Purpose: No consensus regarding the efficacy of zirconia implants in maintaining peri-implant hard and soft tissue health has yet been obtained. The aim of this retrospective follow-up study was to gain knowledge about peri-implant bone behavior and about implant survival and success after treatment with zirconia dental implants in patients with normal and compromised soft and hard tissue conditions. Materials and Methods: This follow-up study involved 86 patients with 123 zirconia implants (Straumann PURE Ceramic Implant) that were radiographically investigated directly after implant placement (day 0), 3 months after placement, and 1 year after the definitive implant crown placement. The clinical assessment was done at the 1-year postloading appointment and also included the modified Plaque Index, modified Sulcus Bleeding Index, and sulcus pocket depths. Eighteen patients with periodontally compromised conditions were compared to 68 patients with healthy periodontal conditions. Results: The survival rate was 100% and success rate was 94.5%, with no differences between the two groups. The alveolar crest around the ceramic implants showed no significant difference between day 0 and 1 year postloading for both groups (P > .05). There was also no significant difference at 1 year postloading between the groups in the distance from the implant shoulder to the peri-implant bone crest (P = .67) or in pocket depth (P = .07). Conclusion: No significant peri-implant bone loss was observed in the first year. The survival and success rates showed no differences between the periodontally healthy and periodontally compromised groups; however, only a limited number of patients with periodontally compromised conditions were included in this study. Keywords: alveolar crest, esthetics, gingiva, zirconia implants