A systematic review of the influence of the implant-abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions

Clin Oral Implants Res. 2018 Oct:29 Suppl 18:160-183. doi: 10.1111/clr.13362.


Objectives: The objective of this systematic review was to assess the influence of implant-abutment connection and abutment material on the outcome of implant-supported single crowns (SCs) and fixed dental prostheses (FDPs).

Methods: An electronic Medline search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective and retrospective studies with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using robust Poisson regression, and comparisons were made with multivariable Poisson regression models.

Results: The search provided 1511 titles and 177 abstracts. Full-text analysis was performed for 147 articles resulting in 60 studies meeting the inclusion criteria. Meta-analysis of these studies indicated an estimated 5-year survival rate of 97.6% for SCs and 97.0% for FDPs supported by implants with internal implant-abutment connection and 95.7% for SCs and 95.8% for FDPs supported by implants with external connection. The 5-year abutment failure rate ranged from 0.7% to 2.8% for different connections with no differences between the types of connections. The total number of complications was similar between the two connections, yet, at external connections, abutment or occlusal screw loosening was more predominant. Ceramic abutments, both internally and externally connected, demonstrated a significantly higher incidence of abutment fractures compared with metal abutments.

Conclusion: For implant-supported SCs, both metal and ceramic abutments with internal and external connections exhibited high survival rates. Moreover, implant-supported FDPs with metal abutments with internal and external connections for also showed high survival rates.

Keywords: biological; ceramic; complications; implant abutments; implant crowns; implant fixed dental prostheses; meta-analysis; metal; survival; systematic review; technical; titanium; zirconia.

Publication types

  • Systematic Review

MeSH terms

  • Ceramics / adverse effects
  • Ceramics / therapeutic use
  • Crowns / adverse effects
  • Dental Abutments* / adverse effects
  • Dental Implant-Abutment Design* / adverse effects
  • Dental Implantation, Endosseous* / adverse effects
  • Dental Implantation, Endosseous* / methods
  • Dental Prosthesis, Implant-Supported* / adverse effects
  • Dental Restoration Failure
  • Humans
  • Metals / adverse effects
  • Metals / therapeutic use


  • Metals