A non-inflammatory periimplantar soft tissue in ceramic implants is u. a. due to the following factors:

• The circular bleeding of the surrounding soft tissue corresponds with ceramics [high-performance ceramics – as used in Zeramex P6 and XT] rather that of the natural tooth and is significantly reduced in titanium (Kajiwara et al. 2015).
• Better circulatory blood circulation is known to mean healthier gingiva, which not only results aesthetically better results (Tartsch 2018).
• According to the 3- and 5-year results already available in 2018, zircon dioxide shows the same «marginal bone loss» as titanium implants (Cionca N, Mombelli A et al. 2016, Spies et al. 2018, Janner et al. 2018). In the study of “Ligature-Induced Peri-implant Bone Loss Around Loaded Zirconia and Titanium Implants” by Roehling et al. (2018) this is even less than titanium implants. This trend is confirmed by preclinical studies as well as the clinical experience (Tartsch 2018). Periimplantitis in ceramic implants could not be detected during this period (Cionca N, Mombelli A et al. 2016, Spies et al. 2018, Janner et al. 2018, Roehling et al. 2018).
• Compared to titanium, the material zircon dioxide shows less plaque placement and less bacterial adhesion (Scarano et al. 2004, Ichikawa et al. 1992). In addition, a smaller thickness of the stored biofilm was detected in zircon dioxide (Roehling et al. 2016).

The authors point out the need for long term studies. Find the sources cited in image 3 below(literature).