Influence of abutment materials on peri-implant tissues health-a systematic review

Abutment materials play a critical role in maintaining peri-implant tissue health, influencing both biological responses and aesthetic outcomes in implant-supported restorations. With the introduction of newer materials and digital fabrication techniques, an updated evaluation of their clinical performance is warranted.

This systematic review aimed to evaluate the influence of different abutment materials-titanium, zirconia, and polyether ether ketone (PEEK)-on peri-implant tissue health based on contemporary clinical evidence.

A systematic literature search was conducted in PubMed and Scopus databases in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies published between 2019 and 2026 were included to reflect current advancements in implant prosthodontics. Eligible human studies assessing the impact of abutment materials on peri-implant tissue health were selected based on predefined criteria. Risk of bias was assessed using the ROBINS-I tool. Due to heterogeneity in study design, outcome measures, and follow-up duration, a meta-analysis was not feasible, and a qualitative synthesis was performed.

A total of 13 studies were included. Titanium abutments demonstrated consistent performance, with stable marginal bone levels, low inflammatory response and high long-term predictability. Zirconia abutments showed comparable biological outcomes, with superior soft tissue response and aesthetic integration, particularly in anterior regions. Evidence regarding PEEK abutments was limited; however, preliminary findings suggest reduced inflammatory response and favorable biocompatibility. The included studies exhibited substantial heterogeneity in methodology and outcome reporting, limiting direct comparisons.

Titanium remains the most reliable abutment material due to its well-established clinical performance and mechanical stability. Zirconia represents a suitable alternative in aesthetically demanding situations, offering favorable soft tissue outcomes. PEEK demonstrates promising biological potential but lacks sufficient long-term clinical evidence to support routine use. Future research should focus on well-designed, long-term comparative studies with standardized outcome measures to strengthen the evidence base and guide clinical decision-making.