21D Patient Community
If you've been researching full mouth implants, you've almost certainly come across zirconia - often described as the premium, stronger, longer-lasting option. At 21D, we offer a metal-acrylic combination of PMMA and titanium. Which is better - it’s one of the most common questions we're asked. Our clinical and research team reviewed every published study comparing the two materials, built a twenty-year cost model, and put the results forward for independent academic scrutiny.
This article explains what we found - including the parts that are still uncertain.
Why We Looked Into This
Material choice in full jaw rehabilitation is argued about a great deal and evidenced surprisingly little.
Patients are often told one material is simply better than the other. Clinics have strong preferences. But when we went looking for the research behind those claims, we found that nobody had ever pulled it together and assessed it properly.
That's a problem, because this isn't a small decision. It affects the cost of your treatment, what happens if something needs repairing years down the line, and how your rehabilitation performs over decades.
You deserve to make that choice based on evidence rather than marketing - including ours.
What We Did
In March 2026, we searched five major research databases for every study ever published that compared the two materials directly in full jaw treatment. We applied no date limit, so nothing was excluded for being old.
We found eight studies, covering 396 patients and 551 prostheses between them.
A few things about how we did it are worth knowing, because they're what separate a genuine review from a selective one:
- We registered our method publicly before we collected any data, so we couldn't quietly change the question if we didn't like the answer.
- Two reviewers extracted the data independently of one another.
- We then built an economic model projecting the costs and health outcomes of each material over twenty years.
The full analysis - every study, every assumption, every figure - has been published openly for anyone to check.
What We Found
Four findings came out of the work.
Both Materials Perform Well
Implant and prosthesis survival was high across every study, in both groups. This is genuinely reassuring news whichever material you end up with.
No Clear Difference in Outcomes
On the outcomes that actually matter to you - whether the implant survives, whether the prosthesis survives, whether it fractures - there was no statistically significant difference between the two materials in any study we found.
Zirconia Costs More Over Time With No Additional Benefit
Our model projected total costs at a difference of roughly £5,875 between zirconia and titanium-PMMA. These are research estimates from the economic model, not price quotations. Health economists measure benefit in quality-adjusted life years. Zirconia gained 0.019 of one. In plain terms, that's about one extra week of good health - spread across two decades.
What the Research Can't Tell Us
This is the part most clinics would leave out. We think it matters more than anything above.
All eight studies looked backwards at patients who had already been treated. None was a randomised trial - the gold standard for comparing two treatments fairly. We graded the overall certainty of this evidence as very low, and we said so plainly in the paper.
So the honest position is this: there is no evidence that zirconia performs better, yet it almost always costs more.
Why We Took This to EAO
Our study was accepted for presentation at the European Association for Osseointegration (EAO) Congress 2026. The EAO is one of the most respected implant dentistry bodies in the world. Its annual congress is where implant research is presented.
This means that independent reviewers judged the work methodologically sound enough to put in front of the profession.
The paper is freely available. You're very welcome to read it, or to take it to another clinician and ask what they make of it. We'd genuinely encourage it.
What This Means For You
If you're weighing up providers and materials, these are worth asking of anyone - including us:
- Which material are you recommending for me, and what is it about my case that decides it?
- If the prosthesis chips or fractures in year six, what actually happens - is it repaired or replaced, and what does that cost me?
- What is and isn't included in the price over the next ten years?
- What evidence are you basing that recommendation on?
A provider who can answer those clearly is giving you what you need to decide. One who can't may be selling you a material rather than a treatment plan.
Why This Matters
Full mouth rehabilitation is a significant decision, and you should be able to make it with clear information rather than competing sales claims.
We use titanium and PMMA because the evidence supports it as a safe, predictable and cost-effective choice - and because we went and checked rather than assuming. If stronger evidence emerges that changes the picture, we'll update this page and say so.
Your material and prosthetic design are discussed in detail during your Free Clinical Assessment, where we assess your bone, bite, medical history and anatomy before making any recommendation.
And if you'd like to read the research yourself, or have questions about any of it, our team is always on hand.
Source: Coote E, Patel N, Vijayanarayanan R. Zirconia-based versus metal-framework veneered complete-arch implant-supported fixed dental prostheses: a systematic review with integrated cost-effectiveness analysis. medRxiv 2026. Study plan registered at OSF. Presented at the EAO congress, 2026. This paper is published in full and openly available; it has not yet completed peer review.
.png)
.png)
