Influence of abutment materials on peri-implant tissues health—a systematic review
DOI:
https://doi.org/10.2340/biid.v13.46210Keywords:
Abutments, Titanium, ZirconiaAbstract
Background: Abutment materials play a critical role in maintaining peri-implant tissue health, influencing both biological responses and aesthetic outcomes in implant-supported restorations. With the introduction of newer materials and digital fabrication techniques, an updated evaluation of their clinical performance is warranted.
Objective: This systematic review aimed to evaluate the influence of different abutment materials—titanium, zirconia, and polyether ether ketone (PEEK)—on peri-implant tissue health based on contemporary clinical evidence.
Materials and Methods: A systematic literature search was conducted in PubMed and Scopus databases in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies published between 2019 and 2026 were included to reflect current advancements in implant prosthodontics. Eligible human studies assessing the impact of abutment materials on peri-implant tissue health were selected based on predefined criteria. Risk of bias was assessed using the ROBINS-I tool. Due to heterogeneity in study design, outcome measures, and follow-up duration, a meta-analysis was not feasible, and a qualitative synthesis was performed.
Results: A total of 13 studies were included. Titanium abutments demonstrated consistent performance, with stable marginal bone levels, low inflammatory response and high long-term predictability. Zirconia abutments showed comparable biological outcomes, with superior soft tissue response and aesthetic integration, particularly in anterior regions. Evidence regarding PEEK abutments was limited; however, preliminary findings suggest reduced inflammatory response and favorable biocompatibility. The included studies exhibited substantial heterogeneity in methodology and outcome reporting, limiting direct comparisons.
Conclusions: Titanium remains the most reliable abutment material due to its well-established clinical performance and mechanical stability. Zirconia represents a suitable alternative in aesthetically demanding situations, offering favorable soft tissue outcomes. PEEK demonstrates promising biological potential but lacks sufficient long-term clinical evidence to support routine use. Future research should focus on well-designed, long-term comparative studies with standardized outcome measures to strengthen the evidence base and guide clinical decision-making.
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References
Enkling, Marder M, Bayer S, Götz W, Stoilov M, Kraus D. Soft tissue response to different abutment materials: a controlled and randomized human study using an experimental model. Clin Oral Implants Res. 2022;33(6):667–79. DOI: https://doi.org/10.1111/clr.13932
Donker VJJ, Raghoebar GM, Jensen‑Louwerse C, Vissink A, Meijer HJA. Monolithic zirconia single tooth implant‑supported restorations with CAD/CAM titanium abutments in the posterior region: a 1‑year prospective case series study. Clin Implant Dent Relat Res. 2022;24(1):125–32. DOI: https://doi.org/10.1111/cid.13069
Fonseca M, Molinero‑Mourelle P, Forrer FA, Schnider N, Hicklin SP, Schimmel M, et al. Clinical performance of implant crowns with customized zirconia abutments: a prospective cohort study with a 4.5‑ to 8.8‑year follow‑up. Clin Oral Implants Res. 2021;32(7):853–62. DOI: https://doi.org/10.1111/clr.13761
Milinkovic I, Krasavcevic AD, Jankovic S, Sopta J, Aleksic Z. Immunohistochemical analysis of soft tissue response to polyetheretherketone (PEEK) and titanium healing abutments on dental implants: a randomized pilot clinical study. BMC Oral Health. 2022;22(1):484. DOI: https://doi.org/10.1186/s12903-022-02536-0
Weigl P, Trimpou G, Grizas E, Hess P, Nentwig GH, Lauer HC, et al. All‑ceramic versus titanium‑based implant supported restorations: preliminary 12‑months results from a randomized controlled trial. J Adv Prosthodont. 2019;11(1):48–54. DOI: https://doi.org/10.4047/jap.2019.11.1.48
Strauss FJ, Siegenthaler M, Hämmerle CHF, Sailer I, Jung RE, Thoma DS. Restorative angle of zirconia restorations cemented on non‑original titanium bases influences the initial marginal bone loss: 5‑year results of a prospective cohort study. Clin Oral Implants Res. 2022;33(7):745–56. DOI: https://doi.org/10.1111/clr.13954
Smirani R, Chantler JG, Endres J, Jung RE, Naenni N, Strauss FJ, et al. Clinical outcomes of single implant supported crowns utilising the titanium base abutment: a 7.5‑year prospective cohort study. J Dent. 2024;149:105306. DOI: https://doi.org/10.1016/j.jdent.2024.105306
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):89. DOI: https://doi.org/10.1186/s13643-021-01626-4
Hosseini M, Worsaae N, Gotfredsen K. Survival rate of implant‑supported, single‑tooth restorations based on zirconia or metal abutment in patients with tooth agenesis: a 5‑years prospective clinical study. J Evid Based Dent Pract. 2024;24(2):101970. DOI: https://doi.org/10.1016/j.jebdp.2024.101970
Pozzi A, Arcuri L, Fabbri G, Singer G, Londono J. Long‑term survival and success of zirconia screw‑retained implant‑supported prostheses for up to 12 years: a retrospective multicenter study. J Prosthet Dent. 2023;129(1):96–108. DOI: https://doi.org/10.1016/j.prosdent.2021.04.026
Koller M, Steyer E, Theisen K, Stagnell S, Jakse N, Payer M. Two‑piece zirconia versus titanium implants after 80 months: clinical outcomes from a prospective randomized pilot trial. Clin Oral Implants Res. 2020;31(4):388–96. DOI: https://doi.org/10.1111/clr.13576
Kumar S, Singha A, Dhingra J, Verma G, Singh SD, Kumar A. Evaluation of zirconia and titanium abutments on peri-implant tissues: a comparative study. Bioinformation. 2024;20(12):1809–12. DOI: https://doi.org/10.6026/9732063002001809
Savitha PN, Solanki S, Soni M, Razdan RA, Gupta A, Patel KN. Impact of different abutment materials on peri-implant tissue health and esthetics in fixed prosthodontics. Bioinformation. 2024;20(10):1340–44. DOI: https://doi.org/10.6026/9732063002001340
Bernabeu‑Mira JC, Soto‑Peñaloza D, Peñarrocha‑Diago M, Peñarrocha‑Oltra D. Influence of abutment characteristics on marginal bone level changes in immediate loading implant‑supported full‑arch fixed dental prostheses: a retrospective case series study with 1‑year follow‑up. Front Oral Maxillofac Med. 2021;3:34. DOI: https://doi.org/10.21037/fomm-21-64
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Copyright (c) 2026 Waad Kheder, Renita Rego, Marwan Mansoor Mohammed, Zaid Hamdoon, Waseem Jerjes
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Biomaterial Investigations in Dentistry is a Diamond Open Access peer-reviewed journal, publishing research in oral biomaterials science. The publishing of articles is free for authors, thanks to the support of Acta Odontologica Scandinavica Society (AOSS), a not-for-profit society. 
