Influence of surface modifications on the fracture resistance of aged zirconia implants: A systematic review of in vitro experimental studies

Objectives: This systematic review aimed to evaluate the literature and answer the question: Do surface-treated zirconia implants exhibit higher fracture resistance when subjected to aging than untreated ones?Material and methods: This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA) guidelines and was registered in the Open Science Framework (osf.io/ukhdz). A personalized search strategy was applied in the Embase, PubMed, Scopus, Science Direct, and Web of Science databases. The article's selection was independently conducted in two steps by the reviewers. The risk of bias analysis was performed by adapting the Joanna Briggs Institute's quasi-experimental studies tool.Results: A total of 648 articles were found in the initial search. After excluding the duplicates, 601 were evaluated according to the title and abstract. Of these, 29 papers were selected for full-text reading, and 15 met the eligibility criteria.Concerning the risk of bias, 12 had a low risk of bias, and 3 had a moderate risk of bias. Conclusion: The articles included in this review were heterogeneous regarding the influence of surface treatment on the fracture resistance of zirconia implants. The literature reviewed allowed inferring that there is a need for care in the zirconia implant development to have fracture resistance according to the parameters defined in ABNT, ASTM, or ISO standards, ensuring the survival of the rehabilitation.

Automated summary

This systematic review evaluated the impact of surface treatment on the fracture resistance of zirconia implants and found that the literature in this area is heterogeneous. The reviewed articles suggest that the development of zirconia implants should adhere to specific standards to ensure their fracture resistance.