites, if detectable. CONCLUSION: Zr and Ti implants showed similar peri-implant health, marginal bone stability, esthetic outcomes, and patient satisfaction after 3 years. Zr implants, however, demonstrated a slightly lower survival rate and more chipping. TRIAL REGISTRATION: The trial is registered in the German Clinical Trials Register (DRKS) under the ID DRKS00008591.