On the basis of available peer-reviewed data, osseointegration of zirconia dental implants may be comparable with that of titanium implants. They were also found to have low, well distributed and similar stress distribution when compared with titanium implants. Furthermore, zirconia particles used for surface modifications of titanium implants may have the potential to improve initial bone healing and resistance to removal of torque. The surface roughness of zirconia was found to be comparable with that of titanium implants. Although fabrication of surface modifications for zirconia is difficult, CO2 lasers revealed distinct surface alterations to zirconia, and additional studies about this technique may help to improve surface roughness. Coated or surface-modified zirconia implants showed higher removal torque values than machined zirconia implants. To fulfill biomechanical requirements, restoring zirconia implants with high strength ceramics or metal ceramics would be beneficial
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