Table 1.
Summary of the features of the included studies (legend: n.m. = not mentioned; n.r. = not reported. Columns include the following data: first author, year of publication, follow-up, abutment material, interproximal papilla (PES), recession (REC) in mm, number of patients/sample size, gender, mean age/range, implant type, regenerative procedures, implant position, abutment type, implant survival rate, prosthetic survival rate, complications, pink esthetic score (Overall PES), midfacial mucosal recession (PES), drop-out and notes).
| Study | Year | Follow-Up | Abutment Material | PES (Pink Esthetic Score) IntPapilla | REC | Number of Patients | Gender F/M | Mean Age/Range | Implant Type |
|---|---|---|---|---|---|---|---|---|---|
| Borges et al. [21] (CCT) | 2014 | 12 months | cad-cam zirconia or cad cam grade 4 titanium coated with titanium nitride vs custom metal abutment in the control group | mean overall papilla score 1.66 +/− 0.48 relative to cad-cam group versus 1.05 +/− 0.65 relative to custom abutment group | n.m. | 38 | 14 females and 24 males | 49 years (range 28–90) | Osseospeed Astra Tech dental |
| Lops et al. [22] (CCT) | 2014 | 24 months | stock zirconia or titanium (ZirDesign or TiDesign) abutment vs cad-cam zirconia or titanium abutment | n.m. | (marginalREC) 0.3 mm zirconia stock; 0.3 mm titanium stock; 0.1 mm zirconia cad-cam; −0.3 titanium cad-cam | 72 | 33 females and 39 males | 46 years (range 26–58) | Osseospeed Astra Tech dental |
| Borzangy et al. [23] (RCT) | 2015 | 12 months | cad-cam zirconia vs stock titanium | baseline stock titanium 1.335 t12 stock titanium 1.535; baseline cad-cam zirconia 1.325 t12 cad-cam zirconia 1.415 | Prefabricated abutments at 1 year and cad-cam customized abutments at 1 year showed improving papilla height about 0.5 mm (mean); on the contrary prefabricated abutment at 1 year showed less than 0.5 mm marginal recession and cad-cam customized abutments showed less than 0.5 mm (mean) coronal growth of the soft tissue margin | 30 | 15 females and 14 males | 45.03 ± 13.77 years (range 22–73) | Straumann |
| Schepke et al. [24] (RCT) | 2017 | 12 months | cad-cam zirconia abutments vs stock (Zirdesign) abutment | t1 stock 1.0 t12 stock 1.6; t1 customized 1 t12 customized 1.7 | n.m. | 50 | 33 females and 17 males | 48.3 years (range 18–79) | Osseospeed Astra Tech dental |
| Wittneben et al. [25] (multicenter RCT) | 2017 | 12 months | stock zirconia abutment vs cad-cam zirconia abutment | baseline stock 1.395 t12 stock 1.415; baseline cad-cam 1.475 t12 cad-cam 1.475 | n.m. | 40 | n.m. | n.m. | Bone level implant Straumann |
| Lops et al. [9] (CCT) | 2017 | 24 months | stock zirconia or titanium (ZirDesign or TiDesign) abutment vs cad-cam zirconia or titanium abutment | n.m. | (intREC) 0.53 mm stock titanium; 0.52 mm stock zirconia; −0.46 custom zirconia; −0.56 custom titanium | 72 | 33 females and 39 males | 46 years (range 26–58) | Osseospeed Astra Tech dental |
| Regenerative Procedures | Implant Position | Abutment Type | Implant Survival Rate | Prosthetic Survival Rate | |||||
| 12 out of 38 implants withresorbable membrane+ autologous bone | Maxilla between teeth 13–23 | cad-cam, Atlantis; stock, CastDesign | 100% | 100% | |||||
| no hard and/or soft tissue augmentation procedure | from the second premolar forward | cad-cam, Atlantis; stock TiDesign or ZirDesign | 98.60% | 96% | |||||
| n.m. | single tooth gaps in the anterior maxilla position 14 to 24 | Zr abutments (Etkon abutment, Straumann AG, Basel, Switzerland)/porcelain fused to Zr crowns or prefabricated anatomic Ti abutments (Straumann AG, Basel, Switzerland)/porcelain fused metal crowns were fabricated and delivered to a clinician | 100% (authors reported implant success rate) | 95.2% stock titanium abutment; 97.5% cad-cam Zirconia abutment | |||||
| n.m. | single mandibular or maxillary premolar | cad-cam Atlantis zirconia; stock ZirDesign zirconia | 100% | 100% | |||||
| contour augmentation | single tooth gaps in the anterior maxilla position 14 to 24 | cad-cam Atlantis zirconia; stock ZirDesign zirconia | 100% | 94.7% stock abutment; 100% cad-cam abutment | |||||
| no hard and/or soft tissue augmentation procedure | from the second premolar forward | cad-cam, Atlantis; stock TiDesign or ZirDesign | 98.60% | 96% | |||||
| Complications | Overall PES | Marginal Soft Tissue Stability | Drop-out | Note | |||||
| n.r. | n.m. | n.m. | n.r. | none | |||||
| fracture of one implant in the cad-cam zirconia abutment group; 2 abutment unscrewing in the stock abutment group | n.m. | (marginalREC) 0.3 mm zirconia stock; 0.3 mm titanium stock; 0.1 mm zirconia cad-cam; −0.3 titanium cad-cam | n.r. | negative values indicate soft tissue growth | |||||
| Mechanical complications involved debonding of the crown form the abutment and abutment screw fracture. Debonding of the crown occurred twice in two different patients in the Ti group (2.38%) by the time of the one-month and one-year follow-up visits. Abutment screw fracture happened during the delivery of a Zr abutment (1.27%). Technical complications reported in this study were crown shade mismatch (1.19%) and veneering porcelain chipping (2.46%). Shade mismatch was noticed in the Ti group during initial delivery of the crown, and it was corrected before the final crown delivery. Minor veneer porcelain chipping occurred in one patient in each group at the six-month follow-up visit. One patient in the Ti group required just finishing and polishing to the crown to eliminate a sharp edge, while one patient in the Zr group received a small composite restoration. |
prefabricated titanium abutments at 6 months = mean 8.31 (sd1.18); CAD/CAM customized zirconia abutments at 6 months = mean7.36 (sd1.80); Prefabricated titanium abutments at 1 year = mean 8.38 (sd1.19); CAD/CAM customized zirconia abutments at 1 year = mean 7.78 (sd1.93) | level of facial mucosa as item of PES: stock titanium t1 1.5; cad-cam zirconia t1 1.5; stock titanium t12 1.92; cad-cam zirconia 1.67 | 1 | none | |||||
| n.r. | prefabricated zirconia abutments t1(two weeks) = 9.2 (1.8); cad-cam zirconia abutments t1(two weeks) = 9.0 (2.5); prefabricated zirconia abutment t12(twelve months) = 10.9 (1.6); cad-cam zirconia abutments t12(twelve months) = 10.6 (2.1) | level of soft tissue margin as item of PES: stock t1 1.4; stock t12 1.6; customized t1 1.5; customized t12 1.6 | n.r. | none | |||||
| 1 ceramic fracture (incisal edge) in the stock group | prefabricated zirconia abutment 1 year 7.00; cad-cam zirconia abutment 1 year 7.65; | level of labial mucosa as item of the modified PES: baseline stock 1.26; t12 stock 1.44; baseline cad-cam 1.65; t12 cad-cam 1.60 | 1 | none | |||||
| fracture of one implant in the cad-cam zirconia abutment group; 2 abutment unscrewing in the stock abutment group | n.m. | n.m. | n.r. | negative values indicate soft tissue growth | |||||