Constant and healthy vertical dimensions of the peri-implant soft tissues are very important with regard to pink esthetics and peri-implant papilla formation. Around teeth and implants, these vertical soft tissue dimensions are represented by sulcus depth, junctional epithelium and connective tissue contact, which as a unit make up the biologic width. Experimental studies reported similar qualitative and quantitative soft tissue integration and biologic width dimensions for monotype and 2-piece tissue level zirconia implants compared to 2-piece tissue level titanium implants. However, faster maturation processes of epithelial and connective tissues around zirconia implants were assumed. For both implant materials, biologic width dimensions and peri-implant papilla height were independent from loading and surgical protocol but dependent on implant design and position of the micro-gap between implant and prosthetic supra structure. Over time, clinical studies reported a significant increase in periimplant papilla height formation for zirconia implants, whereas the distance between the alveolar crest at the neighboring tooth and the lowest point of the contact area of the crown were considered to be an important factor affecting papilla formation. In conclusion, material characteristics - ceramics compared to titanium - did not have any major/ significant effects on peri-implant soft tissue integration. Thus, similar physiological processes might be supposed for both materials with regard to morphogenesis of peri-implant soft tissues.
Keywords: Zirconia implants, titanium implants, soft tissue integration, biologic width