Objectives: The aim of this prospective case series was to evaluate single-piece zirconia implants restored with lithium disilicate CAD/CAM crowns through a long-term follow-up. Methods: In this trial, 20 one-piece zirconia implants were placed in 20 patients. Implants were restored (i) immediately with lithium disilicate CAD/CAM provisionals, and (ii) permanently four months after surgery. Patients were followed for 11 years. Clinical parameters and radiological measurements of the zirconia implants were assessed. For the statistical analysis, paired t-test was applied. Results: Four implants were counted as implant failure due to the loss of implant stability, resulting in a Kaplan–Meier survival rate of 80% up to 11 years. The mean bleeding on probing values were 19.1% (SD ± 13.1) and 18.2% (SD ± 17.6) 96 and 11 years after implant placement, respectively. The plaque index revealed a significant decrease over time (p < 0.001) with a value between 25.9% (SD ± 5.7) and 12.6% (SD ± 10.0) at baseline and 11-years follow-up respectively. The marginal bone level revealed a significant decrease 4, 8, and 11 years after implant insertion (p = 0.001, p = 0.019, and p = 0.027, respectively). Conclusions: Immediately loaded zirconia single-piece implants showed a suitable success rate in clinical and radiographic outcomes.

Background/Objectives: The long-term success of dental implants can be influenced by the material properties of abutments and their interaction with peri-implant tissues. This study investigates the impact of three abutment materials—titanium (Ti), zirconium oxide (Zr), and polymethylmethacrylate (PMMA)—on the inflammatory response in peri-implant sulcular fluid (PISF), using active-matrix metalloproteinase-8 (aMMP-8) as a biomarker. Methods: In this prospective, randomized clinical trial, 30 patients were assigned to Ti, Zr, or PMMA abutment groups. PISF samples were collected at predefined intervals over 12 months and analyzed for aMMP-8 levels using enzyme-linked immunosorbent assays (ELISA). Clinical parameters (probing depth, bleeding on probing, and plaque index) and radiographic assessments of bone resorption were also evaluated. Results: Two weeks after implant uncovering, baseline aMMP-8 levels varied significantly among materials, with Zr demonstrating the highest levels. Over time (2, 3, 6 and 12 months after implant uncovering), aMMP-8 levels decreased across all groups, with no significant differences observed at 12 months. Radiographic assessments indicated no statistically significant differences in bone resorption, with clinical parameters remaining comparable across all groups. Conclusions: Initial inflammatory responses to abutment materials may vary; however, all tested materials—Ti, Zr, and PMMA—showed long-term biocompatibility and supported healthy peri-implant tissue integration. These findings indicate that selecting any of the tested abutment materials does not significantly affect long-term peri-implant health.