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Background: Immediate implant placement in the esthetic zone, particularly in Class II extraction sockets with partial facial bone loss, presents challenges in achieving soft and hard tissue stability. Customized computer-aided design/computer-aided manufacturing (CAD/CAM) titanium abutments may offer advantages over prefabricated stock abutments. This study compared the clinical, radiographic, and patient-reported outcomes of customized CAD/CAM titanium abutments versus stock Laser-Lok stock abutments. Materials and methods: In a single-center, double-blind randomized clinical trial, 48 patients received immediate maxillary anterior implants restored with either customized CAD/CAM titanium abutments (n = 24) or stock titanium abutments (n = 24). Primary outcomes included peri-implant probing depth (PD), mucosal height, Pink Esthetic Score (PES), crestal bone level changes, and patient satisfaction assessed at baseline, 6, and 12 months post-loading. Statistical analysis included effect sizes and 95% confidence intervals. Results: At 12 months, the customized abutment group showed significantly shallower PD (mean difference: −0.54 mm; 95% CI: −0.72 to −0.35; p < 0.001), higher PES (12.21 ± 0.35 vs. 10.41 ± 1.17; p < 0.0001; Cohen’s d = 2.08), and less crestal bone loss (1.75 ± 0.36 mm vs. 2.33 ± 0.52 mm; p < 0.0001). Patient satisfaction scores were also higher in the customized group (p = 0.003). Within-group improvements were observed in both groups over time. No implant failures occurred. Conclusions: At 1-year follow-up, customized CAD/CAM titanium abutments demonstrated improved peri-implant soft tissue parameters, esthetics, and patient satisfaction compared to stock abutments. While these findings support their use in esthetically demanding immediate implant cases, the short-term duration and single-center design warrant further long-term multicenter studies to confirm durability. Trial registration: Registered at ClinicalTrials.gov on 19/01/2025 (NCT06791655).

With the evolution of CAD/CAM technology, custom titanium and/or zirconia abutments are increasingly being used, leading to several comparisons in the literature, both mechanical and aesthetic, to evaluate performance differences between these two types of abutments. Therefore, the aim of this comprehensive review is to present the most recent data on the latest comparisons between CAD/CAM and stock abutment applications. The PICO model was used to perform this review, through a literature search of the PubMed (MEDLINE) and Scopus electronic databases. CAD/CAM abutments allow individualization of abutment parameters with respect to soft tissue, allow increased fracture toughness, predict the failure mode, show no change in the fracture toughness over time, reduce the prosthetic steps, and reduce the functional implant prosthesis score and pain perceived by patients in the early stages. The advantages associated with the use of stock abutments mainly concern the risk of corrosion, time spent, cost, and fit, evaluated in vitro, in the implant–abutment connection. Equal conditions are present regarding the mechanical characteristics during dynamic cycles, screw loss, radiographic fit, and degree of micromotion. Further randomized controlled clinical trials should be conducted to evaluate the advantages reported to date, following in vitro studies about titanium and/or zirconia stock abutments.

Background Limited research evaluates how the type of implant-abutment connection and the material of the abutment together affect the biomechanical behavior of load transfer within both the implant components and the surrounding bone under axial and oblique loading conditions. This 3-dimensional (3D) finite element analysis (FEA) study aimed to provide biomechanical insights to assist clinicians in choosing optimal connection designs and abutment materials, enhancing implant longevity and clinical outcomes. Methods Two internal implant-abutment connections were modeled in 3D: model (S), which is a star-shaped tube-in-tube design, and model (H), which is a Morse taper combined with an internal hex, both intended to support a mandibular first molar crown and its associated bone geometry. Four abutment materials (Titanium grade V/Ti, Co-Cr, soft-milled Co-Cr–Mo/Co-Cr-S, and zirconia/Zr) were examined using both connection designs. Each crown was subjected to two loading protocols: (1) 200 N vertically was applied at six occlusal points, and (2) 100 N obliquely (at 45º) was applied to three occlusal points on the buccal bevel of the buccal cusp. FEA was performed to analyze the maximum and minimum principal stresses and strains on the peri-implant bone, as well as the von Mises stresses on the implants, abutments, screws, and crowns. Results Principal stresses and strains were predominantly concentrated in the crestal cortical bone. Under axial loading, stress values were similar across connection types. The highest stress was observed in the H (Zr) model (15.683 MPa) and the lowest in S (Ti) (14.265 MPa). Oblique loading caused higher compressive stresses, peaking at 99.06 MPa in the H (Co-Cr) model. In cancellous bone, stresses were lower, ranging from 0.12888 MPa for H (Ti) to 0.21535 MPa for S (Zr). The highest cortical strain was observed in S (Co-Cr) under oblique loading conditions, measuring 6700 με. Conversely, all models exhibited reduced cancellous elastic strain values, with the maximum strain recorded at 1200.0 με in the S (Co-Cr) axially and 980.0 με in the S (Co-Cr) obliquely. The von Mises stress was localized at the implant and abutment necks, with peak implant stress attaining 135.0 MPa in the S (Co-Cr) model under oblique loading. Titanium abutments demonstrated the lowest stress values consistently across various loading conditions. All models exhibited minimal directional screw deformation (3.897 µm axial; 1.257 µm oblique), demonstrating mechanical stability. Conclusions Star-shaped tube-in-tube and hybrid Morse taper with internal hex connections showed similar stress patterns, with values below the titanium alloy's yield strength and safe bone stress levels. Oblique loading, however, produced cortical strains above the safe limit. Zirconia, Co-Cr, and soft-milled Co-Cr–Mo abutments had moderate stress distribution, while titanium showed the most favorable profile. Both connections caused minimal screw deformation, suggesting low loosening risk.

Background The internal fit of the implant-abutment connection plays a crucial role in implant success. This study aims to assess the impact of various connection designs and materials of customized implant abutments on the gap distance at the implant-abutment interface. Methods Two internal connection implant systems, star-shaped tube-in-tube and hybrid Morse taper with internal hex anti-rotation feature ( n  = 24 each, total n  = 48) were evaluated. Each group was subdivided into four material groups: zirconia (Zr), titanium (Ti), cobalt-chromium (Co-Cr), and soft-milled cobalt-chromium-molybdenum (Co-Cr-Mo). The internal fit was assessed via micro-computed tomography (µCT). Results All specimens demonstrated clinically acceptable microgap values (≤ 150 μm). The star-shaped tube-in-tube connection exhibited significantly narrower gaps compared to the hybrid connection. Zr showed the greatest gaps among materials, followed by Ti, Co-Cr, and soft-milled Co-Cr-Mo, which had the smallest gaps. Conclusions The star-shaped tube-in-tube connection demonstrated superior internal fit to the hybrid connection. Zirconia abutments demonstrated inferior internal adaptability. Dimensional changes during sintering of soft milled materials may have influenced these outcomes and should be considered when interpreting the data. All tested abutments fell within clinically acceptable misfit ranges.

This study presented a rehabilitation option for malpositioned implants; this involved obtaining their position and inclination through intraoral scanning, and producing a customized abutment with CAD/CAM technology. The patient in this case report presented a root fracture in tooth 21 and was subjected to extraction, implant installation, and immediate provisional prosthesis. The implant was installed with a distal inclination due to anatomical limitations. After osseointegration, an intraoral scanning transfer provided a digital model (file extension .stl), which reproduced the implant’s position and inclination. Then, the file was sent so that a customized abutment (CAD/CAM) could be manufactured, promoting the final rehabilitation of the case; this allowed for good hygiene, load distribution in the dynamic interocclusal relationship, and favorable esthetics, whereas many would otherwise recommend implant removal. The result presented lower costs, a shorter time frame, and a lower morbidity for the patient.

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.

The accuracy of a digital impression technique to fabricate the implant restoration and abutment for a dental implant using an intraoral laser scanner was evaluated in 36 patients who were missing a single posterior tooth in either the mandible or maxilla that was restored with a single implant. The spatial position of each integrated implant, including the surrounding anatomic hard and soft tissues of adjacent structures, was captured utilizing a special scanning abutment with an intraoral laser scanner. Data from the scanning protocol was then delivered via the Internet in the form of an STL file to the manufacturing site for the production of a custom computer-aided design abutment and crown. All 36 restorations and abutments were delivered to the patients and evaluated for marginal integrity, interproximal contact points, and occlusion. Of the 36 patients, 6 required contact adjustments, 7 required occlusal adjustments, and 3 required a gingivectomy around the implant to completely seat the restoration. Chair time for adjustments did not exceed 15 minutes. The findings suggest that an intraoral laser scanner can be used with confidence to obtain consistent and accurate digital impressions to fabricate custom restorations and abutments for dental implants.

Background The flexibility in designing the submucosal part of CAD/CAM customized implant abutments and the individual positioning of its shoulder line has been suggested to reduce the risk of leaving undetected cement residues, thus preventing adverse effects on peri-implant tissues. A high correlation between excess cement left in the soft tissues and the occurrence of increased biofilm accumulation with sulcular bleeding and/ or suppuration has been reported. This in turn may cause peri-implant inflammation and peri-implant marginal bone loss. The aim of this study was to assess the frequency of cement remnants after the luting of zirconia crowns on CAD/CAM custom molar abutments with different margin levels and to evaluate the impact of the luting material. Material and methods A total of 20 titanium molar CAD/CAM implant abutments (BEGO Medical GmbH) with internal taper connection/ internal hex anti-rotation protection, and a convex emergence profile with different margin positions (0, 1, 2 and 3 mm below the mucosa), were virtually designed (Implant Studio, 3Shape) and manufactured. A master cast was scanned, duplicated by a 3D printer and individual gingival masks were produced to simulate peri-implant soft tissues. 20 corresponding zirconia crowns were designed (Cerec 3D, Dentsply Sirona), produced and cemented to the abutments with two different luting materials; a zinc oxide non-eugenol cement (Temp Bond NE) or a methacrylate cement (Panavia V5). To ensure retrievability of the crown/abutment connection, occlusal openings providing access to the abutment screws were designed. Excess cement was thoroughly removed and the crown/abutment units were unscrewed to evaluate the occurrence of cement residues. All the quadrants of each specimen were evaluated for calculation of the ratio between the cement remnant area and the total specimen area using Adobe Photoshop. Spearman analysis was performed to detect correlations between different variables. A two-sided t-test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests were applied to detect differences between the groups. Results Cement remnants were found in every depth of the crown abutment complex and in almost every area investigated. The amount of cement residues increased as the crown-abutment margin was located more submucosally. Lingual areas were more prone to cement remnants than other surface areas ( p  = 0.0291). Excess cement was not only found at the margins of the crown-abutment complex, but also underneath (basal) the abutment itself, where cleaning was impossible. No statistical difference in the effect of zinc oxide non-eugenol- and methacrylate cement on the frequency of excess material at the lateral abutment surfaces could be demonstrated in vitro. The proportion of basal abutment aspects covered with cement residues was, however, significantly smaller in Panavia V5 samples with an average of 4.9 ± 3.7% compared to Temp Bond samples with an average of 8.6 ± 5.5%. Conclusions Given the results obtained in the present investigation the margin of CAD/CAM molar abutments should be located as coronally as possible to minimize the amount of cement remnants. If an epigingival or supragingival margin location is not feasible due to esthetic concerns, it cannot be recommended to place the margin of molar CAD/CAM abutments deeper than 1.5 mm in the proximal and oral regions.

To evaluate the effect of an ultrasonic cleaning and disinfection method for CAD/CAM abutment surfaces on cell viability and inflammatory response in vitro. Untreated and manually polished surfaces of CAD/CAM generated titanium and zirconia disks were randomly assigned, either to a 3-step ultrasonic cleaning and disinfection process (test: TiUF, TiPF, ZrUF, ZrPF) or to 30 sec steam cleaning (control: TiUS, TiPS, ZrUS, ZrPS). Pre-cleaning surface analyses using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and surface profilometry were performed. Human gingival fibroblasts (HGFs) were cultured on test and control specimens and subsequently examined for cell viability and inflammatory response. Expression of acute inflammatory cytokine interleukin (IL)-6 and vascular endothelial growth factor A (VEGFA) were assessed by means of RT-qPCR. Cells on all specimens exhibited a satisfactory viability, indicating firm attachment. Cells on polished zirconia samples, cleaned by means of sonication (ZrPF), exhibited significantly higher viability than cells on the same material cleaned by steam (ZrPS), p=0.019. For all other three material/ surface treatment combinations (TiU, TiP, ZrU), no such difference was observed between the cleaning methods. The messenger ribonucleic acid (mRNA) levels of IL-6 and VEGFA were between 50 and 105% of that of the control cells on the non-toxic control surface. mRNA levels of IL-6 and VEGFA correlated well with each other. Except for higher viability of cells cultured on polished zirconia specimens, no universally applicable advantage could be found for the ultrasonic cleaning procedure for zirconia and titanium abutment surfaces regarding cell viability, IL-6 expression or VEGFA expression. The cleaning procedures did not have any negative effect either.

Purpose of Review The purpose of this review is to discuss the use of computer-aided design and computer-aided manufacturing (CAD/CAM) custom abutments in the anterior region with a focus on abutment design and material selection. Advantages, disadvantages, and complications of CAD/CAM abutments are also considered. Recent Findings CAD/CAM abutments are available in various materials and with different connection platforms to the implant in order to meet esthetic, functional, and biological demands. Use of CAD/CAM concepts in the fabrication of custom abutments allows for definite advantages over both stock abutments and conventional cast custom abutments. Summary CAD/CAM technology should be considered when restoring dental implants in the esthetic zone.