Clinical Outcomes of Zirconia Abutments for Implant Dentistry: Systematic Review

Background: Dental implants have become integral in restoring partially or completely edentulous patients due to their reported long-term success. While titanium remains the primary material for implants and abutments due to its mechanical properties and biocompatibility, zirconia has emerged as a promising alternative, especially for aesthetic regions. This systematic review aimed to assess whether zirconia abutments present a rational alternative to titanium in modern implantology, focusing on their mechanical and clinical performances. Method: The workflow used for this review included the PRISMA checklist. The eligibility criteria included various study types, with a preference given to clinical trials. The search strategy employed the PICO model, including a large number of relevant studies, and online research was carried on the online databases PubMed and Scopus, with “implant” AND “abutment” AND “zirconia” and “zirconia abutment” AND “mechanical properties” used as search strings. Results: Six clinical studies were included with an adequate follow-up and patient cohort; they suggest that while zirconia abutments offer improved aesthetics and biological integration, concerns persist regarding their mechanical properties, particularly regarding their fatigue resistance and connection stability. In vitro studies have revealed differences between titanium and zirconia abutments, with the latter showing greater susceptibility to fatigue-induced deformation and fretting wear. The clinical outcomes, however, demonstrate favourable long-term performance, with zirconia abutments promoting healthy soft tissue conditions. CAD/CAM technologies enable the precise customization of zirconia abutments, enhancing their compatibility and aesthetic outcomes. Conclusions: Although this review faces limitations due to the scarcity of comparative studies and varied methodologies, it underscores the potential of zirconia abutments in implantology. In conclusion, while zirconia abutments offer promising advantages, the careful consideration of patient-specific factors and the long-term outcomes is warranted for their optimal utilisation in implant-supported prostheses.