Mechanical Factors Implicated in Zirconia Implant Fracture Placed within the Anterior Region—A Systematic Review

Background: To analyze the fracture resistance of zirconia implants within the anterior region and evaluate whether zirconia–zirconia implants can be a viable alternative to titanium implants. Methods: Four online databases (Cochrane Library, Ovid, PubMed, and Scopus) were searched for the period of January 2011 to July 2021. All studies that analyzed the in vivo clinical outcome of two-piece implants in the anterior region in English language were included. Results: The search strategy identified 242 studies. Of these studies, three studies were included for qualitative synthesis based on the pre-determined eligibility criteria. The results showed that there is significant difference in biological results, fractal behavior and other complications between one-piece and two-piece zirconia implants. Two-piece zirconia implants demonstrated favorable longevity and success rates within anterior maxillary in short-term trials. Conclusions: Although factors involved in fractures have been identified—sandblasting, implant diameter, occlusal load, age and implant coating—there is limited quantitative assessment to gauge the fracture resistance of two-piece zirconia implants. Hence, further research with long-term clinical evidence is required.