Is Zirconia Better Than Titanium Abutments for Soft Tissue Color? A Systematic Review and Meta-analysis of Spectrophotometric Evaluation

Int J Oral Maxillofac Implants. 2021 Sep-Oct;36(5):875-884. doi: 10.11607/jomi.8904.


Purpose: The aim of this systematic review was to evaluate the influence of zirconia and titanium as abutment materials on peri-implant soft tissue color.

Materials and methods: The searched electronic databases included MEDLINE/PubMed, LILACS, Web of Science, Scopus, and LIVIVO. Two types of studies were included: randomized clinical trials (RCTs) and controlled clinical trials (CCTs) that compared zirconia (Zr) and titanium (Ti) abutments. The outcomes measured were as follows: implant crown esthetic index, visual analog scale, esthetic index, gingiva discoloration index-spectrophotometry, papilla index, recession index, and pink esthetic score. Two reviewers selected the records, assessed quality, and extracted data of included studies independently.

Results: A total of 323 patients enrolled in 13 studies were included in this analysis with 11 RCTs and 2 CCTs. Due to the wide variety of methodologies used, meta-analysis was only possible for RCTs that performed spectrophotometric analysis. The use of zirconia or titanium for implant abutments does not seem to be the principal factor for influencing peri-implant soft tissue color. The meta-analysis showed no difference between zirconia and titanium abutments.

Conclusion: This study does not support any better advantage of the use of zirconia in comparison to the use of titanium related to peri-implant tissue color.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Crowns
  • Dental Abutments*
  • Esthetics, Dental
  • Gingiva
  • Humans
  • Spectrophotometry
  • Titanium*
  • Zirconium


  • Zirconium
  • Titanium
  • zirconium oxide