Citation Information :
Saini D, Sanan R, Malhotra P, Yadav B, Shetty OK, Kumar B. Comparison of Biologic and Esthetic Outcome of Zirconia and Titanium Implant Abutments Placed in Anterior Esthetic Zone: A Randomized Controlled Trial. World J Dent 2024; 15 (9):755-761.
Aim: To assess and compare the esthetic and functional outcome of single-tooth anterior implant restorations as affected by the abutment materials, that is, zirconia and titanium abutments restored with layered zirconia crowns, using an esthetic index combined with patient feedback.
Materials and methods: This randomized controlled trial had a duration of 2 years and included 20 patients with a single anterior missing tooth rehabilitated with an implant-supported prosthesis. Ten patients were rehabilitated with a titanium abutment (group A) and 10 with a zirconia abutment (group B). After cementation of the crowns, photographs were taken at intervals of 1 month and 3 months. Analysis was performed using parametric tests; that is, the Wilcoxon paired t-test was used for paired data, and the Mann–Whitney U test was used for unpaired data. Evaluation of esthetic outcomes was done by two equally experienced prosthodontists who were blinded. The pink esthetic score (PES) and white esthetic score (WES) were recorded through the clinical photographs taken.
Results: The study groups included both males and females aged between 18 and 40 years. On intergroup comparison of PES and WES of single-tooth implant restorations between the two groups, the mean values for PES for groups A and B at 1 month and 3 months were 3.3, 3.7, and 3.0, 2.5, respectively. The mean values for WES for groups A and B at 1 month and 3 months were 3.9, 3.3, and 3.3, 3.3, respectively. As the p-value was set at >0.05, the results were statistically insignificant for both groups, although better scores were obtained for group B (Zr).
Conclusion: Within the limitations of this study, it can be concluded that zirconia abutments have better esthetic and biologic results than titanium abutments. Patient satisfaction achieved was higher with zirconia abutments.
Clinical significance: Clinical relevance is attributed to the color difference between the soft tissues around implants and teeth. Making wise treatment choices may benefit from an understanding of both the patient's perspectives and those of experienced clinicians.
Chang M, Wennstrom JL, Odman PA, et al. Implant supported single tooth replacements compared to contralateral natural teeth. Crown and soft tissue dimensions. Clin Oral Implants Res 1999;10:185–194. DOI: 10.1034/j.1600-0501.1999.100301.x
Meijer HJA, Stellingsma K, Meijndert L, et al. A new index for rating aesthetics of implant-supported single crowns and adjacent soft tissues—the Implant Crown Aesthetic Index. Clin Oral Implants Res 2005;16:645–649. DOI: 10.1111/j.1600-0501.2005.01128.x
Carrillo de Albornoz A, Vignoletti F, Ferrantino L, et al. A randomized trial on the aesthetic outcomes of implant-supported restorations with zirconia or titanium abutments. J Clin Periodontol 2014;41:1161–1169. DOI: 10.1111/jcpe.12312
Bressan E, Paniz G, Lops D, et al. Influence of abutment material on the gingival color of implant-supported all-ceramic restorations: a prospective multicenter study. Clin Oral Implants Res 2011;22:631–637. DOI: 10.1111/j.1600-0501.2010.02008.x
Hefferman MJ, Aquilino SA, Diaz-Arnold AM, et al. Relative translucency of six all-ceramic systems. Part I: core materials. J Prosthet Dent 2002;88:4–9. DOI: 10.1016/S0022-3913(02)00040-9
Hefferman MJ, Aquilino SA, Diaz-Arnold AM, et al. Relative translucency of six all-ceramic systems. Part II: core and veneer materials. J Prosthet Dent 2002;88:10–15. DOI: 10.1016/S0022-3913(02)00041-0
Jung RE, Holderegger C, Sailer I, et al. The effect of all-ceramic and porcelain-fused-to-metal restorations on marginal peri-implant soft tissue color: a randomized controlled clinical trial. Int J Periodontics Restorative Dent 2008;28:357–365. DOI: 10.5167/uzh-9284
Salihoglu U, Boynuegri D, Engin D, et al. Bacterial adhesion and colonization differences between zirconium oxide and titanium alloys: an in vivo human study. Int J Oral Maxillofac Implants 2011;26:101–107.
Rimondini L, Cerroni L, Carrassi A, et al. Bacterial colonization of zirconia ceramic surfaces: an in vitro and in vivo study. Int J Oral Maxillofac Implants 2002;17:793–798.
Scarano A, Piattelli M, Caputi S, et al. Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study. J Periodontol 2004;75:292–296. DOI: 10.1902/jop.2004.75.2.292
Do Nascimento C, Pita MS, de Souza Santos E, et al. Microbiome of titanium and zirconia dental implants abutments. Dent Mater 2016;32(1):93–101. DOI: 10.1016/j.dental.2015.10.014
Şen N, Şermet IB, Gürler N. Sealing capability and marginal fit of titanium versus zirconia abutments with different connection designs. J Adv Prosthodont 2019;11(2):105–111. DOI: 10.4047/jap.2019.11.2.105
Kajiwara N, Masaki C, Mukaibo T, et al. Soft tissue biological response to zirconia and metal implant abutments compared with natural tooth: microcirculation monitoring as a novel bioindicator. Implant Dent 2015;24(1):37–41. DOI: 10.1097/ID.0000000000000167
Barwacz CA, Brogden KA, Stanford CM, et al. Comparison of pro-inflammatory cytokines and bone metabolism mediators around titanium and zirconia dental implant abutments following a minimum of 6 months of clinical function. Clin Oral Implant Res 2015;26:35–41. DOI: 10.1111/clr.12326
Bharate V, Kumar Y, Koli D, et al. Effect of different abutment materials (zirconia or titanium) on the crestal bone height in 1 year. J Oral Biol Craniofac Res 2020;10(1):372–374. DOI: 10.1016/j.jobcr.2019.10.001
Liebert MF, Fouque-Dervelle C, Santani A, et al. Smile line and periodontium visibility. Perio 2004;1:17–25.
Dayakar MM, Shipilova A, Rekha M. Evaluation of smile esthetics by photographic assessment of the dento-labio-gingival complex. J Dent Allied Sci 2015;4:65–68. DOI: 10.4103/2277-4696.171515
Forna N, Agop-Forna D. Esthetic aspects in implant-prosthetic rehabilitation. Med Pharm Rep 2019;92:S6–S13. DOI: 10.15386/mpr-1515
Becker W, Ochsenbein C, Tibbetts L, et al. Alveolar bone anatomic profiles as measured from dry skulls. Clinical ramifications. J Clin Periodontol 1997;24:727–731. DOI: 10.1111/j.1600-051x.1997.tb00189.x
Jivraj S, Reshad M. Esthetic implant dentistry: diagnosis and treatment planning. Oral Maxillofac Surg 2018:391–409.
Sailer I, Zembic A, Jung RE, et al. Single-tooth implant reconstructions: esthetic factors influencing the decision between titanium and zirconia abutments in anterior regions. Eur J Esthet Dent 2007;2(3):296–310.
Lops D, Stellini E, Sbricoli L, et al. Influence of abutment material on peri-implant soft tissues in anterior areas with thin gingival biotype: a multicentric prospective study. Clin Oral Implants Res 2017;28(10):1263–1268. DOI: 10.1111/clr.12952
Gehrke SA, Poncio da Silva PM, Calvo Guirado JL, et al. Mechanical behavior of zirconia and titanium abutments before and after cyclic load application. J Prosthet Dent 2016;116(4):529–535. DOI: 10.1016/j.prosdent.2016.02.015
Ahmad I. Yttrium-partially stabilized zirconium dioxide posts: an approach to restoring coronally compromised nonvital teeth. Int J Periodontics Restorative Dent 1998;18(5):454–465.
Gehrke P, Riekeberg U, Fackler O, et al. Comparison of in vivo visual, spectrophotometric and colorimetric shade determination of teeth and implant-supported crowns. Int J Comput Dent 2009;12(3):247–263.
Yilmaz H, Aydin C, Gul BE. Flexural strength and fracture toughness of dental core ceramics. J Prosthet Dent 2007;98(2):120–128. DOI: 10.1016/S0022-3913(07)60045-6
Chai J, Chu FCS, Chow TW, et al. Chemical solubility and flexural strength of zirconia-based ceramics. Int J Prosthodont 2007;20(6):587–595.
Stadlinger B, Hennig M, Eckelt U, et al. Comparison of zirconia and titanium implants after a short healing period. A pilot study in minipigs. Int J Oral Maxillofac Surg 2010;39(6):585–592. DOI: 10.1016/j.ijom.2010.01.015
Van Brakel R, Cune MS, van Winkelhoff AJ, et al. Early bacterial colonization and soft tissue health around zirconia and titanium abutments: an in vivo study in man. Clin Oral Implants Res 2011;22(6):571–577. DOI: 10.1111/j.1600-0501.2010.02005.x
Kollar A, Huber S, Mericske E, et al. Zirconia for teeth and implants: a case series. Int J Periodontics Restorative Dent 2008;28(5):479–487.
Baldini N, D'Elia C, Clementini M, et al. Esthetic outcomes of single-tooth implant-supported restorations using metal-ceramic restorations with zirconia or titanium abutments: a randomized controlled clinical study. Int J Periodontics Restorative Dent 2016;36(4):e59–e66. DOI: 10.11607/prd.2599
Abrahamsson I, Berglundh T, Glantz PO, et al. The mucosal attachment at different abutments. An experimental study in dogs. J Clin Periodontol 1998;25(9):721–727. DOI: 10.1111/j.1600-051x.1998.tb02513.x
Arunyanak SP, Pollini A, Ntounis A, et al. Clinician assessments and patient perspectives of single-tooth implant restorations in the esthetic zone of the maxilla: a systematic review. J Prosthet Dent 2017;118(1):10–17. DOI: 10.1016/j.prosdent.2016.10.036
Linkevicius T, Vaitelis J. The effect of zirconia or titanium as abutment material on soft peri-implant tissues: a systematic review and meta-analysis. Clin Oral Implants Res 2015;26(Suppl 11):139–147. DOI: 10.1111/clr.12631
