Evolution of zirconia materials and current applications for dental restorations: a narrative review

Abstract

Objective: This narrative review synthesizes the current literature on modern zirconia materials used for tooth-supported and implant-supported restorations. It provides an up-to-date review of the evolution of zirconia materials, modern manufacturing technologies, and clinical applications and provides guidance for clinicians' decision-making.

Methods: A non-systematic literature review was conducted using PubMed/MEDLINE and Scopus on 30 June 2025. The following keywords were used: “zirconia” AND “dental” AND “restoration” OR “prosthesis”. Filters applied: from 30 June 2015 to 30 June 2025 (last 10 years). This study focused on reviews, clinical studies and in vitro studies concerning the evolution of zirconia materials and their current clinical applications for tooth-supported and implant-supported restorations, with particular reference to advances in manufacturing technologies and monolithic solutions.

Results and Discussion: Over the last ten years, the increase in demand for metal-free restorations and advances in CAD-CAM technologies have made zirconia an increasingly popular solution for tooth and implant-supported restorations. The first generations of zirconia materials were widely used in producing prosthetic restorations in the form of zirconia-ceramic systems. Still, they had aesthetic limitations and technical complications that affected their use. Recent developments in zirconia materials have focused on effectively balancing aesthetic and mechanical properties. Monolithic shade-gradient and strength-gradient multilayered zirconia materials represent the latest development, introduced to imitate the characteristics of natural teeth and potentially expand clinical applications in aesthetic areas. These materials, together with modern manufacturing and sintering technologies, which are increasingly efficient and offer potential advantages in terms of time and cost, are promising but, to date, lack clinical data.

Conclusions:  Monolithic zirconia is a promising alternative to traditional tooth and implant-supported restoration systems. Furthermore, advances in manufacturing processes and simplified design make it an advantageous option in terms of time and cost. However, monolithic zirconia restorations lack medium- and long-term clinical data. For this reason, in-depth knowledge of the latest generation of zirconia materials is recommended regarding their chemical and physical properties and the technical manufacturing processes involved. This allows for the correct selection of materials, safe restoration design, a favorable prognosis, and aesthetic results in line with patient expectations.