Comparison of the Clinical Outcomes of Titanium and Zirconia Implant Abutments: A Systematic Review of Systematic Reviews

Abstract

Background: Dental implants are widely used and in order to answer to esthetic demands, zirconia has been introduced as an abutment material as an alternative to titanium. Several studies have been published on this topic, but the results have been often inconsistent. The objective of the present study is to systematically analyze the existing literature comparing clinical outcomes of titanium and zirconia implant abutments. The study was designed as a systematic review of systematic reviews. Methods: This systematic review is in accordance with the Transparent Reporting of Systematic Reviews and Meta-analyses. A MEDLINE/PubMed, Cochrane Database of Systematic Reviews and SCOPUS literature search was performed up to and including June 2021. Data were extracted independently by two reviewers and tAMSTAR2 was used to assess the quality of the systematic reviews. Results: The electronic search identified 1146 papers, and 175 duplicates were removed. After manual screening, 954 studies were excluded and the final analysis was conducted on 11 papers. Both mechanical and esthetic outcomes and biological complications were analyzed. Conclusions: It can be concluded that titanium abutments have a better mechanical resistance than zirconia ones. Plaque accumulation is reported to be slightly higher on titanium but without any significant inflammatory process. The esthetic outcomes seem to be more related to the thickness (>3 mm) of the soft tissues than to the abutment material.

One‐piece versus two‐piece zirconia abutment supported single implant crown in the esthetic region: 3‐Year results from a split‐mouth randomized controlled clinical trial

“…The lower fracture rate in Group 2 may be attributed, to a large extent, to the ductility of the titanium base, which provides higher resistance to chewing force and allows for some deformation when exposed to unfavorable movements. This finding is consistent with previous systematic reviews, which reported zirconia abutment fracture rates varying from 1.08% to 17.86% depending on age, sex, abutment and implant systems, and implant-abutment connections (Gou et al, 2019;Halim et al, 2022). The present study similarly found that more fractures were observed in young male patients compared to females (37.50% vs. 0%, p = .029).…”

“…The titanium abutment has long been considered the gold standard for implant restoration longevity due to its high mechanical stability and excellent biocompatibility (Halim et al, 2022; Sailer et al, 2009). However, as dental technology and materials continue to advance, metal‐free treatment options are becoming increasingly popular in the field of dentistry due to their advantages over traditional metal‐based treatments.…”

Clinical performance of single implant prostheses restored using titanium base abutments: A systematic review and meta‐analysis

“…Previous analysis on the difference between titanium and zirconia abutments under mechanical, biological and aesthetic aspects has not been statistically significant (Halim et al, 2022). The previously reported high short‐term survival rate of 97.6% for monolithic and veneered single implant prosthesis (Pjetursson et al, 2021) was affirmed by this present systematic review.…”

The effect of different abutment materials on peri‐implant tissues—A systematic review and meta‐analysis

“…This problem of not taking into considerations problems that might have occurred over time with the abutment/reconstruction has also been reported in other systematic reviews (Pjetursson et al, 2018). And it is common knowledge that survival does not equal a successful treatment (Halim et al, 2022).…”