Influence of abutment material on stability of peri-implant tissues: A systematic review

Vilnius Implantology Center, Kalvariju str. 121-2, LT-08221, Vilnius, Lithuania.
The International journal of oral & maxillofacial implants (Impact Factor: 1.45). 05/2008; 23(3):449-56.
Source: PubMed


The aim of this systematic review was to evaluate available evidence for a difference in the stability of peri-implant tissues between titanium abutments versus gold alloy, zirconium oxide, or aluminum oxide abutments.
Studies were identified by examining several electronic databases and major dental implant, prosthetic, and periodontal journals. To be selected for the preliminary article pool, the article must have been written in the English language and published from 1980 to March 2007. Articles were sorted based on the nature of the study. In vitro studies and literature reviews were excluded. The included articles were clinical, human histology, and animal studies. Case reports, case series, uncontrolled clinical trials, and clinical studies with teeth treated as a control were excluded from the final review.
The initial article pool included 40 articles of which 9 met the inclusion criteria: 3 animal studies, 2 human histological studies, and 4 randomized clinical trials. Soft tissue recession was not accurately measured in the included clinical studies. Assessment of peri-implant tissues around zirconium oxide and titanium abutments was described only in animal and human histologic studies. Due to differences in study types, timing of follow-ups, and outcome variables, meta-analysis could not be performed.
Included studies revealed that titanium abutments did not maintain a higher bone level in comparison to gold alloy, aluminum oxide, or zirconium oxide abutments. However, there is a lack of information about the clinical performance of zirconium oxide and gold alloy abutments as compared to titanium abutments.

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Available from: Tomas Linkevicius, Jan 12, 2014
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    • "Abrahamsson et al. (14) claim that the abutment material may play an important role in the prevention of crestal bone and soft tissue recession. Controversially, Linkevicius and Apse (16) reviewed the literature and concluded that there was no evidence that titanium abutments perform better in maintaining stable peri-implant tissues, compared to other materials. "
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    ABSTRACT: Objectives: A randomized controlled trial was performed to assess soft tissue cell adhesion to implant titanium abutments subjected to different cleaning procedures and test if plasma cleaning can enhance cell adhesion at an early healing time. Study Design: Eighteen patients with osseointegrated and submerged implants were included. Before re-opening, 18 abutments were divided in 3 groups corresponding to different clinical conditions with different cleaning processes: no treatment (G1), laboratory customization and cleaning by steam (G2), cleaning by plasma of Argon (G3). Abutments were removed after 1 week and scanning electron microscopy was used to analyze cell adhesion to the abutment surface quantitatively (percentage of area occupied by cells) and qualitatively (aspect of adhered cells and presence of contaminants). Results: Mean percentages of area occupied by cells were 17.6 ± 22.7%, 16.5 ± 12.9% and 46.3 ± 27.9% for G1, G2 and G3 respectively. Differences were statistically significant between G1 and G3 (p=0.030), close to significance between G2 and G3 (p=0.056), and non-significant between G1 and G2 (p=0.530). The proportion of samples presenting adhered cells was homogeneous among the 3 groups (p-valor = 1.000). In all cases cells presented a flattened aspect; in 2 cases cells were less efficiently adhered and in 1 case cells presented filipodia. Three cases showed contamination with cocobacteria. Conclusions: Within the limits of the present study, plasma of Argon may enhance cell adhesion to titanium abutments, even at the early stage of soft tissue healing. Further studies with greater samples are necessary to confirm these findings. Key words:Connective tissue, dental abutments, randomized controlled trial, clinical research, glow discharged abutment, plasma cleaning.
    Medicina oral, patologia oral y cirugia bucal 10/2013; 19(2). DOI:10.4317/medoral.19329 · 1.17 Impact Factor
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    • "This murine model also can be used for studying how surface and shape modifications to the neck of the implant, or the connector, affect the adhesion of the connective tissue fibroblasts in vivo. Similar studies have been conducted in dogs [39], but mice offer a wide array of molecular and cellular tools with which to analyze the cellular and tissue-level responses that are unavailable for canine species. Other groups [19] [20] [21] have used rodents with similar maxillary models, where implant is placed in a ridge defect model where a tooth never existed. "
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    ABSTRACT: Many of our assumptions concerning oral implant osseointegration are extrapolated from experimental models studying skeletal tissue repair in long bones. This disconnect between clinical practice and experimental research hampers our understanding of bone formation around oral implants and how this process can be improved. We postulated that oral implant osseointegration would be fundamentally equivalent to implant osseointegration elsewhere in the body. Mice underwent implant placement in the edentulous ridge anterior to the first molar and peri-implant tissues were evaluated at various timepoints after surgery. Our hypothesis was disproven; oral implant osseointegration is substantially different from osseointegration in long bones. For example, in the maxilla peri-implant pre-osteoblasts are derived from cranial neural crest whereas in the tibia peri-implant osteoblasts are derived from mesoderm. In the maxilla, new osteoid arises from periostea of the maxillary bone but in the tibia the new osteoid arises from the marrow space. Cellular and molecular analyses indicate that osteoblast activity and mineralization proceeds from the surfaces of the native bone and osteoclastic activity is responsible for extensive remodeling of the new peri-implant bone. In addition to histologic features of implant osseointegration, molecular and cellular assays conducted in a murine model provide new insights into the sequelae of implant placement and the process by which bone is generated around implants.
    Bone 07/2013; 58. DOI:10.1016/j.bone.2013.07.021 · 3.97 Impact Factor
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    • "An animal study indicates that the soft tissue healing of both titanium and zirconia abutments remain, stable between 2 and 5 months, whereas a gold/palladium alloy abutments showed signs of “apical shift of the barrier epithelium and marginal bone between 2 and 5 months of healing,” which may result from lower amounts of collagen and fibroblast and greater amounts of leukocytes than in titanium and zirconia abutments [38]. These results are in contrast with a recent systematic review of the literature that has analyzed the difference in peri-implant stability of titanium abutments, compared with gold, aluminum, and zirconium oxide [39]. The conclusions collected by the authors indicate that there is no evidence to prove that titanium abutments perform better in terms of maintaining an unaltered tissue condition as compared to the other materials. "
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    ABSTRACT: The ongoing pursuit of aesthetic excellence in the field of implant therapy has incorporated prosthetic concepts in the early treatment-planning phase, as well as the previously discussed surgical concepts. The literature has addressed these prosthetic and laboratory approaches required to enhance and perfect the soft and hard tissue management (SHTM). After surgically providing an acceptable hard tissue architecture and adequate timing of loading of the implant, the prosthetic phase is responsible for the soft tissue modeling, through correctly planned and executed procedures, which induce a satisfactory soft tissue profile by considering the microvasculature, the abutment connection and positioning, and the implementation of an adequate provisional phase. The objectives are the modeling of the soft tissues through the use of a conforming periorestorative interface which will produce desired and stable results.
    International Journal of Biomaterials 07/2012; 2012(2):356817. DOI:10.1155/2012/356817
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