ObjectivesLong-term studies of modern zirconia implants are still insufficient. This prospective 8-year follow-up study investigated one-piece zirconia implants.Materials and methodsPatients who had received a one-piece zirconia dental implant (PURE ceramic implant, Institut Straumann GmbH, Basel, Switzerland) were included in this study. Next to the implant survival and success rates, the radiographic and clinical implant parameters were assessed.ResultsThe overall survival rate of 67 zirconia implants in 39 patients was 100%. The overall success rate was 89.6%. Around the immediate zirconia implants, the success rate was 94.7%, and around the delayed implants, 87.5%. The immediate implants showed a significantly higher bone crest compared to the delayed implants (p= 0.0120). According to the pink esthetic score, the immediate implants revealed more favorable esthetic results compared to the delayed implants after an 8-year follow-up (p= 0.0002).ConclusionsAfter 8 years, the one-piece zirconia implants presented an 89.6% success rate. Regarding the timing of implantation, in individual cases, immediate implantation can have slight advantages over delayed implantation.Clinical relevanceImmediate implants can also be considered for zirconia implants and should not be excluded on principle.