Background: Two-piece zirconia implants offer a metal-free alternative to titanium implants, but only limited long-term data are available. The aim of this retrospective study was to evaluate the clinical outcomes of two different, identically designed two-piece zirconia implants (NobelPearl™ and Zeramex XT) in a private dental practice.

Material and methods: Between 2017 and 2024, 167 implants were placed in 106 patients and followed up to 88 months (Ø 39.1 months). In addition to the implant survival rate, marginal bone loss (MBL), clinical parameters and surface properties were examined using 3D profilometry. The statistical analysis included descriptive evaluations and a survival analysis using the life table method.

Results: Three implants were lost (two fractures, one failed osseointegration), corresponding to an effective survival rate of 98.2%. The mean marginal bone loss varied between -0.14 mm and -0.58 mm. The surface roughness was minimal (Sa ~0.5 µm). No risk factor showed a significant association with implant loss in the univariate analysis.

Conclusion: Two-piece, screw-retained zirconia implants showed a high survival rate and stable peri-implant tissue conditions over a period of up to seven years. They represent a promising metal-free alternative to titanium implants. Further prospective long-term studies are needed to validate these results and to better understand potential risk factors.