Impact of implant–abutment connection and positioning of the machined collar/microgap on crestal bone level changes: a systematic review
Article first published online: 18 JUN 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Clinical Oral Implants Research
Volume 25, Issue 4, pages 417–425, April 2014
How to Cite
Impact of implant–abutment connection and positioning of the machined collar/microgap on crestal bone level changes. A systematic review. Clin. Oral Impl. Res. 25, 2014, 417–425., , .
- Issue published online: 5 MAR 2014
- Article first published online: 18 JUN 2013
- Manuscript Accepted: 16 MAY 2013
- Camlog Foundation
- animal studies;
- clinical studies;
- crestal bone level changes;
- systematic review
To address the following focused question: What is the impact of implant–abutment configuration and the positioning of the machined collar/microgap on crestal bone level changes?
Material and methods
Electronic databases of the PubMed and the Web of Knowledge were searched for animal and human studies reporting on histological/radiological crestal bone level changes (CBL) at nonsubmerged one-/two-piece implants (placed in healed ridges) exhibiting different abutment configurations, positioning of the machined collar/microgap (between 1992 and November 2012: n = 318 titles). Quality assessment of selected full-text articles was performed according to the ARRIVE and CONSORT statement guidelines.
A total of 13 publications (risk of bias: high) were eligible for the review. The weighted mean difference (WMD) (95% CI) between machined collars placed either above or below the bone crest amounted to 0.835 mm favoring an epicrestal positioning of the rough/smooth border (P < 0.001) (P-value for heterogeneity: 0.885, I2: 0.000% = no heterogeneity). WMD (95% CI) between microgaps placed either at or below the bone crest amounted to −0.479 mm favoring a subcrestal position of the implant neck (P < 0.001) (P-value for heterogeneity: 0.333, I2: 12.404% = low heterogeneity). Only two studies compared different implant–abutment configurations. Due to a high heterogeneity, a meta-analysis was not feasible.
While the positioning of the machined neck and microgap may limit crestal bone level changes at nonsubmerged implants, the impact of the implant–abutment connection lacks documentation.