Acta Scientific Dental Sciences (ISSN: 2581-4893)

Volume 2 Issue 8 August 2018

Review Article

Implant Abutment Selection Criteria

Mumcu E1* and Erdinç G2

1
Associate Professor and HOD, Department of Prosthodontics, Eskişehir Osmangazi University, Turkey
2
Research Assistant, Department of Prosthodontics, Eskişehir Osmangazi University, Turkey

*Corresponding Author: Mumcu E, Assistant Professor and HOD, Department of Prosthodontics, Eskişehir Osmangazi University,
Eskişehir, Turkey

Received: June 01, 2018; Published: July 04, 2018

Abstract
Dental implants have been successfully used to treat tooth loss for many years. Titanium owing to its well-documented biome-
chanical properties, it is accepted as standard material for implant abutments. However, metal components often cause gray reflec-
tion from gingiva. For these reasons ceramic-based abutment materials have entered dental sector. There might be a relationship
between material selection and implant restoration success. Long-term follow-up of implant treatments is important. Prosthetic,
periodontal and esthetic examinations of the restorations should be performed in these follow-up appointments. We made a search
of articles of peer-reviewed Journals in PubMed/Medline, crossing the terms “Dental Abutment Material”, “Titanium”, “Dental Por-
celain” and “Zirconia”. The review was divided by subtopics: mechanical evaluation, biological evaluation and esthetic evaluation. A
number of studies have examined whether there is a relationship between these factors and dental materials. No significant differ-
ence was found between abutment material and success rates in available studies. Selection of abutment should be done by assessing
the requirements for each case. The studies in which ceramic abutment materials are evaluated in the present studies are lower time
and lower number than those of titanium. Long-term clinical follow-ups should be performed to obtain clearer information. The pur-
pose of this review were to update available literature and to evaluate the relationship between material selection and mechanical,
biological and esthetic factors.
Keywords: Implant; Abutment Material; Titanium; Zirconium Abutment; Bone Loss

Abbreviation To achieve higher esthetic results, ceramic abutments have

been developed and manufactured in 1994 by CerAdapt company
Y-TZP: Yttria Stabilized Zirconia
using intensely sintered pure aluminum oxide. All ceramic implant
Introduction abutments are two types: aluminum oxide and yttrium-reinforced
zirconium dioxide [10]. These materials are not only optical prop-
Dental implants have been successfully used to treat tooth
erties but also acceptable materials with appropriate mechanical
loss for many years [1,2]. Moreover, many researchers reported
properties, adequate clinical properties and longevity [9]. Nowa-
that ideal survival rates for reconstructions supported by titani-
days, yttrium-reinforced zirconium dioxide implant abutments are
um abutments [3,4]. Titanium (Ti) owing to its well-documented
frequently used to their superior properties than alumina [11,12].
biomechanical properties, it is accepted as standard material for
Zirconia was first used as abutment material in 1996 [10]. Ceram-
implant abutments [5,6]. However, metal components often cause
ics are naturally fragile and susceptible to tensile stresses, so use
gray reflection from gingiva. This situation is more important for
of ceramics as implant abutments is limited [13]. However, zirco-
region where the gingival biotype is thin [7]. In addition, color of
nia (ZrO2) ceramics show great biocompatibility and advanced
restoration can be affected by metal abutment when using ceramic
esthetics due to their high flexural strength (900-1200 MPa), frac-
crowns in the restoration of titanium abutments [8]. Along with the
ture toughness (6 MPa·m1/2) and compressive strength (2000
improvements in dentistry, the translucency mimicking the natural
MPa) [10,14,15]. Contrary to these favorable properties, decrease
appearance has been increased and materials without metal are
in toughness and strength could be observed after that aging and
needed. This has led to the development of aesthetically compat-
sensitivity to low-temperature [10].
ible and biocompatible ceramics [9].

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.
Implant Abutment Selection Criteria

32

There are many studies available that were compared survival The long-term success of the implant depends on many factors,
and failure rates of titanium and zirconia implant abutments. In a such as bone quality and quantity in the recipient region, treat-
5-year study by Zembic., et al. they found that zirconia and titanium ment planning, oral hygiene and characterization of implant com-
abutment is comparable and using of zirconia as an abutment is ponents [24]. According to available information, five year failure
clinically suitable [4]. Because of these reasons zirconia has a wide rates of metal and ceramic abutments are similar [25]. Failure rate
use area. of alumina abutments is slightly higher than prefabricated metal
abutments [26]. Propagation of cracks during alumina abutment
The choice of abutment material is very important for the suc-
preparation causes abutment fracture and failure [27].
cess of the prosthetic treatment and requires the evaluation of
many criteria. The purpose of this review were to update available Full ceramic abutments cannot be manufactured to the equal
literature and to evaluate the relationship between material selec- degree of precision as metal abutments. Inadequate implant abut-
tion and mechanical, biological and esthetic factors. ment connection can lead to screw loosening and clinical failures
such as infection and bone loss [28]. Implant-abutment interface
Search strategy: A Medline search was conducted, and the publica-
design is one of the factors among the reasons for failure. The
tions of the last twenty years have been taken into consideration.
internal implant-abutment connection distributes forces more
The key words used in the Pubmed search are: ‘dental implants’,
widely through the interface than external design [16].
‘dental abutments’, ‘titanium’, ‘gold’, ‘ceramic’, ‘alumina’ and ‘zirco-
nia’. This publication includes about sixty articles in only English. Ceramic abutment production requires a time-consuming and
precise procedure. Microcraks can be occur during abutment pro-
Mechanical evaluation
duction and customization, after that a decrease in fracture tough-
In implant restoration therapies, it is necessary to have features ness of the abutment can be observed [27].
such as adequate fracture toughness, suitability for intraoral con-
Yıldırım., et al. tested external hexagonal implant connections
ditions, and survival in order for the materials to be successfully
and Mitsias conical seal design tested implant connections. Both
identified. For proper material selection, the mechanical properties
have found that when zirconia abutment assemblies fail, they fail
of the material and suitability for the case should be carefully ex-
in the cervical portion of the abutment near the gold screw and
amined.
implant platform. This area is assumed to be the area of the high-
Fracture Strength est torque and stress concentrations due to the pulling effects.
The present data suggests a malfunction point near the abutment
Absolute minimum strength is not specified for abutments but
screw head bed [16].
that must show resistance to functional loading [16]. The studies
were reported about 206N loads and a maximum of 290N chewing Internal/external connections
forces in the aesthetic area [17,18]. To assess the success of a res-
There are two types of abutment and implant connection: ex-
toration, it is desirable that abutments be able to withstand higher
ternal connection and internal connection. The connection be-
forces than these forces and be used for at least five years [19].
tween abutment and implant is via a screw. The problems associ-
Thickness and angulations of abutment materials can affect the ated with abutment screw as loosening or fracture are the most
fracture resistances. Albosefi., et al. compared fracture resistance of common complications on implant rehabilitation. The lots of re-
the abutments that different thickness and individual zirconia. They searcher focused on this subject on their studies [25].
reported that while thickness of restoration wasn’t significantly dif-
The type of implant-abutment connection may affect to inci-
ferent, angular individual zirconia abutment was showed lower
dence of screw loosing. In vitro study, external hexagonal connec-
fracture resistance [20].
tion was exhibit significantly lower strength than internal conical
The mean fracture load of abutments supported by glass infil- connection. Similarly, Norton., et al. and Khraisat., et al. found that
trated ceramic crowns is 170N for aluminum abutment and 737N the complication of abutment screw was lower with an internal
for zirconia abutment [21,22]. Butz., et al. compared titanium, zir- connection [29,30].
conia and alumina abutments after chewing simulation and static
loading. Mean fracture values obtained as a result of the study; During occlusal loading in implant restorations, the region

for alumina 239N, for zirconia 294N and for titanium 324N [12]. around head of the abutment screw is the region with highest

Foong., et al. reported that mean load of titanium abutments is stati- torque stress. Similar occlusal forces create screw fractures in

cally higher than zirconia abutments [23]. metal and ceramic abutments, but occur screw deformation in
metal abutments [25].

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.
Implant Abutment Selection Criteria

33

Asvanund., et al. reported that external implant abutment con- suitable for colonization of microorganisms and these microgaps
nection is more stressed than internal implant abutment connec- are seen in implant and abutment connection areas. Bacterial ac-
tion when the prosthesis anteriorly and unilaterally loaded at the cumulation in these areas can cause inflammation in peri-implant
implant and abutment connection level. The studies indicated that tissue. Baldassari., et al. examined implant connections of titanium
internal abutment connection exhibited fatigue resistance that was and zirconia abutments and found that micro gap were 3 - 7 times
high to the external connection. The other study by Mollersten., et less in the titanium abutment-implant connection than zirconia
al. also showed more succeed the internal abutment connection. abutments [39]. Similarly, Abrahamsson., et al. found that there
The authors indicated that internal abutment connection was more was more bacterial contamination in ceramic abutments com-
resistant to bending moments [31]. pared to titanium abutments due to greater microgap formation
[33]. Unlike the other studies, there was no significant difference
Biological evaluation between the titanium, aluminum oxide and zirconium oxide abut-
Beside esthetic and mechanical properties of the abutment ma- ment groups regarding the microgap at the abutment and implant
terial, biological properties of the abutment material are also im- interface in study of Yüzügüllü., et al [40].
portant because it affects stability of peri-implant soft tissue and
Bone loss
bone. The type of abutment material effects attachment of between
Bone loss can also be influenced by abutment material, as well
mucosa and abutment surface. Depending on the nature of the ma-
as by reasons such as insufficient oral hygiene, incompatible im-
terial, plaque accumulation and bacterial adhesions that occur later
plant abutment attachment and periodontal infection associated
in the period result in periodontal infection and bone loss, threaten-
with them. Kohal., et al. found that there was no difference in the
ing the health of peri-implant tissues [32,33].
osseointegration of titanium and zirconium in their studies. Dif-
Biocompatibility of ceramics have indicated paralel soft tissue ferently, Sailer., et al. found that bone loss around metal abutments
integration of alumina, titanium and zirconia [33-35]. In a systemic was higher than that of ceramic abutments in a systematic review
review, the cumulative rate for biological complications was 5.2% study [25].
for ceramic abutments and was 7.7% for metal abutments (there
Andersson., et al. performed short and long-term clinical evalu-
was no statistically difference) [4,32]. Unlike this studies, a review
ations of implants and upper structures. In all cases of the study,
showed a higher incidence of soft tissue recession at ceramic abut-
the soft tissue around the implant was found to be healthy but
ments. The cumulative rate for recession after five years was 3.8%
peri-implant bone loss of titanium abutment was found to be high-
with metal abutments and 8.9% with ceramic [25].
er than the ceramic abutments. The mean bone loss was found 0.4
Periodontal health mm for titanium abutment and 0.2 mm for alumina abutment [26].

Due to technical or aesthetic reasons, the clinical condition of Bacterial adhesion

the implant treatment may require titanium alternative materials
The composition and surface properties of abutment materials
in the transmucosal portion of the implant. However, the choice of
can directly affect the adherence and permanence of oral biofilm
material should be based on the ability to support the integration of
and consequently affect the colonization and growth of microor-
the peri-implant mucosa into the connective tissue during recovery
ganism in the oral cavity [41]. Surface roughness and surface free
[36].
energy have been shown to be effective on colonization. Zirconia
Bleeding on probing of zirconia abutments is slightly more [37]. has been shown to be an alternative to titanium because of its es-
Sailer., et al. was found same results for bleeding on their 1 year thetic properties and potentially fewer bacterial adhesions [24].
of clinic study. Degidi., et al. evaluated peri-implant soft tissue and The gingival barrier is necessary to prevent periodontal damage
was compared titanium and zirconium dioxide healing cap. It was which is due to occur bacteria and toxins reaching the biological
found that zirconium dioxide produced less reaction in tissues than space. The biocompatible properties of zirconia are better than
other restorative materials such as titanium. Inflammatory infiltra- titanium. Bacterial adhesion of zirconia restorations is less than
tion and the microvascular density were reported higher around titanium [42-44].
titanium healing caps [38].
Scarano., et al. recorded a degree of bacterial coating of 12.1%
Microgap in the zirconia, compared to 19.3% in the titanium. They reported
The impermeability of the abutment and implant interface has that bacterial adhesion is less than titanium in ceramics like zirco-
been explored in detail and remains one of the most crucial chal- nia [44]. Similarly, Rimondini., et al. showed with an in vivo study
lenges that must be overcome in longtime therapy with two piece in which crystals of yttrium-TZP accumulated less bacteria than
implants. Throughout this interface, bacterial leaks have been re- titanium [42]. Zembic., et al. declared that plaque accumulation is
ported continuously in vitro and in vivo studies [24]. Microgaps are similar for zirconia and titanium [37].

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.
Implant Abutment Selection Criteria

34

Burgers., et al. evaluated biofilm formation on two different Restorating a dental implant can be challenge, especially when
titanium surfaces by in vitro and in vivo. Similar to the results of working in anterior region because esthetics appearance is im-
Nascimento., et al. authors define less bacterial adhesion on pure portant. Several methods have been tried to improve aesthetic
titanium compared to sanded titanium [24,45]. In another similar properties such as the use of gold-colored titanium nitride-coated
study, Grobner-Schreiber., et al. founded less rates of total bacterial abutments and use of ceramic abutments made of zirconia or alu-
colonization on zirconia compared to titanium surfaces. No signifi- mina [23]. The zirconia abutment is pure white. If shade of low
cant difference was observed in the diversity of the determined bac- was required this situation maybe it could be problem. It is neces-
terial species among all the surfaces analyzed [46]. sary to increase the porcelain thickness to obtain the desired color
[8]. Alumina abutment is higher esthetic advantage than zirconia
Microorganisms in the first order in the biofilm are effective in
abutment [22]. But zirconia is a more popular material than alu-
increasing the number of pathogens, peri-implantitis and loss of
mina with its superior fracture resistance and high biocompabil-
implants. For this reason, the development of a material that de-
ity.
creases initial adhesion of microorganisms may reduce prevalence
and progress of oral infections [24]. Bressan., et al. were compared Cad/Cam titanium abutment,
Cad/Cam zirconia abutment and cast gold alloy abutment in twen-
Survival rate
ty patients. Three types abutment is also restored with all ceramic
Survival rate of metal abutments very high due to their excel- crowns. Color change of peri-implant mucosa were evaluated by
lent properties. Metals are ductile material thus that can tolerate spectrophotometer. Color change in peri-implant mucosa is least
to small cracks or defects. In contrast, ceramics are fragile material shown in zirconia abutments. As a result of the work, color change
and they do not resistance to tensile force. As a result of the devel- of peri-implant mucosa was found to be lowest in zirconia abut-
opment of high strength ceramics such as zirconia and alumina, this ment and the highest in titanium abutment [53].
materials have been successfully used as abutment materials [25].
The researchers found that if the thickness of the mucosa was
Sailer., et al. reported that the survival rate of ceramic abutments more than 2 mm, color change of between titanium and zirconia
was 99,1% and survival rate of metal abutments was 97.4% in their abutments in peri-implant mucosa is may not be perceived sub-
systemic review. They found no significant different in the survival jectively stated [54].
rates of metal and ceramic abutments [25]. In another study, surviv-
al rate is 93 - 100% [47] for alumina abutments and 100% [48,49] Discussion
for zirconia abutments in single crowns applied in anterior and pre- In the past, implant abutments were made exclusively of metal.
molar regions. Unlike the first work, the survival rate of zirconia In order to answer the esthetic demands of dentists and patients,
abutments was significantly lower than that of titanium abutments prefabricated or individual abutments were manufactured. Tita-
[23]. nium abutment prevents corrosive and galvanic reactions at the
implant abutment interface. However, extreme oxidation of tita-
Esthetic evaluation
nium at ceramic melting temperatures and low adhesion. Oxides
Esthetics is one of the most important criteria in dentistry. Es- on the surface of this material can be an issue in titanium/porce-
pecially in frontal area restorations, it is necessary to pay careful lain systems. Metal abutments can only partially find a way out the
attention to material selection in order to obtain a natural appear- aesthetic, functional and hygienic problem [7].
ance. There are studies to produce more aesthetic and mechanically
stronger restorations at the same time in the dental sector. The disadvantage of the metal abutment is the dark gray color
that is reflected from gingival margin. Ceramic abutments has
Esthetic been developed to solve this problem of metal abutments. Because
One of the disadvantages of the titanium abutment is the dark of the mechanical properties of zirconia, it has been found suitable
gray color that is reflected from gingival margin [50]. Because of for use as an abutment. The first ceramic abutments were Cer-
this reflection, it is difficult to obtain an aesthetic result when the Adapt that made of alumina. Andersson., et al. evaluated short and
gingival thickness is less than 2 mm. The shoulder type of the res- long term clinical functions of CerAdapt abutments. Two years
toration can be selected subgingival to reduce gray reflection but it later, the cumulative survival rate was 97.2% for restorations on
is more difficult to clean the cement [8]. Zirconia was first used as implants (94.7% for ceramic abutments and 100% titanium abut-
abutment material in 1996 [51]. Zirconia abutments was developed ments). Marginal bone loss of ceramic abutment (0.2 mm) was less
for optimal mucogingival esthetics. Choice of abutment material is than titanium abutments (0.4 mm). It has been found by the au-
one of the important factors for success of restoration [25,52]. thors that the use of ceramic abutments is appropriate [26,55,56].

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.
Implant Abutment Selection Criteria

35

In a study comparing alumina abutments and zirconia abut- The composition and surface properties of abutment materials
ments, although both are acceptable in the literature, of the zirco- can directly affect the adherence and permanence of oral biofilm
nia abutment is found to be twice that of alumina. There are many and consequently affect the colonization and growth of micro-
case reports in the literature that show the clinical success of zir- organism in the oral cavity [41]. Surface free energy and surface
conium abutments. Zirconia allows for the production of posterior roughness have been shown to be effective on colonization [24]. In
fixed dentures thanks to its adequate mechanical properties. Some some studies, surface roughness has been reported to be the most
physical and mechanical properties of zirconia: zirconia can be important factor supporting microbial adhesion on titanium sur-
found in three different forms; monoclinic, tetragonal and cubic. It faces [61,62]. In other studies, surface free energy in the forma-
is in monoclinic form at room temperature, it transforms to tetrago- tion of the first fungal biofilm on the surface of zirconia has been
nal form when it reaches above 1170. Among these forms, phase shown to be more important [63,64].
transformations can affect the physical properties of the material.
Stabilizing agents such as MgO, CeO2 and Y2O3 are added to mini- Implant materials cannot fully prevent bacterial adhesion and
mize these phase transformations. The most commonly used and colonization. A number of studies have been conducted to reduce
most adequate properties are 2 - 3 moles of Y2O3 [43,55,57]. This implant-abutment interface contamination. In studies, it has been
addition produces a stronger and harder material than the other reported that if the penetration of bacteria through the interface is
ceramics. Factors such as water, moisture and polishing can weaken not controlled, the long term success of the implant can be jeopar-
the material by causing the material to transform from tetragonal dized. The mechanical properties of the materials affect the adhe-
to monoclinic form [9]. sion of the bacteria. For this reason, the development of materials
that reduce microorganism adhesion may improve periodontal
The fit between implants and implant-supported prostheses ef- health [24].
fect biologic response of the peri-implant in tissue and complica-
tions of prosthesis restoration. Adjustment between the internal Sampatanukul., et al. evaluated different abutment materials
hexagon of the implant and external hexagon the of the abutment and examined histological changes and inflammatory responses
should permit rotation of less than 5° to keep the screw union con- around anutment. As a result, they found that the tissues around
stant. Vertical and horizontal deflections apply extra load to bone the gold alloy abutments were worse than titanium and zirco-
and implant. Therefore, some complications as loosening of the nia abutments [65]. In a different study, Hahnel and colleagues
prosthesis retention, abutment fracture and crestal bone loss may showed that biofilm formation on the surface of PEEK is equal
occur [55,58]. to or lower than titanium and zirconia, within the limits of their
work [66].
In order to accept other abutment types as a viable alternative,
they must exhibit similar or superior mechanical and biological In a systemic review, the rate of biological complications was
properties to the universally used titanium. The strength rate of 7.7% for metal abutments and was 5.2% for ceramic abutments.
the abutments must be higher than the 90 - 370N (maximum bite Unlike this studies, a review showed a lower incidence of soft tis-
force for the anterior region region). Yıldırım., et al. compared the sue recession at metal abutments. This result is not clear. This may
fracture resistance of different abutments materials. Fracture resis- be due to the fact that ceramic abutments are usually used in an-
tance of zirconia abutments was found higher than alumina abut- terior region and that there is more recession in this region than
ments. Both materials showed a resist able to bear incisal forces posterior area [25].
documented in the literature. Yıldırım., et al. had similar results to
The gingival barrier is necessary to prevent periodontal dam-
the results of Att., et al. study [49,56,59].
age which is due to occur bacteria and toxins reaching the biologi-
There are many studies on the fracture strength of abutments. cal space. The biocompatible properties of zirconia are better than
El Sayed and colleagues examined the fracture strength and failure titanium. Bacterial adhesion of zirconia restorations is less than
mode of different ceramic implant abutments and reported that the titanium [42-44].
fracture strength of ZrO2 without metal matrix is the lowest. How-
ever, no statistically significant difference was found between the There are two types of abutment and implant connection: ex-
groups [60]. ternal connection and internal connection. The connection be-
tween the abutment and the implant is via a screw. The problems
In Butz., et al. study, was compared survival rate, fracture associated with abutment screw as loosening or fracture are the
strength and way of failure of the ceramic abutments. The authors most common complications on implant rehabilitation. Incidence
determined the strength of the zirconia abutments was comparable of screw fracture is not affected by the type of connection and
to those of titanium. Therefore, the authors proposed zirconia abut- material (metal-based or zirconia-based). However, it has been
ments as an alternative for restoration of implant rehabilitations in shown in available studies that the type of connection is effec-
the anterior area [12].

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.
Implant Abutment Selection Criteria

36

tive on screw loosening. The external connection type shows more 4. Jung RE., et al. “Systematic review of the survival rate and
screws loosening for both metal-based and zirconia. The screw the incidence of biological, technical, and aesthetic compli-
must be pre-loaded and tightened at the recommended torque to cations of single crowns on implants reported in longitudi-
nal studies with a mean follow-up of 5 years”. Clinical Oral
reduce complication incidence [67].
Implants Research 23.6 (2012): 2-21.
The type of implant and abutment connection affects to inci-
5. Adell R., et al. “A 15-year study of osseointegrated implants
dence of screw loosing. External hexagonal connection was exhibit in the treatment of the edentulous jaw”. International Jour-
significantly lower strength than internal conical connection. The nal of Oral Surgery 10.6 (1981): 387-416.
complication of abutment screw was lower with an internal con-
6. Aboushelib MN., et al. “Zirconia implant abutment fracture:
nection [25]. Szpak., et al. reviewed the effect of survival on implant
clinical case reports and precautions for use”. International
abutment connection type and reported 1.1% implant loss for coni-
Journal of Prosthodontics 22.6 (2009): 616-619.
cal implants and 0.7% implant loss for hexagonal implants [68].
Sailer., et al. investigated the effect of internal and external connec- 7. Prestipino V., et al. “All-ceramic implant abutments: Esthetic
tions of zirconia implant abutments on narrow diameter implants indications”. Journal of Esthetic Dentistry 8.1 (1996): 255-
262.
and showed that narrow diameter zirconia abutments with inner
connections exhibit higher fracture strength than outer connec- 8. Tan PL., et al. “An esthetic comparison of a metal ceramic
tions and zirconia abutments [69]. crown and cast metal abutment with an all-ceramic crown
and zirconia abutment: a clinical report”. Journal of Pros-
Sailer., et al. have shown that there is no statistical difference thetic Dentistry 91.3 (2004): 215-218.
between ceramics and metal abutments in their review. Successful
9. Raigrodski AJ., et al. “Survival and complications of zirconia-
survival rates for both alumina and zirconia have been demonstrat-
based fixed dental prostheses: A systematic review”. Journal
ed. In short, highly durable ceramic abutments can be successfully
of Prosthetic Dentistry 107.3 (2012): 170-177.
used and show similar survival rates as metal abutments [25].
10. Denry I., et al. “State of the art of zirconia for dental applica-
Conclusions tions”. Dental Materials 24.3 (2008): 299-307.

There is no significant difference in the 5-year failure rates and 11. Prestipino V., et al. “Esthetic high-strength implant abut-
technical/biological results of ceramic and metal abutments ac- ments. Part I”. Journal of Esthetic Dentistry 5.1 (1993): 29-
cording to the available studies. Both type abutments of survival 36.
rates are similar. However, number and period of studies evaluat-
12. Butz F., et al. “Survival rate, fracture strength and failure
ing ceramic abutments is less than metal abutments. In order to
mode of ceramic implant abutments after chewing simula-
achieve clearer results on ceramic and metal abutments, in vivo and tion”. Journal of Oral Rehabilitation 32.11 (2005): 838-843.
in vitro studies with longer follow-up time are needed.
13. Anusavice KJ. “Recent developments in restorative dental
Conflict of Interest ceramics”. Journal of the American Dental Association 124.2
(1993): 72-84.
We have no conflict of interest to declare.
14. Hisbergues M., et al. “Zirconia: Established facts and per-
Bibliography spectives for a biomaterial in dental implantology”. Journal
of Biomedical Materials Research Part B Applied Biomateri-
1. Zarb GA., et al. “The longitudinal clinical effectiveness of os- als 88.2 (2009): 519-529.
seointegrated dental implants: The Toronto study. Part I:
Surgical results”. Journal of Prosthetic Dentistry 63.4 (1990): 15. Conrad HJ., et al. “Current ceramic materials and systems
451-457. with clinical recommendations: a systematic review”. The
Journal of Prosthetic Dentistry 98.5 (2007): 389-404.
2. Jemt T., et al. “Oral implant treatment in posterior partially
edentulous jaws: a 5-year follow-up report”. International 16. Adatia ND., et al. “Fracture resistance of yttria-stabilized
Journal of Oral and Maxillofacial Implants 8.6 (1993): 635- zirconia dental implant abutments”. Journal of Prosthodon-
640. tics 18.1 (2009): 17-22.

3. Andersson B., et al. “Single‐tooth restorations supported by 17. Kiliaridis S., et al. “The relationship between maximal bite
osseointegrated implants: results and experiences from a force, bite force endurance, and facial morphology during
prospective study after 2 to 3 years”. International Journal of growth. A cross-sectional study”. Acta Odontologica Scandi-
Oral and Maxillofacial Implants 10.6 (1995):. navica 51.5 (1993): 323-331.

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.
Implant Abutment Selection Criteria

37

18. Haraldson., et al. “Functional state, bite force and postural 32. Pjetursson BE., et al. “Comparison of survival and complica-
muscle activity in patients with osseointegrated oral implant tion rates of tooth-supported fixed dental prostheses (FDPs)
bridges”. Acta Odontologica Scandinavia 37.4 (1979): 195- and implant-supported FDPs and single crowns (SCs)”. Clini-
206. cal Oral Implants Research 18.3 (2007): 97-113.

19. Eltorky I., et al. “Effect of Abutment’s Material, Length, Sur- 33. Abrahamsson I., et al. “The mucosal attachment at different
face Treatment and Cement Type on Retention of Implant abutments”. Journal Clinal Periodontology 25.9 (1998): 721-
Restoration”. Egyptian Dental Journal 60.2 (2013). 727.

20. Albosefi A., et al. “An In Vitro Comparison of Fracture Load 34. Hashimoto M., et al. “Single-crystal sapphire endosseous
of Zirconia Custom Abutments with Internal Connection dental implant loaded with functional stress-clinical and
and Different Angulations and Thickness: Part I”. Journal of histological evaluation of peri-implant tissues”. Journal of
Prosthodontics 23.4 (2014): 296-301. Oral Rehabilitation 15.1 (1988): 65-76.

21. Cho Hye-Won., et al. “A study on the fracture strength of 35. Kohal RJ., et al. “Loaded custom-made zirconia and titanium
implant-supported restorations using milled ceramic abut- implants show similar osseointegration: an animal experi-
ments and all-ceramic crowns”. International Journal of ment”. Journal of Periodontology 75.9 (2004): 1262-1268.
Prosthodontics 15.1 (2002): 9-13.
36. Welander M., et al. “The mucosal barrier at implant abut-
22. Yildirim Murat., et al. “In vivo fracture resistance of implant- ments of different materials”. Clinical Oral Implants Research
supported all-ceramic restorations”. Journal of Prosthetic 19.7 (2008): 635-641.
Dentistry 90.4 (2003): 325-331.
37. Zembic., et al. “Randomized‐controlled clinical trial of cus-
23. Foong JKW., et al. “Fracture resistance of titanium and zirco- tomized zirconia and titanium implant abutments for sin-
nia abutments: An in vitro study”. The Journal of Prosthetic gle‐tooth implants in canine and posterior regions: 3‐year
Dentistry 109.5 (2013): 304-312. results”. Clinical Oral Implants Research 20.8 (2009): 802-
808.
24. Nascimento C do., et al. “Bacterial adhesion on the titanium
and zirconia abutment surfaces”. Clinical Oral Implants Re- 38. Degidi Marco., et al. “Inflammatory infiltrate, microvessel
search 25.3 (2014): 337-343. density, nitric oxide synthase expression, vascular endo-
thelial growth factor expression, and proliferative activity
25. Sailer I., et al. “A systematic review of the performance of in peri-implant soft tissues around titanium and zirconium
ceramic and metal implant abutments supporting fixed im- oxide healing caps”. Journal of Periodontology 77.1 (2006):
plant reconstructions”. Clinical Oral Implants Research 20.4 73-80.
(2009): 4-31.
39. Baldassarri M., et al. “Marginal accuracy of three implant-ce-
26. Andersson B., et al. “Ceramic implant abutments used for ramic abutment configurations”. International Journal Oral
short-span fixed partial dentures: a prospective 2-year mul- and Maxillofacial Implants 27.3 (2012): 537-543.
ticenter study”. International Journal of Prosthodontics 12.4
(1999): 318-324. 40. Yüzügüllü., et al. “The Implant‐Abutment Interface of Alumi-
na and Zirconia Abutments”. Clinical Implant Dentistry and
27. Luthardt RG., et al. “Reliability and properties of ground Related Research 10.2 (2008): 113-121.
Y-TZP-zirconia ceramics”. Journal of Dental Research 81.7
(2002): 487-491. 41. Teughels W., et al. “Effect of material characteristics and/or
surface topography on biofilm development”. Clinical Oral
28. Binon PP. “Implants and components: entering the new mil- Implants Research 17.2 (2006): 68-81.
lennium”. International Journal of Oral and Maxillofacial Im-
plants 15.1 (2000): 76-94. 42. Rimondini L, et al. “Bacterial colonization of zirconia ceram-
ic surfaces: an in vitro and in vivo study”. International Jour-
29. Norton., et al. “The Astra Tech Single-Tooth Implant System: a nal of Oral and Maxillofacial Implants 17.6 (2002): 793-798.
report on 27 consecutively placed and restored implants”. In-
ternational Journal of Periodontics and Restorative Dentistry 43. Piconi C., et al. “Zirconia as a ceramic biomaterial”. Biomate-
17.6 (1997): 574-583. rials 20.1 (1999): 1-25.

30. Khraisat A., et al. “Fatigue resistance of two implant/abut- 44. Scarano., et al. “Bacterial adhesion on commercially pure ti-
ment joint designs”. Journal of Prosthetic Dentistry 88.6 tanium and zirconium oxide disks: an in vivo human study”.
(2002): 604-610. Journal of Periodontology 75.2 (2004): 292-296.

31. Asvanund P., et al. “Photoelastic stress analysis of external 45. Burgers R., et al. “In vivo and in vitro biofilm formation on
versus internal implant-abutment connections”. The Journal two different titanium implant surfaces”. Clinical Oral Im-
of Prosthetic Dentistry 106.4 (2011): 266-271. plants Research 21.2 (2010): 156-164.

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.
Implant Abutment Selection Criteria

38

46. Grobner-Schreiber B., et al. “Modified implant surfaces show 60. Elsayed A., et al. “Comparison of fracture strength and fail-
different biofilm compositions under in vivo conditions”. ure mode of different ceramic implant abutments”. Journal
Clinical Oral Implants Research 20.8 (2009): 817-826. of Prosthetic Dentistry 117.4 (2017): 499-506.

47. Andersson., et al. “Alumina ceramic implant abutments used 61. Esposito M., et al. “Biological factors contributing to fail-
for single-tooth replacement: a prospective 1-to 3-year mul- ures of osseointegrated oral implants. (I). Success criteria
ticenter study”. International Journal of Prosthodontics 14.5 and epidemiology”. European Journal of Oral Science 106.1
(2001): 432-438. (1998): 527-551.

48. Canullo., et al. “Clinical outcome study of customized zirco- 62. Quirynen M., et al. “Infectious risks for oral implants: a re-
nia abutments for single-implant restorations”. International view of the literature”. Clinical Oral Implants Research 13.1
Journal of Prosthodontics 20.5 (2007): 489-493. (2002): 1-19.

49. Glauser., et al. “Experimental zirconia abutments for implant- 63. Hahnel S., et al. “In vitro evaluation of artificial ageing on
supported single-tooth restorations in esthetically demand- surface properties and early Candida albicans adhesion to
ing regions: 4-year results of a prospective clinical study”. prosthetic resins”. Journal of Materials Science: Materials in
International Journal of Prosthodontics 17.3 (2004): 285-290. Medicine 20.1 (2009): 249-255.

50. Park., et al. “Optical phenomenon of peri‐implant soft tissue. 64. Burgers R., et al. “Adhesion of Candida albicans to various
Part I. Spectrophotometric assessment of natural tooth gingi- dental implant surfaces and the influence of salivary pellicle
va and peri‐implant mucosa”. Clinical Oral Implants Research proteins”. Acta Biomaterialia 6.6 (2010): 2307-2323.
18.5 (2007): 569-574.
65. Sampatanukul., et al. “Histological evaluations and inflam-
51. Vanlıoğlu., et al. “Reınforced ceramıc abutments ın ımplant matory responses of different dental implant abutment
retaıned restoratıons ın the esthethıc”. Journal of Atatürk Uni- materials: A human histology pilot study”. Clinical İmplant
versity Dentistry Faculty 22 (2012). Dentistry and Related Research 20.2 (2018): 160-169.

52. Ekren., et al. “The effect of ımplant-abutment connectıon type 66. Hahnel Sebastian., et al. “Biofilm formation on the surface of
to the clınıcal success of ımplant supported fıx restoratıons: modern implant abutment materials”. Clinical Oral İmplants
a lıterature revıew”. Journal of Atatürk University Dentistry Research 26.11 (2015): 1297-1301.
Faculty 2 (2009).
67. Gracis S., et al. “Internal vs. external connections for abut-
53. Bressan E., et al. “Influence of abutment material on the gin- ments/reconstructions: A systematic review”. Clinical Oral
gival color of implant-supported all-ceramic restorations: Implants Research 23.6 (2012): 202-216.
a prospective multicenter study”. Clinical Oral Implants Re-
search 22.6 (2011): 631-637. 68. Szpak., et al. “The survival of dental implants with different
implant-abutment connection systems”. Current Issues in
54. van Brakel R, et al. “The effect of zirconia and titanium im- Pharmacy and Medical Sciences 29.1 (2016): 11-13.
plant abutments on light reflection of the supporting soft
tissues”. Clinical Oral Implants Research 22.10 (2011): 1172- 69. Sailer., et al. “Fracture strength of zirconia implant abut-
1178. ments on narrow diameter implants with internal and ex-
ternal implant abutment connections: A study on the tita-
55. Gomes., et al. “Zirconia implant abutments: a review”. Medic- nium resin base concept”. Clinical Oral İmplants Research
ina Oral Patologia Oral y Cirugia Bucal 16.1 (2011): e50-e55. 29.4 (2018): 411-423.

56. Yildirim M., et al. “Ceramic abutments--a new era in achieving

optimal esthetics in implant dentistry”. International Journal Volume 2 Issue 8 August 2018
of Periodontics Restorative Dentistry 20.1 (2000): 81-91. © All rights are reserved by Mumcu E and Erdinc G.
57. Manicone PF., et al. “An overview of zirconia ceramics: Ba-
sic properties and clinical applications”. Journal of Dentistry
35.11 (2007): 819-826.

58. Garine WN., et al. “Measurement of the rotational misfit and

implant-abutment gap of all-ceramic abutments”. Interna-
tional Journal of Oral and Maxillofacial Implants 22.6 (2007):
928-938.

59. Att W., et al. “Fracture resistance of single tooth implant-sup-

ported all-ceramic restorations: an in vitro study”. Journal of
Prosthetic Dentistry 95.2 (2006): 111-116.

Citation: Mumcu E and Erdinc G. “Implant Abutment Selection Criteria”. Acta Scientific Dental Sciences 2.8 (2018): 31-38.