The oral microbiome is notably diverse, but a recent study published in Nature has further developed the understanding that this decreases at sites with zirconia and titanium implants.
Having a variety of bacteria in the oral cavity is a good thing – not all microorganisms are harmful to health, though minimising the destructive types is important.
The study used a randomised controlled clinical trial, where 20 patients with an edentulous lower jaw were provided with a pair of zirconia and a pair of titanium implants each, attaching to a removable denture. Fluid samples were then taken a year later from the areas surrounding the implants and the natural teeth.
Within the microbiome, 138 genera and 399 species were identified, but the top 10 most prevalent genera differed at the different implant sites.
The zirconia and titanium implants also featured less diverse microbiota, creating a biofilm that was also considered to be more pathogenic.
There is a clinically significant group of anaerobic oral bacteria known as the ‘red complex’ – according to a 2019 study in the Journal of Family Medicine and Primary Care, they have a strong relationship with pocket depth and bleeding on probing, showing they may be linked heavily with periodontal disease. Interestingly, the study in Nature observed a distinctly lower presence of these around the zirconia implants. This could be due to the zirconia structures disincentivising adhesion and the maturation of these pathogens.
This is not to say that titanium implants should be disregarded entirely. They are still renowned for their osseointegration properties, but clinicians should be aware of the differences on a minute level when recommending solutions.
It must also be noted that studies currently find increased survival rates for titanium implants (92.6%–100%) compared to their zirconia counterparts (87.5%–91.25%), according to a 2026 article in Cureus. Zirconia may still be preferred in an aesthetically demanding case.
Clinicians have many vital decisions to make when planning implant cases. Design, placement approach, the time between placement and loading and more are all factors that will change the outcomes for an individual. Studies continue to show that material has a notable impact on the microbiome – adding just another differential to contend with in each and every case.
>Since you’re here, why not read about the change in attitudes towards Hollywood smiles?
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