What is the impact of titanium base versus multi-unit abutments on immediate loading outcomes: a systematic review

This systematic review, conducted per PRISMA guidance, evaluated clinical outcomes of titanium-base (TiB) versus multi-unit (MU) abutments in immediate-loading dental implant protocols, focusing on implant survival, prosthetic and biological complications, and patient-reported outcomes.

PubMed and Scopus were searched for original English-language clinical studies published between 2001 and 2025, including RCTs, cohort studies, and clinical series with at least 12 months of follow-up. Only studies evaluating TiB and MU abutments in immediate-loading protocols were included. Due to heterogeneity in study designs, case selection, outcome measures, and follow-up duration, a narrative descriptive synthesis was performed without pooled statistical analysis.

Seventeen clinical studies met the inclusion criteria. Both TiB and MU abutments showed high implant survival rates, generally in the high 90 s. TiB abutments performed well in single-tooth anterior restorations, showing fewer mechanical complications and better esthetic ratings. MU abutments were predominantly used in full-arch cases, demonstrating reliable long-term function but with higher mechanical maintenance needs. Marginal bone loss remained within acceptable limits across studies. Patient-reported outcomes were inconsistently assessed, though TiB tended to score higher for esthetics and MU for functional comfort.

Both TiB and MU abutments effectively support immediate loading when primary stability and proper prosthetic planning are achieved. TiB may be preferable for esthetic single-tooth cases, while MU abutments remain suitable for full-arch rehabilitation. The limited number of head-to-head studies highlights the need for well-designed randomized trials with standardized outcomes and validated patient-reported measures.