Background: The long-term performance of dental implants is a critical factor in determining the success of restorative dental procedures. Zirconia and titanium are two commonly used materials for dental implants, each offering distinct advantages in terms of biocompatibility and aesthetic appeal. However, comparative studies on their long-term clinical outcomes remain limited. Objective: The objective of this study was to compare the long-term clinical performance of zirconia and titanium dental implants over a 12-month period, with a focus on implant survival rates, marginal bone loss (MBL), peri-implant soft tissue health, and complication incidence. Methods: This prospective comparative study included 100 patients who received either zirconia or titanium dental implants. Radiographic assessments were performed to evaluate marginal bone loss at baseline and at 12 months post-loading. Clinical evaluations included probing depth (PD), bleeding on probing (BOP), and keratinized tissue width (KTW). The incidence of complications such as implant fractures, peri-implantitis, and prosthetic failure was also recorded. Results: Both zirconia and titanium implants demonstrated high survival rates at the 12-month follow-up, with titanium implants showing a slightly higher survival rate (98%) compared to zirconia implants (94%). Marginal bone loss was minimal in both groups, with zirconia implants showing 0.50 ± 0.15 mm and titanium implants showing 0.47 ± 0.13 mm. Peri-implant soft tissue health was comparable, with probing depth values of 2.8 ± 0.5 mm for zirconia and 2.7 ± 0.4 mm for titanium implants. The incidence of complications was low, with zirconia implants experiencing a slightly higher rate of peri-implantitis (4%) compared to titanium implants (2%), while prosthetic failure was more frequent in titanium implants (2%). Conclusion: Both zirconia and titanium dental implants demonstrated favorable long-term clinical performance over a 12-month period. Titanium impl