Esthetic Outcomes of Implant-Supported Single Crowns Related to Abutment Type and Material: A Systematic Review

PURPOSE: To systematically review the influence of abutment material and configuration on the soft tissue esthetic outcomes of implant-supported single crowns (iSCs) after 3 years.

MATERIALS AND METHODS: An electronic search on MEDLINE (PubMed) from January 2000 to July 2019 was conducted for clinical trials with no language restrictions. The focus question was: In partially edentulous patients with iSCs, does the abutment material (metal vs ceramic) or the configuration (standardized vs customized) have an effect on the soft tissue esthetic outcomes? Randomized controlled trials, controlled clinical trials, and prospective or retrospective case series with at least 10 patients and a minimum of 3 years of follow-up were included. The esthetic outcomes Pink Esthetic Score (PES), PES/White Esthetic Score (WES; ie, modPES), Papilla Index (PI), soft tissue recession, and papilla height change were extracted. Meta-analysis was performed when applicable.

RESULTS: Of the 6,399 titles identified, 27 studies were included. Combined mean PES/modPES scores, translated into a scale of 0 to 100, were 68.8 for ceramic, 74.2 for metal (P = .392), 71.9 for customized, and 71.3 for standard (P = .981) abutments. Mean soft tissue recession was also similar between the abutment groups, abutment material (P = .850), and configuration (P = .849), ranging from -1.09 mm to +0.59 mm gain. Papilla height changes ranged from -1.22 mm to +1.0 mm gain. The reported mean PI was 2.16 for customized, 2.06 for standard (P = .552), 2.01 for ceramic, and 2.28 for metallic (P = .04) abutments.

CONCLUSION: This systematic review showed that the abutment material and configuration had minimal impact on the evaluated soft tissue esthetic outcomes. Future research focusing on the included parameters in a randomized controlled manner is needed to validate the present findings.