2021 - Systematic Review Accuracy of Original Vs Non Original Abutments Using Various Connection

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Accuracy of Original vs. Non-Original Abutments Using
Various Connection Geometries for Single Unit Restorations:
A Systematic Review
Naureen Rizvi, BDS, MFDS, MClinDent Pros, M Prost RCSEd ,1 Yasir Alyahya, BDS, MSc Cons,1,2
Ali Rizvi, BDS, MFDS,1 Unnati Narvekar, BDS, MJDF, MSc Cons, MClinDent Pros,1 &
Haralampos Petridis, DDS, MS, Cert Prosthodont, PhD, FHEA 1
1
Unit of Prosthodontics, UCL Eastman Dental Institute, London, United Kingdom
2
Department of Conservative Dentistry, College of Dentistry, Qassim University, Qassim, Saudi Arabia
Keywords Abstract
Compatible; components; connection
geometry; dental implants; interchangeable;
Purpose: To ascertain whether the compatibility of non-original abutments (NOAs)
non-original abutments. with dental implants is influenced by the type of implant connection, i.e.- internal or
external, and whether certain combinations of componentry may be as compatible as
Correspondence the original components.
Naureen Rizvi, BDS, MFDS, MClinDent Pros, Methods: A structured literature search was conducted using 3 electronic databases
M Prost RCSEd, Unit of Prosthodontics, (MEDLINE® , The Cochrane Library, and Web of Science Core Collection) for stud-
Department of Restorative Dentistry, UCL ies reporting on the use of non-original abutments published between 1995 and 2020.
Eastman Dental Institute, Rockefeller This was supplemented with hand searching in relevant journals and references, as
Building, 21 University Street, London WC1E well as searching grey literature. Relevant studies were selected according to specific
6DE, United Kingdom. inclusion criteria. Data was collected for the following parameters: precision of fit,
E-mail: naureen.rizvi.18@ucl.ac.uk microleakage, micromorphological differences, micromotion, rotational misfit, screw
loosening, maximum load capacity, fracture resistance, tensile strength, compressive
Accepted November 18, 2021 strength and invivo implant and prosthesis outcomes.
Results: The electronic search and hand search yielded titles and abstracts of 5617
doi: 10.1111/jopr.13464 studies following de-duplication; based on the eligibility criteria, 40 studies were
finally selected. Overall, original abutments showed better precision of fit, ability
to resist microleakage, prevention of rotational misfit and micromotion, and fatigue
strength compared with non-original abutments. Some non-original abutments on ex-
ternal connections were comparable with original abutments in terms of precision of
fit and resistance to screw loosening and may be associated with less catastrophic
failures than those on internal connections.
Conclusion: Original abutments present more predictable outcomes than non-
original abutments with regards to the parameters investigated. However, it seems
that external connections can provide some level of compatibility in terms of pre-
cision of fit and may also exhibit less catastrophic failures than NOAs on internal
connections. This may be due to the increased rotational freedom external connec-
tions provide. There is a lack of information regarding the influence of connection
geometry on many aspects of compatibility and therefore the current clinical recom-
mendation should be to use original abutments. More laboratory studies comparing
non-original abutments on different implant connections are required. In addition,
there is a need for long-term in vivo studies providing data on the clinical perfor-
mance of non-original abutments.
Clinicians and dental technicians may use “non-original” abut- ity of original abutments (OAs) from the same manufacturer
ments produced by a manufacturer different to that of the as the implant. Non-original abutments (NOAs) can also be
implant system, in order to reduce costs, to implement dig- referred to as interchangeable, after-market, third-party, look-
ital computer-aided design and computer-aided manufactur- alike, copy, clone or compatible abutments. Although often
ing (CAD-CAM) workflows, or due to the lack of availabil- less expensive, the problem with NOAs is that they are not an
Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists. e21
1532849x, 2022, 7, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jopr.13464 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [29/10/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Non-Original Abutments and Connection Geometry Rizvi et al
exact replica due to differences in the manufacturing process same search strategy terms were used, with symbols changed
and dimensional inaccuracies, leaving uncertainty with regards according to the format for each database. ProQuest Disserta-
to the actual degree of compatibility.1,2 tions & Theses Global and Open Grey databases were used for
A precise fit at the implant-abutment interface (IAI) is cru- identification of grey literature, with search terms being input
cial in order to minimize the risk of mechanical and biological individually.
complications. Microgaps at the implant-abutment interface The electronic search covered January 1995 to July 2020 and
can serve as a bacterial reservoir, causing inflammatory was supplemented by hand-searching of the following journals
changes in the soft tissues and possible bone loss.3,4 from January 2010 to July 2020: Clinical Implant Dentistry
Studies, including a systematic review by Tallarico et al,5 and Related Research, Clinical Oral Implants Research, Eu-
demonstrate that the fit between NOAs and dental implants is ropean Journal of Oral Implantology, Implant Dentistry, In-
less precise compared with that of OAs, creating microgaps at ternational Journal of Oral and Maxillofacial Implants, In-
the implant-abutment interface. The assumption is that this in ternational Journal of Prosthodontics, Journal of Prosthetic
turn increases the incidence of mechanical complications and Dentistry, Journal of Prosthodontic Research, and Journal of
microleakage.1–5,6 In other studies, NOA combinations have Prosthodontics. Articles obtained were scanned to find further
been shown to produce results comparable with OAs. NOAs studies.
on implants with external connections appeared to result in less
misfit and severe failures than combinations utilizing deeper Study selection
internal connections.7–10
The first screening phase of the articles returned via searching
The aim of this study was to ascertain whether the compat-
involved review of the title, abstracts and/or full texts by the
ibility of non-original abutments with dental implants is influ-
reviewers based on inclusion and exclusion criteria.
enced by the connection geometry and whether certain combi-
The criteria for inclusion were: studies published between
nations may be as compatible as the original components and
January 1995 and July 2020 (including e-publications ahead of
potentially reduce the risk of complications. The focused PI-
print), abstracts and full texts in English, in vitro and in vivo
COS question formulated was “when non-original abutments
prospective, retrospective, observational or interventional case
are connected to dental implants for single-unit prostheses,
control and cohort studies. These studies would be testing non-
does the implant connection type, i.e. internal or external, in-
original abutments for single-unit implant restorations, com-
fluence the compatibility?.” “P” denotes the population (sin-
paring NOAs to OAs and/or variations in connection geometry.
gle implants), “I” is the intervention (use of non-original abut-
The exclusion criteria were: publications dated prior to Jan-
ments), “C” is the comparison (between different connection
uary 1995, studies published in languages other than English,
geometries), “O” is the outcome (effect on compatibility) and
studies involving only multi-unit fixed or removable restora-
“S” is the study design (in vitro and in vivo studies). Spe-
tions or frameworks, author opinions, case reports on individ-
cific parameters investigated as a measure of compatibility
ual patients, studies where abutments are only connected to
included: precision of fit, microleakage, micromorphological
implants from the same manufacturer and studies testing abut-
differences, micromotion, rotational misfit, screw loosening,
ments not connected to dental implants.
maximum load capacity, fracture resistance, tensile strength,
The full texts of all studies returned from the first phase of
compressive strength and in vivo implant and prosthesis out-
screening and hand searching were obtained for further eligi-
comes.
bility analysis and screened independently. The results were
then compiled, and a Kappa Score was calculated to indicate
Methods agreement regarding inclusion/exclusion between the two re-
viewers for phase 2 screening. Bias within the studies was as-
This systematic review followed the Preferred Reporting Items sessed according to indication of conflicts of interest, sponsor-
for Systematic Reviews and Meta-Analyses (PRISMA) State- ships or provision of components used.
ment guidelines.11
Data extraction and statistical analysis
Search strategy
Data from the studies finally selected was extracted and
A structured literature search was conducted by two review- tabulated for the following parameters: precision of fit
ers (NR and AR) in July 2020, using three different electronic at the implant-abutment interface, microleakage, micro-
databases (MEDLINE® , The Cochrane Library, and Web of morphological differences, micromotion and displacement,
Science Core Collection) for laboratory and clinical studies rotational misfit, screw loosening (removal torque values),
reporting on the use of non-original abutments for dental im- maximum load capacity and fracture resistance, tensile and
plants. compressive strengths and in vivo implant and prosthesis out-
Search terms were identified using MeSH terms relevant to comes. Statistical analysis was not possible due to the hetero-
the focus area of the study and keywords found during a pre- geneity of the studies.
liminary review of the literature. A medical librarian was con-
sulted regarding the structure of the search strategy. A repre- Results
sentation of the search strategy is depicted in Table 1. The
MEDLINE® database was searched first, followed by The Searching of the electronic databases yielded 7606 studies and
Cochrane Library and Web of Science Core Collection. The hand searching yielded 88 titles, which, following removal of
e22 Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.
Rizvi et al Non-Original Abutments and Connection Geometry
Table 1 MEDLINE® search strategy
Input
no. Search entry
1 exp Dental Implants/

2 (dental adj3 (implant∗ or abutment∗ or prosthe∗ )).mp. [mp = title, abstract, original title, name of substance word, subject heading word,
floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare
disease supplementary concept word, unique identifier, synonyms]
3 1 or 2
4 exp Dental Prosthesis, Implant-Supported/
5 (single-unit adj3 implant).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word,
keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary
concept word, unique identifier, synonyms]
6 4 or 5
7 exp Dental Implant-Abutment Design/
8 (implant∗ adj3 abutment∗ adj3 connection∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease
supplementary concept word, unique identifier, synonyms]
9 (implant∗ adj3 abutment∗ adj3 compatib∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
10 (implant∗ adj3 abutment∗ adj3 interface∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
11 (implant∗ adj5 connect∗ adj3 geometr∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
12 (implant∗ adj5 internal adj3 connection∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
13 (implant∗ adj5 external adj3 connection∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
14 7 or 8 or 9 or 10 or 11 or 12 or 13
15 compatib∗ .mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword
heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word,
unique identifier, synonyms]
16 (fit∗ or (fit∗ adj3 (accuracy∗ or precis∗ or vertical∗ or horizontal∗ or margin∗ ))).mp. [mp = title, abstract, original title, name of substance word,
subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol
supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
17 toleran∗ .mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading
word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique
identifier, synonyms]
18 15 or 16 or 17
19 3 or 6
20 18 and 19
21 exp Dental Abutments/
22 (dental adj3 implant∗ adj3 abutment∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
23 (original adj3 abutment∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word,
24 (stock adj3 abutment∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word,
25 (pre-fabricated adj3 abutment∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading
word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease
(Continued)
Table 1 (Continued)
Input
no. Search entry
26 (non-original adj3 abutment∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading
27 (abutment∗ adj3 (certified∗ or compatib∗ or lookalike or after-market or cop∗ or interchang∗ )).mp. [mp = title, abstract, original title, name of
substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word,
protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
28 21 or 22 or 23 or 24 or 25 or 26 or 27
29 exp Computer-Aided Design/
30 (implant∗ adj3 abutment∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading
31 29 and 30
32 ((implant∗ adj7 discrepanc∗ ) or (geometr∗ adj3 discrepancy)).mp. [mp = title, abstract, original title, name of substance word, subject
heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary
concept word, rare disease supplementary concept word, unique identifier, synonyms]
33 (implant∗ adj3 abutment∗ adj3 microleakage∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word,
34 (implant∗ adj3 microgap∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word,
35 (implant∗ adj3 micromotion∗ ).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading
36 (implant adj7 (misfit∗ or (rotational adj misfit))).mp. [mp = title, abstract, original title, name of substance word, subject heading word,
37 (implant adj3 (remov∗ adj3 torque∗ )).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
38 (implant∗ adj fracture adj resistance).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating
39 ((abutment∗ or implant∗ ) adj3 (screw∗ adj3 loose∗ )).mp. [mp = title, abstract, original title, name of substance word, subject heading word,
40 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39
41 20 and 28
42 41 or 14 or 31 or 40
43 limit 42 to yr = “1995 -Current”
44 limit 43 to english language
duplicates, gave 5617 studies. No studies were identified via The inter-reviewer agreement regarding eligibility of stud-
searching of the ProQuest Dissertations & Theses Global and ies during Phase 2 was “substantial” (Cohen’s Kappa value:
Open Grey databases. During Phase 1 screening, 203 stud- 0.740).
ies were obtained for full-text screening. One hundred and Twenty-five in vitro studies2,3,6,8,12–32 connected NOAs
sixty-three studies were excluded during Phase 2, with the most to implants with internal connections, whilst 12 stud-
common reason for exclusion being that the implant-abutment ies involved testing of NOAs on implants with exter-
combinations were original only. Based on the eligibility cri- nal connections.1,7,9,10,33–40 Three studies connected NOAs
teria, 40 studies were finally selected. (Supplementary Figure onto implants with both kinds of connection (internal and
1 depicts the process of selecting the final articles). (Table S1 external).41–43
details the final selected articles).
Risk of bias Micromorphological differences

A number of studies acknowledged sponsorship either by fund- Scrutiny of the micromorphological differences between OAs
ing or provision of components, as well as affiliations with and NOAs highlighted the irregularities leading to altered
implant companies. Twelve studies acknowledged university fit when NOAs are connected to implants with internal and
or state grants, 15 studies acknowledged receiving implants external connections, although there were no studies which
and components from companies and 1 study declared a co- compared the connection types directly. Photomicrographs
author was employed by one of the implant companies provid- from the study by Da Cunha et al illustrated misfit, lack of
ing components. Five studies declared they had no conflicts of uniformity, and the presence of horizontal over and under-
interest without further details, and 13 studies did not state any contouring when NOAs were connected to implants with an
details with regards to conflicts of interest or support. external hexagon; in contrast to the micro-gap being evenly
distributed among all measured sites in the original abutment
connection.1
Precision of fit at the implant-abutment Mattheos et al and Fokas et al tested on internal connec-
interface tions and found more marked micromorphological differences
Tables 2 summarizes details of the studies testing precision in NOAs, which also displayed tapering.18,26 On the internal
of fit at the implant-abutment interface in terms of mean gap conical connection, differences were not significant with ti-
widths or areas of tight contact, implant/abutment hexagon di- tanium abutments and minor with gold abutments. Premature
mensions and scratches/wear, respectively. contacts between the abutment and the inner implant surface
Of the 12 studies measuring gap widths between OAs/NOAs hindered seating for zirconia abutments.18
and implants with an external connection, 4 studies found bet-
ter precision of fit with OAs compared with NOAs.1,38–40 One Micromotion after loading and displacement
study found that although the OAs statistically fit better than after torqueing
NOAs, both were within acceptable limits33 ; 5 studies reported Four studies investigated micromotion of abutments connected
no differences between OAs and NOAs.7,9,10,42,43 Two studies on dental implants, the results of which are summarized in
reported better fit when the NOAs were connected to the im- Table 4.
plants, compared with the OAs.34,35 Berberi et al found that NOAs displayed more movement
When OAs and NOAs were connected to implants with in- than OAs when they were placed on implants with an internal
ternal connections, 7 studies found OAs had better precision double hexagon.15 Karl and Taylor found no significant dif-
of fit compared with NOAs.2,13–15,18,26,43 Two studies reported ference in micromotion overall between NOAs and OAs when
that although OAs had a statistically better fit than NOAs, both they were placed on conical connections.21 A later study by
were within limits deemed acceptable12,17 and 1 study reported Karl and Irastorza-Landa also generally reported no significant
no difference between OAs and NOAs.19 differences in micromotion between NOAs and OAs on inter-
In studies directly measuring components, Karl and nal conical connections.22
Irastorza-Landa indicated NOAs were less compatible with When placed on implants with an internal hexagon in an-
implant systems with an internal connection compared with other study,30 no correlation was found between the amount of
OAs due to discrepancies in dimensions.22 Lang et al deemed displacement after torqueing and whether the abutments were
original and non-original abutments compatible with implants NOAs or OAs.30 There were no studies investigating micro-
with an external hexagon.37 One study reported more wear and motion or displacement of NOAs connected to implants with
scratches with NOAs,40 whereas another found less wear with external connections (Table 4).
NOAs and no correlation between wear at the IAI and preci-
sion of fit.39 Measure of rotational misfit
Of the studies which allowed comparison of NOAs on inter-
nal and external connections, Siadat et al, found the horizontal OAs and NOAs were connected to implants with an external
gaps were significantly less on external connections abutments connection in 3 studies,33,36,43 and 2 studies connected abut-
than on internal connections43 whereas Park et al found the ments to implants with internal connections.8,43 The details of
connection type did not influence the gap discrepancies.42 these studies are given in Table 5.
All of the studies showed increased rotational misfit (mea-
sured by degrees of freedom) with NOAs compared with OAs.
Microleakage to indicate degree of misfit Siadat et al allowed direct comparison of the values for rota-
tional freedom in external and internal connections. The de-
The study testing OAs and NOAs on implants with internal
gree of rotational freedom with NOAs on implants with ex-
double hexagon connection found that the percentage volume
ternal connections appeared to reach higher values than when
of microleakage was significantly higher with NOAs compared
NOAs are connected to implants with an internal connection.
to OAs,3 however another study utilizing internal conical con-
nections found no correlation between the type of abutment
Removal torque values as a measure of residual
and amount of microleakage.22 The results of these are sum-
abutment screw preload (screw-loosening)
marized in Table 3. No studies were found investigating mi-
croleakage at the IAI when NOAs are connected to implants Five studies, all of which connected abutments to implants with
with an external connection. internal connections, found that removal torque values were
e26
Table 2 Studies testing precision of fit at the implant-abutment interface
Connection Original Mean gap widths Mean gap widths Difference between OAs
Author(s) Implant system(s) type abutments Non-original abutments (OAs) (μm) (NOAs) (μm) and NOAs significant?
Alikhasi et al. Brånemark (Nobel Biocare, EC (EH) Titanium Easy Abutment Customised ICE zirconia Horizontal: 2 Vertical: Horizontal: 5 No for vertical gaps. Yes
(2013) Göteborg, Sweden) (Nobel Biocare, Gotëborg, abutment (Zirkonzahn, 0 Vertical: 0.6 for horizontal gaps. All
Sweden) Gais, Italy) clinically acceptable.
Assuncao et al. Osseotite Implants (Biomet EC (EH) (I) Gold UCLA abutments (V) Zirconia abutment Vertical: Vertical: Yes, in favor of NOAs
(2011) 3i Inc., Palm Beach (Biomet 3i Inc., Palm obtained by CAD/CAM Pre-loading/post- Pre
Gardens, FL, USA) Beach Gardens, FL, USA) system (Nobel Biocare, loading loading/post-
cast in gold alloy with Goteborg, Sweden) with (I) 24.98/18.78 loading
ceramic veneering ceramic veneering. (II) 16.49/ 14.43 (V) 4.86/ 2.33
(II) Gold UCLA abutment (III) 67.69/ 38.38
(Biomet 3i Inc., Palm (IV) 77.56/ 26.77
Beach Gardens, FL, USA)
Non-Original Abutments and Connection Geometry
cast in gold alloy with

resin veneering
(III) titanium castable
UCLA abutment (Biomet
3i Inc., Palm Beach
Gardens, FL, USA) with
ceramic veneering
(IV) titanium castable
UCLA abutment (Biomet
3i Inc., Palm Beach
Gardens, FL, USA)
Byrne et al. (A) Nobel Pharma (Nobel EC (EH) (I) CeraOneTM (Nobel (III) Cast UCLA abutments (A/I) (A/III) Vertical: 84 Yes. In favor of NOAs.
(1998) Biocare, Göteborg, EC (EH) Biocare AB, Gothenburg, (Implant Innovations Inc.) Vertical: 86 (means for
Sweden) Sweden) (B/II) greatest gap
(B) 3i (Implant innovations (II) STR (Implant Vertical: 36 widths)
Inc., Palm Beach, FL) innovations Inc., Palm (B/III)
Beach, FL) Vertical: 74
(III) Cast UCLA abutments (B/IV)
(Implant Innovations Inc.) Vertical: 45
(IV) Premachined UCLA (B/V)
abutments (Implant Vertical: 40
Innovations Inc.) (means for
(V) Premachined UCLA greatest gap
abutments with metal widths)
coping (Implant
Innovations Inc.)
(Continued)
Rizvi et al
Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Rizvi et al
Table 2 (Continued)
De Morais (A) MK IIITM (Nobel EC (EH) (I) NobelProcera® Zirconia (I) NobelProcera® Zirconia Vertical: Vertical: Yes. In favor of OAs.
Alves da BiocareTM , Göteborg, CAD/CAM (Nobel Biocare, CAD/CAM (Procera, Nobel (A/I) 5.7 (B/I) 9.53
Cunha et al. Sweden) Göteborg, Sweden) Biocare Göteborg, (C/I) 10.62
(2012) (B) Try On (Sistema de Sweden)
Implantes, São Paulo,
Brazil)
(C) Master screw
Conexão® (Sistema de
Prótese, São Paulo, Brazil)
Dellow et al. (SI) Southern Implant EC (EH) (SI) Southern Implant (SI) Southern Implant Marginal: Marginal: No, the microgaps were
(1997) system (Southern EC (EH) System System (SI/SI) 0.23 (SI/BR) 2.89 generally small
Implants, Irene, South EC (EH) (BR) Brånemark (BR) Brånemark (BR/BR) 7.17 (SI/SV) <1.00 indicating good
Africa) EC (EH) (SV) Swede-vent (SV) Swede-Vent (SV/SV) 0.00 (SI/SO) 1.35 machining tolerances.
(BR) Brånemark (Nobel (SO) Steri-Oss (SO) Steri-Oss (SO/SO) <1.00 (BR/SI) 1.00 There were significant
Biocare, Göteborg, (BR/SV) 0.00 differences in
Sweden) (BR/SO) 1.22 overhangs, however.
(SV) Swede-vent Implant (SV/SI) <1.00
(Core-vent corporation, (SV/BR) 0.00
Encino, California)

(SV/SO) <1.00
(SO) Steri-oss Implant (SO/SI) 2.12
(Denar, Anaheim, (SO/BR) 1.90
California) (SO/SV) 1.00
Markarian SIN implant system (SIN EC (EH) (I) Titanium computer (II) Zirconia CNC Milling Marginal gap: Before Marginal gap: Yes, generally in favor of
et al. (2018) Implant System, São numeric control (CNC) Machine – RODERS, loading/ post Before loading/ OAs.
Paulo, São Paulo, Brazil) prefabricated (SIN Implant RXD5 loading post loading
System, São Paulo, São (III) Selective laser melting (I) 1.103/ 2.296 (II) 11.746/
Paulo, Brazil) CoCr – CUBO milling 10.428
centre (III) 24.705/
(IV) CNC CoCr abutment – 18.405
Neoshape, Neodent (IV) 2.609/ 1.898
(V) CoCr Milled abutment (V) 1.098/ 3.583
(Ceramill, Amann Girrbach
AG, Koblach, Austria)
(Continued)
e27
e28
Table 2 (Continued)
Queiroz et al. Titamax EC (EH) (N) Neodent Antirotational (CC) NiCr Completely cast Initial gap/ gap after Initial gap/ after Yes, in favor of OAs.
(2019) (Neodent-Straumann, cobalt-chromium custom Anti-rotational custom loading: loading
Basel, Switzerland) dental implant abutment dental implant abutment (N) 2/ 20 (CC) 37/ 58
with Zirconia CAD/CAM (Talmax, Curitiba, Paraná, (OC) 35/ 41
(Neodent-Straumann, Brazil) (Z) 4/ 19
Basel, Switzerland) (OC) Overcast
Antirotational
cobalt-chromium custom
dental implant abutment
with Ni-Cr-Ti (Talmax,
Curitiba, Paraná, Brazil)
(Z) Zirkonzahn
Antirotational
Zirconia CAD/CAM
(Zirkonzahn, Gais, Italy)
Sola-Ruiz et al. (BF) Biofit Implant EC (EH) (BF) Biofit (Castemaggiore, (BF) Biofit (Castemaggiore, Implant/Abutment fit: (3i/BN): E No, both deemed
(2013) (Castemaggiore, Italy) Italy) Italy) (3i/3i): G (3i/BTI): E acceptable.
(BN) Bioner S.A implant (BN) Bioner S.A (BN) Bioner S.A (BN/BN): G (BTI/NB):E
(Barcelona, Spain) (Barcelona, Spain) (Barcelona, Spain) (BTI/BTI): G (NB/3i): E
(3i) 3i Biomet implant (3i) 3i Biomet (Palm (3i) 3i Biomet (Palm (NB/NB): G (NB/BTI): E
(Palm Beach, Florida, USA) Beach, Florida, USA) Beach, Florida, USA) (BF/BF): A (BF/BN): G
(BTI) BTI implant (Alava, (BTI) BTI (Alava, Spain) (BTI) BTI (Alava, Spain) Note: Authors (BN/3i): G
Spain) (NB) Nobel Biocare (NB) Nobel Biocare denoted gap (BN/BTI): G
(NB) Nobel Biocare (Göteborg, Sweden) (Göteborg, Sweden) widths as: (BN/NB): G
implant (Göteborg, E = Excellent, (BTI/3i): G
Sweden) G = Good or (BTI/BN): G
A = Acceptable (NB/BN): G
(3i/BF): A
(BF/3i): A
(BF/NTI): A
(BF/NB): A
(BN/BF): A
(BTI/BF): A
(NB/BF): A
(Continued)
Rizvi et al

Table 2 (Continued)
Rizvi et al
Zanardi et al. (SIN) SIN implant system EC (EH) (SIN) Rotational abutment (SIN) Rotational abutment Rotational: Rotational: No for the designated
(2012) (SIN Implant System, São SIN implant system SIN implant system (SIN/SIN): 2.6 (SIN/NEO): 4.66 NOA (MIC).
Paulo, São Paulo, Brazil) (NEO) Rotational (NEO) Rotational (NEO/NEO):2.87 (SIN/CON): 9.09 When abutments
(NEO) NEO implant abutment NEO implant abutment NEO implant (CON/CON):10.55 (SIN/MIC): 2.78 simply interchanged
system (Neodent, system system Non rotational: (NEO/SIN): 2.94 there was a lack of
Curitiba, Paraná, Brazil) (CON) Rotational (CON) Rotational (SIN/SIN): 2.97 (NEO/CON): consistency – but
(CON) CON implant abutment CON implant abutment CON implant (NEO/NEO):1.87 7.87 generally within
system (Conexão system system (CON/CON):8.76 (NEO/MIC):4.07 clinically acceptable
Sistemas de Próteses, (SIN) Nonrotational (MIC) MIC Rotational (CON/ SIN): 4.94 limits.
Arujá, São Paulo, Brazil) abutment SIN implant abutment (Microplant (CON/NEO):
system Sistemas de Prótese, São 6.33
(NEO) Nonrotational Paulo, Brazil) (CON/MIC):
abutment NEO implant (SIN) Nonrotational 6.22
system abutment SIN implant Nonrotational:
(CON) Nonrotational system (SIN/NEO): 2.62
abutment CON implant (NEO) Nonrotational (SIN/ CON): 5.34
system abutment NEO implant (SIN/MIC): 2.73
system (NEO/SIN): 3.22
(CON) Nonrotational (NEO/CON): 3.9
abutment CON implant (NEO/MIC): 2.52
system (CON/SIN): 4
(MIC) MIC Nonrotational (CON/NEO):6.48

abutment (Microplant (CON/MIC):
Sistemas de Prótese, São 3.83
Paulo, Brazil)
Alonso-Perez Tapered Screw-Vent IC (IH) Titanium Zimmer Hex-lock Titanium CAD/CAM, Marginal: not Marginal: 2.5 In favor of OAs. Both
et al. (2017) (Zimmer Biomet, Warsaw, contour abutment Laser-sintered (Philbo detectable clinically acceptable.
Indiana, USA) (Zimmer Biomet, Warsaw, Dental Solutions)
Indiana, USA)
Alonso-Perez Straumann® Standard Plus, IC (ICo) (I) CoCr SynOcta® (II) CoCr Ebsynocta, LC® Implant-abutment: (I) Implant-abutment: Yes. In favor of OAs.
et al. (2018) (Straumann®, Basel, prosthetic system (Montcada i Reixac, Spain) 0.7 (II): approx. 1.5
Switzerland) (Straumann®, Basel, (III) CoCr SynOcta type Implant- crown: (I) (estimated from
Switzerland) abutment, (Proclinic®, 5.5 graph)
Zaragoza, Spain) (III): 7.7
Implant-crown:
(II): approx. 9.5
(estimated form
graph)
(III): 35.8
(Continued)
e29
Table 2 (Continued)
e30
Baldassarri (A) Nobel Replace Select IC (IDH) (I) NobelProcera® Zirconia (IV) Astra Tech Atlantis Marginal Gap: (B/IV): 11.8 Yes. In favor of OAs.
et al. (2012) Tapered TiUnite (Nobel CAD/CAM abutments on custom Zirconia Dentsply (A/I) – 8.4
Biocare, Göteborg, Ti base (Procera, Nobel Implants, Mölndal, (B/II) – 5.7
Sweden) Biocare Göteborg, Sweden) (B/III) – 1.6
(B) NanoTite Tapered Sweden)
Certain Implants (Biomet (II) Encode CAD/CAM
3i Inc., Palm Beach zirconia abutments
Gardens, FL, USA) (Biomet 3i Inc., Palm
(III) Encode custom
titanium abutments
(Biomet 3i Inc., Palm
Berberi et al. OsseoSpeed TXTM IC (IDH) (I) TiDesignTM (AstraTech (II) NateaTM (EuroteknikaTM (I): 0 (II): 6.5 Yes, in favor of OAs
(2016) (AstraTech Implant Implant SystemTM , Group, Sallanches, France) (III): 5
SystemsTM , Dentsply Dentsply Implants, (III) ImplanetTM (Derig
Implants, Mölndal, Mölndal, Sweden) LTDA, São Paulo, Brazil)
Sweden)
Duraisamy ADIN Dental Implants IC (IH) Pre-machined Standard Ti Pre- machined standard Ti External portion of External: 2.395 Yes, in favor of OAs, but
et al. (2019) (ADIN, Israel) abutments (ADIN Dental abutments (MIS Implant interface: 1.597 Middle: 2.488 both within clinically
Implants) Technologies, Ltd.) Middle: 1.399 Internal: 3.339 acceptable limits.
Internal: 1.831
Hamilton et al. (SBL) Straumann Bone level IC (ICo) (I) RC Anatomic (Straumann, (V) NobelProcera® (SBL/I) 28.0 (SBL/V) 29.1 No in general, except for
(2013) (Straumann, Basel, IC (ICo) Basel, Switzerland) CAD/CAM titanium (Nobel (SSP/II) 14.2 (SSP/V) 48.7 SSP. (NOAs were
Switzerland) IC (ITC) (II) RN synOcta® titanium Biocare, Göteborg, (SSP/III) 4.0 (OS/V) 29.0 connected to implants
(SSP) Straumann Standard IC (IDH) (Straumann, Basel, Sweden) (NR/IV) 47.7 with internal
Plus (Straumann, Basel, EC (EH) Switzerland) (NR/V) 62.6 connection only)
Switzerland) (III) RN synOcta® + milling (OS/VI) 31.3
(NR) Nobel Replace (Nobel cylinder (Straumann, (BR/IV) 22.3
Biocare, Göteborg, Basel, Switzerland) (BR/V) 21.2
Sweden) (IV) Esthetic (Nobel
(OS) OsseoSpeedTM Biocare, Göteborg,
(Astra Tech Implant Sweden)
Systems, Dentsply (V) NobelProcera
Implants, Mölndal, CAD/CAM titanium (Nobel
Sweden) Biocare, Göteborg,
(BR) Brånemark RP (Nobel Sweden)
Biocare, Göteborg, (VI) TidesignTM (Astra Tech
Sweden) Implant Systems,
Dentsply, Mölndal,
Sweden)
(Continued)
Rizvi et al

Rizvi et al
Table 2 (Continued)
Park et al. Brånemark Mark III implant EC (EH) Gold UCLA abutment (Nobel Custom milled Ti abutment Branemark with Branemark with No difference between
(2014) system (Nobel biocare, IC (IH) biocare, USA) (ADDTECH, South Korea) UCLA: 35.0 Custom milled: OAs and NOAs.
USA) Replace with 32.4 Type of connection not
Replace Select implant UCLA: 31.3 Replace with significant
system (Nobel biocare, Custom milled:
USA) 30.7
Siadat et al. (A) Brånemark (Nobel EC (EH) (I) (Brånemark, Nobel (III) ICE Zirkon, Zirkonzahn (A/I) (A/III) Yes, greater horizontal
(2017) Biocare AB, Göteborg, IC (IH) Biocare AB, Göteborg, GmbH) Horizontal gap: 2 Horizontal gap: and vertical gaps in
Sweden) Sweden) Vertical gap: 0 4 internal connections
(B) Noble Replace (Nobel (II) (Noble Replace, Nobel (B/II) Vertical gap: 0 for OAs and NOAs.
Biocare AB, Göteborg, Biocare AB, Göteborg, Horizontal gap: 59 (B/III) For NOAs, horizontal
Sweden) Sweden) Vertical gap: 63 Horizontal gap: gaps significantly less
39 on external
Vertical gap: 48 connection.
Areas of Tight Contact

Connection Original Areas of tight contact Areas of tight Difference between OAs
Author(s) Implant system(s) type abutments Non-original abutments (OAs) contact (NOAs) and NOAs significant?
Fokas et al. Bone Level Implant; IC (ICo) (Zr1) Cares (Straumann, (Zr2) Atlantis; (Dentsply Length of tight Length of tight Yes. In favor of OAs with
(2019) Straumann AG Basel, Switzerland) Sirona, Sweden) contact at contact at regards to zirconia
(Straumann, Basel, (Ti1) Variobase (Zr3) Aadva Zr (GC connection level connection level abutments.
Switzerland) (Straumann, Basel, Advanced Technologies (mm): left/right (mm): left/ right
Switzerland) Inc, Alsip, Illinois) (Zr1) 0.91/ 0.92 (Zr2) 0.69/ 0.56
(Gold1) Straumann Gold (Ti2) KISS (Blue Sky Bio, (Ti1) 0.71/ 0.73 (Zr3) 0.00/ 0.00
(Straumann, Basel, Grayslake, Illinois, USA) (Gold1) 0.71/ 0.75 (Ti2) 0.85/ 0.84
Switzerland) (Gold2) Gold UCLA (Blue (Gold2) 0.84/
Sky Bio, Grayslake, Illinois, 0.86
USA)
(Continued)
e31
e32
Table 2 (Continued)
Areas of Tight Contact
Connection Original Areas of tight contact Areas of tight Difference between OAs
Author(s) Implant system(s) type abutments Non-original abutments (OAs) contact (NOAs) and NOAs significant?
Mattheos et al. Straumann AG (Straumann, IC (ICo) (I) Straumann SynOcta Gold (II) Ostech Pro – Pack RN Length of total tight Length of total Yes, in favor of OAs
(2016) Basel, Switzerland) Eng II, CoCr Str contact as a tight contact as
(III) Medentika GmbH percentage of a percentage of
POC abutment, CoCr max. possible max. possible
contact area at IAI contact area at
(%): left/ right IAI (%): left/
(I) right
Shoulder: 82.57/ (II)
82.06 Shoulder: 76.10/
Internal: 51.67/ 75.79
53.13 Internal: 0.00/

12.40
(III)
Shoulder: 46.55/
73.17
Internal:0.00/
0.00
Groups (II) and
(III) showed
higher stress
and strain under
finite element
analysis than
group (I).
Mattheos et al. Straumann AG (Straumann, IC (ICo) (I) Straumann Variobase RN (II) Ebi best duo abutment Length of total tight Length of total Yes, in favor of OAS.
(2017) Basel, Switzerland) abutment (III) Implant direct titanium contact at IAI tight contact at
abutment (mm): left/ right IAI (mm): left/
(I) right
Shoulder: (II)
0.81/0.79 Shoulder: -
Internal: 0.39/1.39 Internal: 1.46/
1.43
(III)
Shoulder: 0.40/
0.40
Internal: 0.31/
0.24
(Continued)
Rizvi et al

Table 2 (Continued)
Component Dimensions
Rizvi et al
Component
Connection Original Component dimensions Difference between OAs
Author(s) Implant system(s) type abutments Non-original abutments dimensions (OAs) (NOAs) and NOAs significant?
Lang et al. (A) Procera (Nobel Biocare, EC (EH) Procera CAD/CAM custom Procera CAD/CAM custom Dimensions of each Dimensions of No. All abutments
(2003) Göteborg, Sweden) abutment (Nobel Biocare abutment (Nobel Biocare implant hexagon each implant deemed
(B) Brånemark (Nobel Göteborg, Sweden) Göteborg, Sweden) (A) hexagon interchangeable
Biocare Göteborg, Dimensions of flat-to-flat Dimensions of flat-to-flat Width = 2.73 mm (C) provided the screw is
Sweden) width and height for width and height for Height = 0.9 mm Width = 2.67 from the same
(C) Lifecore Restore abutment abutment (B) mm manufacturer as the
(Lifecore Biomedical, Width = 2.73 mm Width = 2.73 mm Width = 2.69 mm Height = 0.81 abutment.
Chaska, MN, U.S.A) Height = 0.9 mm Height = 0.9 mm Height = 0.70 mm mm
(D) 3i (Palm Beach, FL, (D)
U.S.A.) Width = 2.69
(E) ImplaMed (ImplaMed, mm
Attleboro, MA, U.S.A) Height = 0.70
(F) Paragon Taper-Lock mm
(Encino, CA) (E)
Width = 2.69
mm
Height = 0.69
mm
(F)
Width = 2.69

mm
Height = 0.79
mm
Karl and NobelActive implants with a IC (ICo) (I) Snappy Abutment (III) ArgenIS Titanium Flat-to-flat Flat-to-flat Yes, NOAs deviate from
Irastorza- regular platform (Nobel RP 5.5 mm (Nobel Abutment F-Series (The Dimensions % Dimensions % dimensions of OAs
Landa Biocare) Biocare) – used as Argen Corporation) deviation from deviation from
(2018) reference system. (IV) Atlantis Titanium snappy abutment snappy
Dimensions not disclosed Abutment for A: abutment A:
(II) NobelProcera Titanium cement-retained (II) −0.24 (III) 0.92
Abutment (Nobel Biocare) restorations (Dentsply (IV) 0.11
Sirona Implants) (V) −0.15
(V) Inclusive Custom (VI) 0.34
Titanium Abutments
(Glidewell Laboratories)
(VI) InterActive Straight
Contoured Abutment
(Implant Direct Sybron
Manufacturing)
(Continued)
e33
e34
Table 2 (Continued)
Scratches and Wear
Connection Original Scratches/wear Difference between OAs

Author(s) Implant system(s) type abutments Non-original abutments Scratches/wear (OAs) (NOAs) and NOAs significant?
Tannure et al. Titamax EC (EH) (I) CAD/CAM Zirconia (III) CAD/CAM Zirconia Less scratches in (II) (IV) Had most Yes, in favor of OAs
(2017) (Neodent-Straumann, (Neodent) (Amann Girrbach AG, than (I) scratches, (between the zirconia
Basel, Switzerland) (II) Zirconia abutments on Koblach, Austria) Values not given in indicated a poor abutments)
Titanium base (Neodent, (IV) CAD/ CAM Zirconia study. fit and hexagon
Curitiba, Paraná, Brazil) (Zirkonzahn, Gais, Italy) mismatch.
Queiroz et al. Titamax EC (EH) (N) Neodent Antirotational (CC) NiCr Completely cast Worn surface area Worn surface area Yes, in favor of the NOAs.
(2019) (Neodent-Straumann, cobalt-chromium custom Anti-rotational custom (mm2 ) (mm2 )
Basel, Switzerland) dental implant abutment dental implant abutment (N) 1313 (CC) 231
with Zirconia CAD/CAM (Talmax, Curitiba, Paraná, (OC) 201
(Neodent-Straumann, Brazil) (Z) 735
Basel, Switzerland) (OC) Overcast
Antirotational
with Ni-Cr-Ti (Talmax,
Curitiba, Paraná, Brazil)
(Z) Zirkonzahn
Antirotational
Zirconia CAD/CAM
(Zirkonzahn, Gais, Italy)
EC = external connection, IC = internal connection, (EH) = external hexagon, (IH) = internal hexagon, (IDH) = internal double hexagon, (ICo) = internal conical, (MT) = Morse Taper, (ITC) = internal tri-channel.
Implant-abutment combinations denoted with letters and roman numerals in brackets.
Rizvi et al

Rizvi et al
Table 3 Studies investigating microleakage to indicate degree of misfit
Implant Difference between OAs and

Author(s) system Connection type Original abutments Non-original abutments Microleakage (OAs) Microleakage (NOAs) NOAs significant?
Berberi et al. OsseoSpeedTM (Astra IC (IDH) TiDesignTM (AstraTech NateaTM At 1hr/ at 48hrs At 1hr/ at 48hrs Yes, in favor of OAs
(2014) Tech Implant Implant SystemTM , (EuroteknikaTM 1.48%/ 5.56% NateaTM : 27.92%/
Systems, Dentsply Dentsply Implants, Group, Sallanches, 39.80%
Implants, Mölndal, Mölndal, Sweden) France) DualTM : 10.59%/19.32%
Sweden) DualTM (Implantium, ImplanetTM : 51.03%/
Dentium Implant 66.71%
System, Seoul,
South Korea)
ImplanetTM (Derig
LTDA, São Paulo,
Brazil)
Karl and NobelActive implants IC (ICo) (I) Snappy Abutment RP (III) ArgenIS Titanium After 6 days: After 6 days: No difference between OAs
Irastorza- with a regular 5.5 mm (Nobel Biocare) Abutment F-Series (I) 28.57% (III) 33.33% and NOAs.
Landa platform (Nobel (II) NobelProcera (The Argen (II) 30.95% (IV) 40.48%
(2018) Biocare) Titanium Abutment Corporation) (V) 30.95%
(Nobel Biocare) (IV) Atlantis Titanium (VI) 45.24%
Abutment for

cement-retained
restorations
(Dentsply Sirona
Implants)
(V) Inclusive Custom
Titanium Abutments
(Glidewell
Laboratories)
(VI) InterActive
Straight Contoured
Abutment (Implant
Direct Sybron
Manufacturing)
IC = internal connection, IDH = internal double hexagon, ICo = internal conical.
e35
Table 4 Studies testing micromotion and displacement of abutments
e36
Mean gap widths/ Mean gap widths/micromotion/ Difference between
micromotion/ displacement displacement (NOAs) Pre-/post OAs and NOAs
Authors Implant system Connection type Original abutments Non-original abutments (OAs) Pre-/post loading (μm) loading (μm) significant?
TM
Berberi et al. OsseoSpeed TX IC (IDH) TiDesignTM (AstraTech NateaTM (EuroteknikaTM Gap widths: Gap widths:NateaTM : 6.5 / 12.4 Yes, less movement
(2016) (AstraTech Implant Implant SystemTM , Group, Sallanches, TiDesignTM : ImplanetTM : 5 / 22.8 with OAs.
SystemsTM , Dentsply Implants, France) 0/ 8.4
Dentsply Implants, Mölndal, Sweden) ImplanetTM (Derig
Mölndal, Sweden) LTDA, São Paulo,
Brazil)
Karl and NobelActive IC (ICo) (I) Snappy Abutment RP (III) ArgenIS Titanium Post-loading micromotion Post-loading micromotion No difference between
Irastorza- implants with a 5.5 mm (Nobel Abutment F-Series (I) 65.14 (III) 63.14 OAs and NOAs,
Landa regular platform Biocare) (The Argen (II) 75.74 (IV) 61.68 except group (VI).
(2018) (Nobel Biocare) (II) NobelProcera Corporation) (V) 75.67
Titanium Abutment (IV) Atlantis Titanium (VI) 79.69
(Nobel Biocare) Abutment for
cement-retained
restorations
(Dentsply Sirona
Implants)
(V) Inclusive Custom
Titanium Abutments
(Glidewell
Laboratories)
(VI) InterActive
Straight Contoured
Abutment (Implant
Direct Sybron
Manufacturing)
Karl and Taylor Straumann IC (ICo) Two-piece cementable Two-piece cementable Mean micromotion: Mean micromotion: No, in general.
(2016) Tissue-level (Straumann, Basel, abutment (Dr. Ihde Straumann two-piece: Dr. Ihde: 63.41 / 42.40
(Straumann, Switzerland) Dental AG, 55.33/40.16 Medentika: 43.84 / 34.76
Basel, CAD/CAM titanium Gommiswald, CAD/CAM titanium: NobelProcera® : 33.15 / 30.03
Switzerland) abutment Switzerland) 47.64/ 37.18
(Straumann, Basel, Two-piece CAD/CAM zirconia:44.11/
Switzerland) cementable 35.30
CAD/CAM zirconia abutment (Medentika
abutment GmbH, Hügelsheim,
(Straumann, Basel, Germany)
Switzerland) NobelProcera®
CAD/CAM titanium
(Nobel Biocare,
Göteborg, Sweden)
(Continued)
Rizvi et al

Rizvi et al
Table 4 (Continued)
Mean gap widths/ Mean gap widths/micromotion/ Difference between

micromotion/ displacement displacement (NOAs) Pre-/post OAs and NOAs
Authors Implant system Connection type Original abutments Non-original abutments (OAs) Pre-/post loading (μm) loading (μm) significant?
Yilmaz et al. Tapered Screw-Vent IC (IH) (I) Hex-lock Contour (IV) Atlantis custom 3D - Displacement after 1st 3D - Displacement after 1st Torque/ No, in general
(2015a) Implant (Zimmer stock abutment Titanium (Dentsply Torque/ 2nd Torque 2nd Torque
Inc, Warsaw, (Zimmer, Inc, Implants, Mölndal, (I) 5/ 1 (IV) 16/ 9
Indiana, USA) Warsaw, Indiana, Sweden) (II) 7.5/ 4 (V) 4.5/ 2
USA) (V) Atlantis custom (III) 6.5/ 3 (VI) 10.5/ 7
(II) Zimmer Contour Zirconia (Dentsply (VII) 6/ 1
Zirconia stock Implants, Mölndal, (VIII) 6.5/ 2
Abutment (Zimmer, Sweden) (IX) 11.5/ 3
Inc, Warsaw, Indiana, (VI) Inclusive Custom
USA) Implant Abutment
(III) Zimmer Patient Titanium (Glidewell
Specific Abutment Laboratories,
custom Titanium Frankfurt, Germany)
(Zimmer, Inc, (VII) Inclusive Custom
Warsaw, Indiana, Implant Abutment
USA) All-zirconia (Glidewell

Laboratories,
Frankfurt am main,
Germany)
(VIII) Legacy Straight
Contoured stock
Abutment (Implant
Direct, Kloten,
Switzerland)
(IX) Legacy Zirconia
Straight Contoured
stock Abutment
(Implant Direct,
Kloten, Switzerland)
IC = internal connection, IH = internal hexagon, IDH = internal double hexagon, ICo = internal conical
e37
e38
Table 5 Studies testing rotational misfit of abutments
Mean rotational Mean rotational Difference between OAs

Author(s) Implant system(s) Connection type Original abutments Non-original abutments freedom (degrees) OAs freedom (degrees) NOAs and NOAs significant?
Alikhasi et al. Brånemark (Nobel Biocare, EC (EH) Titanium Easy Customised ICE zirconia 0.99 8.28 Titanium OAs significantly
(2013) Göteborg, Sweden) Abutment (Nobel abutment (Zirkonzahn, display significantly less
Biocare, Gotëborg, Gais, Italy) rotational freedom than
Sweden) zirconia NOAs.
Binon (1995) (NP) Nobelpharma USA EC (EH) (3ia) Implant (NPa) Nobelpharma USA (Xmark/Xmarka): 4.0 (NP/IMPa): 3.5 Both OAs and NOAs
(Chicago IL) EC (EH) innovations Inc. (Chicago IL) (3i/3ia): 4.6 (NP/3ia): 4.9 display rotational
(STR) Stryker (Kalamazoo, Ml) EC (EH) (West Palm Beach, (STRa) Stryker (IMP/IMPa): 5.0 (NP/ISSa): 6.4 freedom.
(SO) Steri-Oss (Anaheim, CA) EC (EH) FL) (Kalamazoo, Ml) (ISS/ISSa): 6.7 (NP/OTCa): 7.9
(3i) Implant innovations Inc. EC (EH) (Xmarka) Crossmark (SOa) Steri-Oss (NP/NPa): 6.7 (3i/IMPa): 4.3
(West Palm Beach, FL) EC (EH) (Belmont, CA) (Anaheim, CA) (3i/ISSa): 6.3
(OTC) Osseodent (Palo Alto, EC (EH) (IMPa) Impla-Med (3ia) Implant innovations (3i/NPa): 6.9
CA) EC (EH) (Sunrise, FL) Inc. (West Palm Beach, (3i/OTCa): 7.4
(ISS) Implant Support EC (EH) (ISSa) Implant FL) (ISS/IMPa): 4.2
Systems (Irvine, CA) EC (EH) Support Systems (OTCa) Osseodent (Palo (ISS/NPa): 7.5
(IMTEC) IMTEC (Ardmore, EC (EH) (Irvine, CA) Alto, CA) (ISS/3ia): 7.5
OK) EC (EH) (IMTECa) IMTEC (ISSa) Implant Support (ISS/OTCa): 8.9
(SV) Dentsply-Core-Vent Div. (Ardmore, OK) Systems (Irvine, CA) (IMP/NPa): 7.9
(Encino, CA) (NPa) Nobelpharma (IMTECa) IMTEC (IMP/3ia): 8.7
(IMP) Impla-Med (Sunrise, FL) USA (Chicago IL) (Ardmore, OK) (IMP/ISSa):8.7
(Bud) Bud Ind. (East Aurora, (SVa) (IMP/OTCa): 9.5
NY) Dentsply-Core-Vent Div. (SO/IMPa): 5.7
(Xmark) Crossmark (Belmont, (Encino, CA) (SO/3ia): 7.3
CA) (IMPa) Impla-Med (SO/ISSa): 8.3
(IMZ) Interpore Int. (Irvine, (Sunrise, FL) (SO/OTCa): 8.6
CA) (Buda) Bud Ind. (East (SO/NPa): 9.3
Aurora, NY) (STR/NPa): 8.8
(Xmarka) Crossmark (STR/3ia): 9.0
(Belmont, CA) (STR/ISSa): 9.3
(IMZa) Interpore Int. (STR/OTCa): 10.1
(Irvine, CA)
(Continued)
Rizvi et al

Rizvi et al
Table 5 (Continued)
Mean rotational Mean rotational Difference between OAs

Author(s) Implant system(s) Connection type Original abutments Non-original abutments freedom (degrees) OAs freedom (degrees) NOAs and NOAs significant?
Gigandet et al. (A) Straumann Roxolid® IC (ICo) (I) CARES® titanium (IV) NobelProcera® (A/I) 1.21 (A/IV): no measurement Yes, less rotational
(2014) (Straumann, Basel, IC (ITC) CAD/CAM titanium CAD/CAM (B/II) 3.50 (C/III) 2.50 possible as abutments freedom/ misfit with
Switzerland) IC (IDH) (Straumann, Basel, (Nobel Biocare Kloten, oversized OAs
(B) Nobel Biocare Switzerland) Switzerland) (A/V): 2.01
Replace/Select Straight (II) NobelProcera® (V) Atlantis® titanium
(Nobel BiocareTM , Kloten, titanium CAD/CAM CAD/CAM (Astra Tech,
Switzerland) (Nobel Biocare Lausanne Switzerland)
(C) Astra Tech OsseoSpeed Kloten, Switzerland)
TXTM (Astra Tech, Lausanne (III) Atlantis® titanium
Switzerland) CAD/CAM (Astra
Tech, Lausanne
Switzerland)
Siadat et al. (2017)
(A) Brånemark (Nobel Biocare EC (EH) (I) Brånemark (Nobel (III) ICE Zirkon, Zirkonzahn(A/I): 0.97 (A/III): 7.911 Yes, less rotational

AB, Göteborg, Sweden) IC (IH) Biocare AB, GmbH) (B/II): 0.000 (B/III): 4.645 freedom with titanium
(B) Noble Replace (Nobel Göteborg, Sweden) OAs on both external
Biocare AB, Göteborg, (II) Noble Replace and internal connections
Sweden) (Nobel Biocare AB, compared with zirconia
Göteborg, Sweden) NOAs.
Influence of connection
type: For NOAs, less
rotational freedom on
internal connections.
EC = external connection, IC = internal connection, (EH) = external hexagon, (IH) = internal hexagon, (IDH) = internal double hexagon, (ICo) = internal conical, (ITC) = internal tri-channel.
e39
higher, i.e., there was less screw loosening with OAs com- (HP) was consulted where required. Selection bias was reduced
pared with NOAs.6,13,16,23,28 Four studies reported differences by hand searching all volumes of relevant journals between
in removal torques between OAs and NOAs were not signifi- January 2010 and July 2020. The Cohen’s Kappa score for
cant. One of these tested on internal connections only,27 1 study inter-reviewer agreement regarding eligibility of studies was
tested on external connections34 and two studies tested on both “substantial,” which indicated reviewers were generally fol-
internal and external connections.42,43 Table 6 details the find- lowing the same criteria and consistent with each other.
ings. With 15 studies declaring directly receiving sponsorship (ei-
The type of implant-abutment connection did not influence ther funding or provision of components) from the manufactur-
removal torque values. In one study, the removal torque value ers of the very same implant systems/components being tested
for NOAs post-loading was higher on the external connection and 1 study stating a co-author was employed by one of these
than on the internal connection,42 whilst another found that companies—there is a potential risk of reporting bias in over
there was greater loss of torque when NOAs were connected to a third of the studies included in this review. Around one third
external connection.43 These differences were not statistically did not state whether there were any conflicts of interest of
significant. sponsorships to be acknowledged, hence the risk of bias may
be even greater.
Maximum load capacity and fracture resistance, Most of the studies included in this review were conducted
tensile and compressive strengths in vitro, therefore results observed may not resemble clinical
Five of 10 studies testing OAs and NOAs on implants with an behavior. There was a high degree of heterogeneity in the stud-
internal connection found no statistical significant differences ies, i.e., abutments tested varied according to brand, fabrica-
between the groups, in general.12,13,24,29,32 Two types of zirco- tion method, material and assembly. There were also differ-
nia NOAs were found to have higher load to failure values than ences in the testing methods, e.g., the studies that measured gap
their original counterparts, however these observations were widths with scanning electron microscopy (SEM) measured
attributed to the incorporation of titanium.24,32 Four studies re- the widths at different points of the implant-abutment interface,
ported better outcomes with OAs compared to NOAs.22,25,31,41 thus, the results could not be pooled together for quantitative
One study unexpectedly found higher load to deformity and analysis.
failure in NOAs compared with OAs.8
Jarman et al conducted the only study which placed an NOA Implications of the review
on internal and external connections and found no statistically The findings of this study were generally in agreement with
significant differences between outcomes on different connec- a previous systematic review,5 which concluded a lower in-
tion types.41 Table 7 summarizes the findings. cidence of mechanical failure and higher marginal accu-
racy overall for original abutments compared to non-original
In vivo implant and prosthesis outcomes abutments.5 Although most studies recommend original abut-
No clinical studies allowing comparison of OAs and NOAs on ments based on these findings, the results show that in
different connections were available at the time this systematic some instances, NOAs are comparable to OAs with regards
review was conducted. to precision of fit and resulted in less severe mechanical
One retrospective clinical study with a mean follow up pe- failures.7,9,10,34,35,42,43 Most of these studies tested NOAs on
riod of 7.2 years allowed comparison of posterior implant external connections.
supported restorations on original prefabricated and compat- Some observations could be made based on the few stud-
ible CAD-CAM titanium abutments on implants with an in- ies which allowed direct comparison of NOAs on internal and
ternal connection.20 No implant failures were reported in ei- external connections. Mechanical failures appeared to be less
ther group. The statistically significant differences were for de- catastrophic when NOAs were placed on external connections
cementation, which was greater in OAs (14.1%) than NOAs compared with on internal connections41 and this may be due
(3.1%) and abutment screw loosening which was seen more to increased rotational freedom this connection provides. The
frequently in NOAs (11%) than OAs (0%). rotational freedom was greater when NOAs were placed on ex-
ternal connections compared with internal connections.43 Con-
Discussion nection type did not influence abutment screw loosening.42,43
With regards to precision of fit, Park et al reported no sig-
This study is the first to specifically investigate the influence of nificant differences between NOAs on internal and external
connection geometry on compatibility of NOAs. The rigorous connections,42 whereas Siadat et al found NOAs showed sig-
searching process enabled detection of a number of additional nificantly more intimate marginal fit on external connections
studies previously not included and provides the most recent compared with on internal connection.43
evidence on the subject.
Recommendations for further research
Strengths and limitations
Reporting on long term in vivo outcomes with the use of orig-
The PRISMA guidelines11 were followed, providing a method- inal versus non-original abutments would give a more accu-
ical and transparent approach to reviewing the literature. Fur- rate representation of the outcomes of clinical use in patients.
ther effort to minimize bias was exercised by the two reviewers, There is also need for more in vitro studies comparing NOAs
who assessed the studies independently, and a third reviewer and OAs on a variety of internal and external connections, as
Rizvi et al
Table 6 Studies testing removal torque values
Implant Connection Non-original Mean post-loading removal Mean post-loading removal Difference between OAs
Author(s) system(s) type Original abutments abutments torque values (RTVs) - OAs torque values (RTVs) - NOAs and NOAs significant?
Alonso-Perez Straumann Standard IC (ICo) (I) SynOcta® prosthetic (II) Ebsynocta, (I) 30.4Ncm (13.1% loss) (II) 26.4Ncm (24.6% loss) Yes, in favor of OAs
et al. (2018) Plus (Straumann, system (Straumann, LC®, Montcada (III) 23.8Ncm (32.1% loss)
Basel, Switzerland) Basel, Switzerland) i Reixac, Spain
(III)SynOcta
type abutment,
Proclinic® ,
Zaragoza, Spain
Cashman et al. Straumann IC (ICo) Straumann regular neck Titan Implant Inc. 42.65N 36.25N Yes, in favor of OAs
(2011) tissue-level solid abutment abutment
(Straumann USA, (Straumann USA, (Titan Implant,
Andover, MA) Andover, MA) Bergenfield,
New Jersey)
Kim et al. Straumann SLA IC (ICo) Straumann® Solid Restore RDS 32.74Ncm Restore: 22.79 Ncm Yes, in favor of OAs
(2012) (Straumann, Basel, abutment COC (Lifecore Neoplant: 12.00 Ncm (6
Switzerland) (Straumann, Basel, Biomedical Inc, screws fractured)
Switzerland) USA) AVANA: 18.67 Ncm (4
Neoplant solid implants fractured)

abutment
(Niobiotech® )
AVANA solid
abutment
(Osstem Co,
Busana, Korea)
Kim and Shin GS II Fixture (Osstem IC (IH) Ti stock abutment CAD/CAM Ti Ti stock: 17.67Ncm Myplant: 15.20Ncm Yes, in favor of OAs.
(2013) Co., Seoul, Korea) (Osstem Co., Seoul, MYPLANT Goldcast: 16.10Ncm
Korea) (Raphabio,
GoldCast abutment Seoul, Korea)
(Osstem Co., Seoul,
Korea)
(Continued)
e41
e42
Table 6 (Continued)
Paek et al. Implantium (Dentium, IC (IH) Stock Abutment Myplant (first loading/ second (first loading/ second loading) No difference between
(2016) Seoul, Korea) IC (IH) (Dentium, Seoul, (Raphabio, loading) Dentium/ Raphabio: OAs and NOAs.
GS (Osstem Co., IC (ICo) Korea) Seoul, Korea) Dentium/ Dentium: 26.67Ncm/ 23.5Ncm
Seoul, Korea) Stock Abutment 27.17Ncm/ 23Ncm Ossteum/ Raphabio:
Straumann Bone (Osstem Co., Seoul, Osstem/ Ossteum: 26.33Ncm/ 22.33Ncm
level (Straumann, Korea) 26.17Ncm/ 22.5Ncm Straumann/ Raphabio:

Basel, Switzerland) Straumann Bone Straumann/ Straumann: 36.67Ncm/ 32.5Ncm
level (Straumann, 37.33Ncm/ 32.67Ncm
Basel, Switzerland)
Park et al. Straumann SLA tissue IC (ICo) Solid abutment Solid abutment Solid: 34Ncm Southern Implants: 25Ncm Yes, in favor of OAs.
(2017) level (Straumann, (Straumann, Basel, (Southern Implant Direct: 23.9Ncm
Basel, Switzerland) Switzerland) Implants, Irene, Blue Sky Bio: 27.9Ncm
South Africa)
Straight
abutment
(Implant Direct
Sybron
International,
Valencia, USA)
Regular
Platform
abutment (Blue
Sky Bio,
Grayslake,
Illinois, USA)
(Continued)
Rizvi et al

Rizvi et al
Table 6 (Continued)
Assuncao et al. Osseotite Implants EC (EH) (I) Gold UCLA (V) Zirconia (I) 23.2Ncm Vertical: No statistical differences
(2011) (Biomet 3i Inc., abutments (Biomet 3i abutment (II) 23.8Ncm Pre-loading/post-loading between OAs and NOAs
Palm Beach Inc., Palm Beach obtained by (III) 22.1Ncm (V) 21.7Ncm
Gardens, FL, USA) Gardens, FL, USA) CAD/CAM (IV) 23.6Ncm
cast in gold alloy with system (Nobel
ceramic veneering Biocare,
(II) Gold UCLA Goteborg,
abutment (Biomet 3i Sweden) with
Inc., Palm Beach ceramic
Gardens, FL, USA) veneering.
cast in gold alloy with
resin veneering
(III) Titanium castable
UCLA abutment

Beach Gardens, FL,
USA) with ceramic
veneering
(IV) Titanium castable
UCLA abutment
Beach Gardens, FL,
USA)
(Continued)
e43
e44
Table 6 (Continued)
Park et al. Brånemark Mark III EC (EH) Gold UCLA abutment Custom milled Ti Branemark with UCLA: Branemark with Custom No difference between
(2014) implant system IC (IH) (Nobel biocare, USA) abutment 23.3 Ncm milled: 21.9 N OAs and NOAs.
(Nobel biocare, (ADDTECH, Replace with UCLA:23.9 Replace with Custom Type of connection not
USA) South Korea) Ncm milled : 21.7N significant.
Replace Select
implant system
(Nobel biocare,
USA)
Siadat et al. (A) Brånemark (Nobel EC (EH) (I) (Brånemark, Nobel (III) ICE Zirkon, Loss of torque values Loss of torque values: Although greater torque
(2017) Biocare AB, IC (IH) Biocare AB, Zirkonzahn (A/I) - 13.42 Ncm (A/III) - 14.20Ncm loss seen in NOAs
Göteborg, Sweden) Göteborg, Sweden) GmbH) (B/II) - 11.43 Ncm (B/III) - 11.86Ncm compared with OAs, and
(B) Noble Replace (II) (Noble Replace, external compared with
(Nobel Biocare AB, Nobel Biocare AB, internal connections, not
Göteborg, Sweden) Göteborg, Sweden) statistically significant.
EC = external connection, IC = internal connection, (EH) = external hexagon, (IH) = internal hexagon, (ICo) = internal conical.
Rizvi et al

Rizvi et al
Table 7 Studies investigating mechanical properties, e.g., load/cycles to failure, fracture resistance, tensile and compressive strengths
Implant Connection Non-original Load/Cycles to failure Load/Cycles to Difference between OAs and
Author(s) system(s) type Original abutments abutments (OAs) failure (NOAs) NOAs significant?
Alonso-Perez et al. Tapered Screw-Vent IC (IH) Zimmer Hex-lock CAD/CAM, Load-bearing capacity: Load-bearing No significant differences
(2017) (Zimmer Biomet, contour abutment Laser-sintered ∼ 750N capacity: ∼ between OAs and NOAs
Warsaw, Indiana, (Zimmer Biomet, (Philbo Dental Mean cycles to 800N
USA) Warsaw, Indiana, Solutions) failure: 423.225 ± Mean cycles
USA) 69.220 to failure:
416.069 ±
85.392
Alonso-Perez et al. Straumann® IC (ICo) (I) (SynOcta® (II) Ebsynocta, LC® , Static load bearing Static load No significant differences
(2018) (Standard Plus, prosthetic Montcada i Reixac, capacity: bearing between OAs and NOA
Straumann, system, Spain (I) 1098N capacity:
Basel, Straumann, (III) SynOcta type Load to (II)1057N
Switzerland) Basel, abutment, deformation: (III) 973N
Switzerland) Proclinic® , Zaragoza, (I) 842N Load to
Spain deformation:
(II) 736N
(III) 760N
Gigandet et al. Straumann Roxolid® IC (ICo) CARES® titanium NobelProcera® Straumann/ Straumann/ Yes, in favor of NOAs
(2014) (Straumann, IC (ITC) CAD/CAM titanium CAD/CAM Straumann Nobel Biocare
Basel, IC (IDH) (Straumann, (Nobel Biocare Force to fracture = Force to
Switzerland) Basel, Kloten, Switzerland) 553N

fracture =
Nobel Biocare Switzerland) Atlantis® titanium Force to 700N
Replace/Select NobelProcera® CAD/CAM (Astra deformation = Force to
Straight (Nobel titanium Tech, Lausanne 487N deformation
BiocareTM , CAD/CAM (Nobel Switzerland) Nobel/ Nobel: = 538N
Kloten, Biocare Kloten, Force to fracture = Straumann/
Switzerland) Switzerland) 555 N Astra Tech:
Astra Tech Atlantis® titanium Force to Force to
OsseoSpeed CAD/CAM (Astra deformation = fracture =
TXTM (Astra Tech, Tech, Lausanne 453N 690N
Lausanne Switzerland) Astra/ Astra: Force to
Switzerland) Force to fracture = deformation
508N = 587N
Force to
deformation =
439N
(Continued)
e45
e46
Table 7 (Continued)
Karl and NobelActive IC (ICo) (I) Snappy (III) ArgenIS Titanium Median fatigue limit Median Fatigue Yes, OAs generally performed
Irastorza-Landa implants with a Abutment RP 5.5 Abutment F-Series (N) limit (N) better than NOAs, with one
(2018) regular platform mm (Nobel (The Argen (I) 326.00 (III) 344.00 exception.
(Nobel Biocare) Biocare) – used Corporation) (II) 326.00 (IV) 246.00
as reference (IV) Atlantis (V) 296.00
system. Titanium Abutment (VI) 279.00
Dimensions not for cement-retained
disclosed restorations
(II) NobelProcera (Dentsply Sirona

Titanium Implants)
Abutment (Nobel (V) Inclusive Custom
Biocare) Titanium Abutments
(Glidewell
Laboratories)
(VI) InterActive
Straight Contoured
Abutment (Implant
Direct Sybron
Manufacturing)
Kim et al. (2013) NobelReplace IC (ITC) NobelProcera, Ti Aadva all zirconia Maximum load Maximum load No significant difference
(Noble Biocare, insert frictional fit CAD/CAM capacity: capacity: between NobelProcera and
Yorba Linda, to zirconia abutment (GC NobelProcera: Aadva: 503.9 Aadva abutments, however
California) abutment (Noble Advanced 484.6 N N Lava NOA with Ti insert
Biocare, Yorba Technologies Inc, Lava: 729.2 N performed better.
Linda, California) Alsip, Illinois)
Lava CAD/CAM
zirconia abutment
bonded to Ti insert
(3M ESPE, St Paul,
Minnesota)
(Continued)
Rizvi et al

Rizvi et al
Table 7 (Continued)
Leutert et al. Straumann Bone IC (ICo) CARES® RC Zirabut zirconia Mean bending Straumann/ Yes, in favor of OAs.
(2012) level (Straumann, IC (IDH) zirconia abutments moments: Zirabut Zi:
Basel, IC (ICo) CAD/CAM (Wohlwend AG) Straumann/CARES restored =
Switzerland) (Straumann, Zi: restored = 117.9Ncm
Astra Micro Basel, 224.8Ncm unrestored =
Thread Switzerland) unrestored = 158.2Ncm
OsseoSpeedTM , zirconia 344.8Ncm
(Astra Tech ZirDesign® Astra/ZirDesign Zi:
Implant Systems, (Dentsply restored =
Dentsply Implants, 292.8Ncm
Implants, Mölndal, unrestored =

Mölndal, Sweden) 324.8Ncm
Sweden) CARES® RC Straumann/CARES
Straumann titanium Ti:
Standard Plus CAD/CAM restored =
(Straumann, (Straumann, 419.4Ncm
Basel, Basel, unrestored =
Switzerland) Switzerland) 678.2Ncm
(Continued)
e47
e48
Table 7 (Continued)
Salaita et al. (2017) Tapered Screw-Vent IC (IH) Zimmer Patient Atlantis titanium (AtlTi) No differences among the abutments for No significant differences
(Zimmer Inc, Specific Dentsply Sirona compression strain values between OAs and NOAs.
Warsaw, Indiana, Abutment (PSA) Atlantis zirconia AtlZr and PSA abutments had highest
USA) custom Titanium (AtlZr) Dentsply tensile strain around the implants.
(Zimmer, Inc, Sirona
Warsaw, Indiana, Inclusive custom
USA) implant abutment
titanium (GlTi)
Glidewell
Laboratories
Inclusive custom
implant abutment
zirconia (GlZr)
Glidewell
Laboratories
Legacy straight
contoured abutment
(IDTi) Implant Direct
Legacy zirconia
straight contoured
abutment (IDZr)
Implant Direct
AstraTech ZirDesign
abutment (AstZr)
AstraTech
AstraTech TiDesign
abutment (AstTi)
AstraTech
(Continued)
Rizvi et al

Table 7 (Continued)
Rizvi et al
Yilmaz et al. Tapered Screw-Vent IC (IH) Zimmer Patient Atlantis custom Did not fracture Atlantis: Screw Yes, in favor of OAs.
(2015b) (Zimmer Inc, Specific Titanium (Dentsply fracture
Warsaw, Indiana, Abutment Implants, Mölndal, 506.62 N
USA) custom Titanium Sweden) Inclusive:
(Zimmer, Inc, Inclusive Custom Screw
Warsaw, Indiana, Implant Abutment fracture
USA) Titanium (Glidewell 524.09 N
Laboratories, TiDesign:
Frankfurt am main, Screw
Germany) fracture
TiDesignTM stock 661.64 N
(AstraTech Implant Legacy:
SystemTM , Dentsply Screw
Implants, Mölndal, fracture
Sweden) 1104.96 N
Legacy Straight
Contoured stock
Abutment (Implant
Direct, Kloten,
Switzerland)
Yilmaz et al. Tapered Screw-vent IC (IH) Zimmer Contour Atlantis custom Abutment (hex) Atlantis No, generally. Differences
(2015c) implants (Zimmer Zirconia stock Zirconia (Dentsply fracture 668 N Abutment seen were due to

Inc, Warsaw, Abutment Implants, Mölndal, fracture 465N incorporation of titanium in
Indiana, USA) (Zimmer, Inc, Sweden) Inclusive Zimmer and Legacy
Warsaw, Indiana, Inclusive Custom abutment abutments.
USA) Implant Abutment fracture 124N
All-zirconia Astratech
(Glidewell abutment
Laboratories, fracture 236N
Frankfurt am main, Legacy screw
Germany) fracture 1017
AstraTech N
ZirDesign®
(Dentsply Implants,
Mölndal, Sweden)
Legacy Zirconia
Straight Contoured
stock Abutment
(Implant Direct,
Kloten, Switzerland)
(Continued)
e49
e50
Table 7 (Continued)
Jarman et al. (A) Straumann Bone IC (ICo) (I) Straumann IPS (V) CAD/CAM milled Load to failure: Load to failure: Yes, in favor of OAs for all
(2017) level (Straumann, EC (EH) e.max ZrO2 Atlantis Zr (A/I) (A/V) types of connections.
Basel, IC (ITC) abutment abutments Straumann:387.20 N Straumann: No significant differences

Switzerland) IC (IH) (II) Procera (B/II) Nobel Biocare: 211.20 N between connection types
(B) Nobel Biocare Straight Aesthetic 408.20 N (B/V) Nobel for NOAs.
RP (Nobel abutment Control (C/III) Nobel Biocare:
Biocare, (III) Nobel Procera Replace 430.00 N 218.60 N
Göteborg, Straight Aesthetic (D/IV) Biomet 3i: (C/V) Nobel
Sweden) Abutment 448.00 N Replace:
(C) Nobel (IV) Biomet 3i 260.00 N
Replace/ Select ZiReal abutment (D/V) Biomet
(Nobel Biocare, 3i: 244.25 N
Göteborg,
Sweden)
(D) Biomet 3i
Certain (Biomet
3i Inc., Palm
Beach Gardens,
FL, USA)
EC = external connection, IC = internal connection, (EH) = external hexagon, (IH) = internal hexagon, (IDH) = internal double hexagon, (ICo) = internal conical, (ITC) = internal tri-channel.
Rizvi et al

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precision of fit, rotational freedom, and torque loss with Table S1. Details of finally selected articles.

2021 - Systematic Review Accuracy of Original Vs Non Original Abutments Using Various Connection

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1532849x, 2022, 7, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jopr.13464 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [29/10/2022].

Table 1 MEDLINE® search strategy

1 exp Dental Implants/

Risk of bias Micromorphological differences

cast in gold alloy with

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Areas of Tight Contact

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Areas of Tight Contact

53.13 Internal: 0.00/

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Scratches and Wear

Connection Original Scratches/wear Difference between OAs

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Table 3 Studies investigating microleakage to indicate degree of misfit

Implant Difference between OAs and

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

IC = internal connection, IDH = internal double hexagon, ICo = internal conical.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Mean gap widths/ Mean gap widths/micromotion/ Difference between

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Mean rotational Mean rotational Difference between OAs

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Mean rotational Mean rotational Difference between OAs

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Table 6 Studies testing removal torque values

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

level (Straumann, Korea) 26.17Ncm/ 22.5Ncm Straumann/ Raphabio:

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

(II) NobelProcera (Dentsply Sirona

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

Basel, IC (ITC) abutment abutments Straumann:387.20 N Straumann: No significant differences

Journal of Prosthodontics 31 (2022) e21–e52 © 2021 by the American College of Prosthodontists.

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