Zirconium (Zirconia) in Dentistry

How the types differ

Zirconia is stabilised with a small amount of yttrium oxide (yttria). Types are now classified by how much yttria they contain², and you may see them written as 3Y, 4Y or 5Y. The traditional 3Y type is opaque. The 4Y and 5Y types contain more yttria and let more light through; they are often called "translucent" zirconia.

The extra yttria has a drawback. Most translucent types no longer benefit from the mechanism that helps stop small cracks from spreading, so their strength is reduced². In a 2026 review of laboratory studies, the 4Y types were significantly stronger than the 5Y types. Even the more translucent types still let less light through than glass ceramics³ such as lithium disilicate. Some newer blocks are built in layers of different colour or composition (multilayer zirconia).

Monolithic and layered zirconia

• Monolithic (single-piece) zirconia is made entirely of zirconia, with no separate layer of porcelain on top. Its surface is polished or glazed.
• Layered (veneered) zirconia has porcelain built up on a zirconia framework. The porcelain allows colour and surface detail to be tailored to the person; small fractures of the porcelain layer (chipping) are more common.

How zirconia fits among the other dental ceramics, from feldspathic porcelain to glass ceramics, is set out on porcelain and dental ceramics.

• Crowns, most often on back teeth, where chewing forces are high. What a zirconia crown involves for the tooth, and how the treatment is carried out, is covered on zirconia crowns.
• Bridges that replace one or more missing teeth. Whether zirconia suits a bridge depends on the type, the length of the gap and the design; see "Assessment and material selection" below.
• Frameworks under porcelain. The opaque 3Y type is used as a framework for layered crowns and bridges, and for implant parts and abutments².
• Crowns on implants, and the connecting parts (abutments) between an implant and its crown.
• Veneers. Possible, but a 2025 review found no long-term data for zirconia veneers: the studies available followed them for an average of 2.6 years⁴. The same review notes that resin bonding to zirconia can be challenging⁴. Options with better-documented long-term results should be considered.

Zirconia implants and abutments

An abutment is the part that connects an implant to its crown, and it can be made of zirconia. In one small trial with 44 patients, most of the zirconia-based implant restorations lost for technical reasons were lost because the zirconia abutment broke⁵. One trial cannot show how often this happens in general.

Some implants are made entirely of zirconia (ceramic implants). A German clinical guideline regards titanium as the international standard⁶ for implants, and titanium has a much longer record. An international expert consensus states that ceramic implants can be an alternative to titanium in selected cases⁷. A position paper for the European Association for Osseointegration looked at one-piece zirconia implants. It found evidence of an outcome comparable to titanium implants when they replace one to three missing teeth⁸ with fixed crowns or a small bridge.

In a one-piece ceramic implant, the part in the bone and the part that carries the crown are a single piece. There is little room to correct its angle or position afterwards, which calls for precise planning and an experienced team⁸. Most of the research is on one-piece implants; the evidence for two-piece implants is limited⁷. The German guideline says a two-piece ceramic implant should be used only after the patient has been told in detail⁶ that long-term data are missing. A ceramic implant can itself break. A 2023 review reported a trial of implants holding removable full dentures. In that trial, three zirconia implants broke within the first year, and no titanium implant did⁹. Ask whether the implant proposed for you is one-piece or two-piece. How the two materials compare is covered on titanium.

The material is chosen for each tooth after an examination, with X-rays where needed. The main questions are:

• Where the tooth is, and how much of it shows when you smile.
• How much of the tooth remains, and how much room there is for the restoration. Thin sections of the more translucent types, which are weaker, need particular care where biting forces are high³.
• Your bite, and whether you clench or grind your teeth.
• Whether it is a single crown, a bridge or a crown on an implant, and how many teeth a bridge would span.
• The colour of the tooth underneath, and what you expect of the result.

An international standard for dental ceramics, ISO 6872, groups ceramics into classes by their minimum strength¹⁰. The standard links each class to the restorations that a ceramic in that class may be used for. Whether a ceramic suits your tooth also depends on the product's instructions for use and on the state of your tooth. For bridges, the authors of a 2026 review of laboratory studies drew a conclusion by type. In their view, 4Y types can be used for three-unit bridges, and 5Y types only for three-unit bridges at the front of the mouth². For bridges of four units or more, they strongly recommended the 3Y type, preferably with porcelain on the outer side for appearance. These are conclusions from laboratory tests. The same review found that manufacturers' strength figures did not always match independent laboratory results. It adds that the manufacturer's instructions for each product still apply.

A crown needs tissue removed from every surface of the tooth, and that cannot be undone. When a tooth needs a crown at all, and when a smaller restoration is enough, is covered on dental crowns.

Ask which zirconia type and product is proposed for each tooth. Ask too why it suits that tooth better than lithium disilicate or metal-ceramic.

The figures below come from published studies, not from our own records.

Benefits

• No metal. Zirconia has no metal alloy or metal framework, so no metal edge shows. The colour of the tooth underneath or a receding gum can still make the edge look darker. On an implant, a zirconia crown or abutment is still fixed to an implant that is usually titanium.
• Strength. Its strength allows use on back teeth and in bridges. Whether it suits a bridge depends on the type, the length of the gap and the design.
• Less chipping when monolithic. A 2026 review of single crowns found that fractures and chipping were significantly less common on single-piece crowns¹¹ than on layered ones.

How long single crowns last

The same review estimated how many of every 100 single crowns on natural teeth would still be in place after five years. For monolithic zirconia, layered zirconia and metal-ceramic alike, it was about 97¹¹. For monolithic lithium disilicate it was 98 to 99. A strong material does not mean the crown will stay in the mouth longer. Being still in place does not mean that a restoration never had a problem or needed a repair.

Limitations

• Appearance. Zirconia lets less light through than glass ceramics. On a front tooth, a layered crown or lithium disilicate may match the neighbouring teeth more closely.
• The translucent types are weaker, and less studied. A 2026 review notes that no long-term clinical studies are available² on translucent zirconia.
• Chipping and fracture. On layered zirconia, small fractures can occur in the porcelain layer on top¹¹. Monolithic zirconia has no separate layer, so no layer can come away; but edge fractures or larger fractures can still occur in the zirconia itself.
• Wear of the opposing tooth. Ceramic crowns can wear down the natural tooth they bite against. A 2020 review looked at studies of monolithic zirconia lasting 6 to 24 months. In them, the deepest wear measured on the opposing tooth averaged about 0.1 mm¹². That review could not reliably say how this compares with the wear natural teeth cause on each other. Surface roughness, polishing and the bite all affect wear. A later review, from 2024, pooled seven small clinical studies of crowns on back teeth, followed for up to two years. In it, single-piece zirconia crowns caused significantly more wear on the opposing teeth than natural teeth did¹³. The authors call for larger trials.
• Bridges. Survival figures for single crowns cannot be applied directly to bridges or implant crowns¹¹. A 2026 review of bridges on natural teeth found decay at the edges and loosening more common with all-ceramic bridges¹⁴ than with metal-ceramic ones. Bridge designs and their trade-offs are covered on dental bridges.
• It cannot be undone. Like every full crown on a natural tooth, a zirconia crown needs tissue removed from all surfaces of the tooth. For a conventional bridge, the teeth on either side of the gap are reduced in the same way, even when they are sound.
• Effect on the tooth's nerve. The pooled results of 37 studies cover teeth that were alive at the start. These teeth then received a crown or a partial restoration, or supported a bridge. In about 5 in every 100 of these teeth, the nerve lost its vitality¹⁵. The studies followed the teeth for different lengths of time. In studies with more than ten years of follow-up, the figure was about 7 in every 100¹⁵. These figures are for all of these restorations together, not for zirconia crowns alone. The certainty of this evidence is low. If the nerve dies, root canal treatment is needed to keep the tooth.

For single crowns on natural teeth, five-year survival is close across zirconia, lithium disilicate and metal-ceramic (see "Benefits and limitations" above). The studies cited on this page do not show that zirconia lasts longer. The choice depends on where the tooth is, how much of it remains, your bite and what you expect of its appearance.

• Lithium disilicate glass ceramic lets more light through and is used for veneers, single crowns and partial restorations. Its properties are explained on lithium disilicate glass ceramic. e.max is the trade name most patients meet; what that name covers is explained on e.max.
• Feldspathic porcelain is used for thin veneers, and as the porcelain layer on layered zirconia and metal-ceramic crowns.
• Metal-ceramic (porcelain fused to metal) has been used for decades for long bridges and under heavy loads. A metal edge may show if the gum recedes.

Your dentist will explain the pros and cons of each option for your tooth.

Zirconia restorations are usually designed on a computer and milled by machine (CAD/CAM). A 2026 review of laboratory studies describes the process. The restoration is milled from a pre-sintered block or disc, about a fifth larger than its final size². It is then heated in a furnace over several hours (sintering), and shrinks to its final size and strength. The review also states that the success of a zirconia restoration depends on a surface free of flaws and defects².

The steps below are for a crown on a natural tooth, which usually needs two or three appointments. Bridges and work on several teeth can take longer. Your dentist will tell you which zirconia product will be used, and where your restoration will be designed, milled and finished. You can ask for this in writing.

A zirconia crown does not protect the tooth beneath it from decay. New decay can develop at its edge or underneath it, and the gum around it needs daily care.

• Brush twice a day with a fluoride toothpaste.
• Clean every day where the crown meets the gum, and under bridges; use interdental brushes or bridge floss.
• If you clench or grind your teeth, wear the night guard your dentist recommends.
• Avoid biting hard objects, such as ice¹⁶.
• Keep up regular check-ups, usually with your own dentist near your home. For crowns on implants, the European Federation of Periodontology guideline calls for a structured supportive care programme¹⁷ once the implants are in use.

Whitening, adjustments and repairs

• Whitening will not work on crowns¹⁸. So if you whiten your natural teeth later, the crown can look darker than them. If you are thinking of whitening, tell your dentist before the shade is chosen.
• If a zirconia crown needs adjusting later, tell the dentist it is zirconia. In laboratory studies, a smooth polish increased the strength of zirconia, while coarse grinding reduced it³.
• Small chips in a porcelain layer can sometimes be smoothed or repaired. More extensive damage may mean the restoration has to be replaced.

When to see a dentist

• The crown feels loose or comes off (keep it, and do not glue it back yourself)
• The crown cracks or porcelain chips off
• Sensitivity that does not settle, or keeps getting worse
• Pain when you bite, or the crown feels high when you bite
• Swelling, bleeding or discharge from the gum around the crown

If pain keeps increasing, or you have facial swelling or a high temperature, see a dentist without waiting for the clinic's reply. Ask your own dentist for an urgent appointment, or see a dentist where you are. A dental abscess does not go away on its own and needs urgent treatment by a dentist¹⁹.

Emergencies. With a suspected dental abscess, the following need urgent medical help¹⁹. Do not wait for a dental appointment or for the clinic's reply. Go to the nearest emergency department or call the emergency number where you are.

• It is hard to breathe, speak, swallow or open your mouth
• A swollen or painful eye, or sudden problems with your eyesight
• A lot of swelling inside your mouth

Ask for these details in writing before treatment.

• Which material each restoration will be made of: monolithic or layered zirconia, and which type.
• The product name and its manufacturer.
• Where the restoration will be designed, milled and finished.
• How many appointments are planned, and whether you will have temporary restorations in between.
• What happens if the work is not finished and checked before you fly home.
• What the clinic's written terms say if a restoration chips, breaks, comes loose or fails, including after you are home.
• Whom you contact then, and who would pay for the repair and any travel.
• The aftercare plan: when your reviews are, and who carries them out.

Take home for your own dentist. Ask for a written record of each restoration: the tooth, the material and type, the product and manufacturer, the shade and the laboratory. For a crown on an implant, add the implant system, what each part is made of, and the part and lot (batch) numbers. When an implant crown is complete, a consensus report recommends that an X-ray and probing measurements be taken as a baseline²⁰. Probing measures the depth of the gap between the gum and the implant. Ask for copies of both. Keep your written aftercare plan with the record. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get copies of the records of the materials used, the tests and the imaging, without charge²¹. In private dental facilities in Turkey, a consent form is required for every intervention²². Two copies of the form are signed, and one is given to you²³. Ask for your copy.

Aftercare. Problems that appear later are usually first seen by your own dentist near your home. Before you go, ask your dentist whether they will see you afterwards. If you do not have a dentist where you live, it helps to find one before you travel. In an emergency, do not wait for the clinic's reply. Go to the nearest emergency department or call the emergency number where you are. What a health service or an insurer covers after treatment abroad differs from country to country. Ask the health service or your insurer where you live what they would cover.

Your choice. A second opinion from a dentist near your home gives you a point of comparison, and having treatment there remains an option. You can say no, or ask to stop, at any stage. Once a tooth has been prepared, that step cannot be undone.

More questions to ask before treatment abroad are listed on our page about zirconia crowns.