What is the principal advantage of a ZIRCONIA implant compared with a titanium implant?

Correct answer: B. Improved aesthetics, particularly with a thin gingival biotype

• A. Zirconia implants are generally MORE expensive than titanium, not less.
• B. CORRECT. The established advantage of zirconia is AESTHETIC. Zirconia is tooth-coloured and white, so it does not produce the grey shine-through that a titanium implant or abutment can cause in a patient with a THIN gingival biotype or a high smile line, particularly where recession exposes the implant shoulder. Zirconia also shows low plaque affinity and favourable soft tissue response, and it appeals to the small subset of patients concerned about metal sensitivity.
• C. Osseointegration of zirconia is COMPARABLE to titanium in many studies, but titanium remains the benchmark with decades of documented long-term survival data. Zirconia does not osseointegrate better.
• D. Fracture resistance is a recognised WEAKNESS of zirconia, not a strength. Zirconia is a ceramic — strong in compression but brittle, with lower fracture toughness than titanium — which is why one-piece designs predominate, why narrow-diameter zirconia implants are a concern, and why low-temperature degradation (ageing) of the material is studied.

Note: Practical summary: titanium remains the standard of care with the strongest long-term evidence base and the versatility of two-piece designs. Zirconia is a reasonable alternative in the aesthetic zone for a thin-biotype patient, or where a patient specifically declines metal — accepting less long-term data and a more restricted prosthetic workflow.