Implant–Abutment Connection Designs: Biomechanical, Biological, and Clinical Implications

Abstract

The design of the implant–abutment connection is a critical factor influencing the long-term success of dental implants in terms of both biomechanical stability and biological integration. Micromovements occurring at the implant–abutment interface increase the risk of complications such as marginal bone loss, screw loosening, and microleakage. Therefore, comprehensive knowledge of connection designs plays a key role in enhancing clinical outcomes. Since the development of the first dental implant systems, numerous connection configurations have been introduced. The aim of this review is to classify current implant–abutment connection systems and evaluate their mechanical and clinical advantages and disadvantages.

Keywords

• Dental Abutments
• Dental Prosthesis
• Dental Implant

Supporting Institution

No financial support was received from any public or private institution for this study.

Ethical Statement

Due to the study design and methodology, ethical approval was not required.

İmplant–Abutment Bağlantı Tasarımları: Biyomekanik, Biyolojik ve Klinik Etkileri

Abstract

İmplant-abutment bağlantı tasarımı, dental implantların uzun dönem başarısında biyomekanik stabilite ve biyolojik entegrasyon açısından kritik bir faktördür. İmplant-abutment arayüzünde oluşan mikro hareketler marjinal kemik kaybı, vida gevşemesi ve mikrosızıntı gibi komplikasyon riskini artırmaktadır. Bu nedenle bağlantı tasarımları hakkında bilgi sahibi olunması, klinik başarının arttırılmasında kritik bir rol oynamaktadır. İlk dental implant sisteminin geliştirilmesinden itibaren farklı bağlantı tasarımlarına sahip birçok sistem ortaya çıkmıştır. Bu derlemede güncel implant-abutment bağlantı sistemlerini sınıflandırmak ve bu sistemlerin mekanik ve klinik açıdan avantajları ile dezavantajlarını değerlendirmek amaçlanmıştır.

Keywords

• Diş Abutmentları
• Diş Protezi
• Diş implant

Supporting Institution

Bu çalışma, herhangi bir kamu veya özel kuruluş tarafından finansal olarak desteklenmemiştir.

Ethical Statement

Çalışmanın tasarımı ve yöntemi gereği etik kurul onayı alınmasına gerek bulunmamaktadır.

References

1. 1. Coelho PG, Sudack P, Suzuki M, Kurtz KS, Romanos GE, Silva NRFA. In vitro evaluation of the implant abutment connection sealing capability of different implant systems. J Oral Rehabil. 2008;35(12):917-924.
2. 2. Brånemark PI, Breine U, Adell R, Hansson BO, Lindström J, Ohlsson Å. Intra-osseous anchorage of dental prostheses: I. Experimental studies. Scand J Plast Reconstr Surg. 1969;3(2):81-100.
3. 3. Bonfante EA, Coelho PG. A critical perspective on mechanical testing of implants and prostheses. Adv Dent Res. 2016;28(1):18-27.
4. 4. Jeong KW, Kim JC, Yeo IS. Clinical significance of internal friction connection and microthreads in implant-supported prostheses: a literature review. Recent Prog Mater. 2020;2:1-13.
5. 5. Muley N, Prithviraj DR, Gupta V. Evolution of external and internal implant to abutment connection. Int J Oral Implantol Clin Res. 2012;3(3):122-129.
6. 6. Shafie HR. Clinical and laboratory manual of dental implant abutments. Hoboken (NJ): John Wiley & Sons; 2014.
7. 7. Karl M, Taylor TD. Parameters determining micromotion at the implant–abutment interface. Int J Oral Maxillofac Implants. 2014;29(6):1334-1341.
8. 8. Sarfaraz H, Paulose A, Shenoy KK, Hussain A. A three-dimensional finite element analysis of a passive and friction fit implant abutment interface and the influence of occlusal table dimension on stress distribution. J Indian Prosthodont Soc. 2015;15(3):229-236.

9. 9. Bozkaya D, Muftu S, Muftu A. Evaluation of load transfer characteristics of five different implants in compact bone at different load levels by finite element analysis. J Prosthet Dent. 2004;92(6):523-530.
10. 10. Maeda Y, Satoh T, Sogo M. In vitro differences of stress concentrations for internal and external hex implant–abutment connections: a short communication. J Oral Rehabil. 2006;33(1):75-78.
11. 11. Lee JH, Huh YH, Park CJ, Cho LR. Effect of the coronal wall thickness of dental implants on screw joint stability in the internal implant–abutment connection. Int J Oral Maxillofac Implants. 2016;31(5):1058-1065.
12. 12. Sutter F, Weber HP, Sorensen J, Belser U. The new restorative concept of the ITI dental implant system: design and engineering. Int J Periodontics Restorative Dent. 1993;13(5):409431.
13. 13. Hansson S. Implant-abutment interface: biomechanical study of flat top versus conical. Clin Implant Dent Relat Res. 2000;2:33-41.
14. 14. Bozkaya D, Müftü S. Mechanics of the tapered interference fit in dental implants. J Biomech. 2003;36:1649-1658.
15. 15. Vinhas AS, Aroso C, Salazar F, López-Jarana P, Ríos-Santos JV, Herrero-Climent M. Review of the mechanical behavior of different implant–abutment connections. Int J Environ Res Public Health. 2020;17(22):8685.
16. 16. Gracis S, Michalakis K, Vigolo P, Vult von Steyern P, Zwahlen M, Sailer I. Internal vs. external connections for abutments/reconstructions: a systematic review. Clin Oral Implants Res. 2012;23:202-216.
17. 17. Ceruso FM, Barnaba P, Mazzoleni S, Ottria L, Gargari M, Zuccon A, et al. Implantabutment connections on single crowns: a systematic review. Oral Implantol. 2017;10(4):349358.
18. 18. Barbosa GAS, Bernardes SR, Neves FDD, Fernandes Neto AJ, Mattos MDGCD, Ribeiro RF. Relation between implant–abutment vertical misfit and torque loss of abutment screws. Braz Dent J. 2008;19:358-363.
19. 19. Siadat H, Najafi H, Alikhasi M, Falahi B, Beyabanaki E, Zayeri F. Effect of lateral oblique cyclic loading on microleakage and screw loosening of implants with different connections. J Dent Res Dent Clin Dent Prospects. 2018;12(3):183-189.
20. 20. Binon PP. Implants and components: entering the new millennium. Int J Oral Maxillofac Implants. 2000;15(1):76-94.
21. 21. Canullo L. Clinical outcome study of customized zirconia abutments for single-implant restorations. Int J Prosthodont. 2007;20(5):489-493.
22. 22. Gil FJ, Herrero-Climent M, Lázaro P, Rios JV. Implant–abutment connections: influence of the design on the microgap and fatigue and fracture behavior of dental implants. J Mater Sci Mater Med. 2014;25(7):1825-1830.
23. 23. Bisognin EDC, Harari ND, Machado SJ, Silva CP, Almeida Soares G, Vidigal GM Jr. Evaluation of implant–abutment microgap and bacterial leakage in five external-hex implant systems: an in vitro study. Int J Oral Maxillofac Implants. 2012;27(2):346-351.
24. 24. Pjetursson BE, Zarauz C, Strasding M, Sailer I, Zwahlen M, Zembic A. A systematic review of the influence of the implant–abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin Oral Implants Res. 2018;29(Suppl 18):160-183.
25. 25. Agarwal N, Pai U, Rodrigues SJ. Implant abutment connections: a review. Karnataka Prosthodont J. 2017;1(3):13-25.
26. 26. Quek HC, Tan KB, Nicholls JI. Load fatigue performance of four implant–abutment interface designs: effect of torque level and implant system. Int J Oral Maxillofac Implants. 2008;23(2):253-262.
27. 27. Tripodi D, D'Ercole S, Iaculli F, Piattelli A, Perrotti V, Iezzi G. Degree of bacterial microleakage at the implant–abutment junction in cone Morse tapered implants under loaded and unloaded conditions. J Appl Biomater Funct Mater. 2015;13(4):367-371.
28. 28. Pera F, Menini M, Bagnasco F, Mussano F, Ambrogio G, Pesce P. Evaluation of internal and external hexagon connections in immediately loaded full-arch rehabilitations: a withinperson randomized split-mouth controlled trial with a 3-year follow-up. Clin Implant Dent Relat Res. 2021;23(4):562-567.
29. 29. Tsouknidas A, Giannopoulos D, Savvakis S, Michailidis N, Lympoudi E, Fytanidis D, et al. The influence of bone quality on the biomechanical behavior of a tooth-implant fixed partial denture: a three-dimensional finite element analysis. Int J Oral Maxillofac Implants. 2016;31(6):e152-e160.
30. 30. Torcato LB, Pellizzer EP, Verri FR, Falcón-Antenucci RM, Júnior JFS, Almeida DA. Influence of parafunctional loading and prosthetic connection on stress distribution: a threedimensional finite element analysis. J Prosthet Dent. 2015;114(5):644-651.
31. 31. Bufalá Pérez M, Zubizarreta-Macho Á, Borrajo Sánchez J, Hernández Rodríguez J, Alonso Pérez-Barquero J, Riad Deglow E, et al. Removal capability, implant–abutment connection damage and thermal effect using ultrasonic and drilling techniques for extraction of fractured abutment screws: an in vitro study. BMC Oral Health. 2022;22(1):603.
32. 32. Siadat H, Belbasi S, Alikhasi M, Nazari V, Beyabanaki E. Effect of implant connection type and depth on the seating accuracy of hand-tightened abutments. J Prosthodont. 2019;28(2):e661-e665.
33. 33. Macedo JP, Pereira J, Vahey BR, Henriques B, Benfatti CA, Magini RS, et al. Morse taper dental implants and platform switching: the new paradigm in oral implantology. Eur J Dent. 2016;10(1):148-154.
34. 34. Elsheikh SA, El-Anwar MI, Hong T, Bourauel C, Alhotan A, Anany NM, et al. Biomechanical analysis of various connector designs of dental implant complex: a numerical finite element study. Int Dent J. 2025;75(4):100873.
35. 35. Prithviraj DR, Muley N, Gupta V. The evolution of external and internal implant–abutment connections: a review. Int Dent Res. 2012;2(2):37-42.
36. 36. Emmerson BT. Prosthetic options in implant dentistry. In: Misch CE, editor. Contemporary implant dentistry. 3rd ed. St. Louis (MO): Mosby; 1999:105-126.
37. 37. Khraisat A, Abu-Hammad O, Dar-Odeh N, Al-Kayed AM. Abutment screw loosening and bending resistance of external hexagon implant system after lateral cyclic loading. Clin Implant Dent Relat Res. 2004;6:157-164.
38. 38. Schwarz F, Alcoforado G, Nelson K, Schaer A, Taylor T, Beuer F, et al. Impact of implantabutment connection, positioning of the machined collar/microgap, and platform switching on crestal bone level changes: Camlog Foundation consensus report. Clin Oral Implants Res. 2014;25(11):1301-1303.
39. 39. da Silva EF, Pellizzer EP, Quinelli Mazaro JV, Garcia Júnior IR. Influence of the connector and implant design on implant-tooth-connected prostheses. Clin Implant Dent Relat Res. 2010;12(3):254-262.
40. 40. Gehrke SA, Delgado-Ruiz RA, Prados Frutos JC, Prados-Privado M, Dedavid BA, Granero Marín JM, et al. Misfit of three different implant–abutment connections before and after cyclic load application: an in vitro study. Int J Oral Maxillofac Implants. 2017;32(4):867-876.
41. 41. ZimVie. TSV implant with gold drills brochure [Internet]. Available from: https://www.zimvie.com/content/dam/zimviecorporate/en/dental/literature/zv1322/zv1322_tsv_implant_with_gold_drills_brochure_final_s ecured.pdf (Erişim Tarihi: 30.10.2025).
42. 42. BEGO. Ürün sayfası [Internet]. Available from: https://www.bego.com/index.php?id=308&L=elyhmopj%27A%3D0a (Erişim Tarihi: 30.10.2025).
43. 43. Zarb GA, Albrektsson T. Towards optimized treatment outcomes for dental implants. J Prosthet Dent. 1998;80(6):639-640.
44. 44. Coppedê AR, Bersani E, de Mattos MDGC, Rodrigues RCS, de Mattias Sartori IA, Ribeiro RF. Fracture resistance of the implant–abutment connection in implants with internal hex and internal conical connections under oblique compressive loading: an in vitro study. Int J Prosthodont. 2009;22(3):283-286.
45. 45. Sammour SR, El-Sheikh MM, El-Gendy AA. Effect of implant abutment connection designs and implant diameters on screw loosening before and after cyclic loading: an in vitro study. Dent Mater. 2019;35(11):e265-e271.
46. 46. Palacios-Garzón N, Ayuso-Montero R, Jané-Salas E, Anglada-Cantarell JM, López-López J. Marginal bone loss in implants with external connection versus internal conical connection prior to prosthetic loading: a randomized clinical study. Coatings. 2020;10(11):1044.
47. 47. Lauritano D, Moreo G, Lucchese A, Viganoni C, Limongelli L, Carinci F. The impact of implant–abutment connection on clinical outcomes and microbial colonization: a narrative review. Materials (Basel). 2020;13(5):1131.
48. 48. Cannata M, Grandi T, Samarani R, Svezia L, Grandi G. A comparison of two implants with conical vs internal hex connections: 1-year post-loading results from a multicentre, randomized controlled trial. Eur J Oral Implantol. 2017;10(2):161-168.
49. 49. Rodrigues VVM, Fae DS, Rosa CDDRD, Bento VAA, Lacerda MFLS, Pellizzer EP, Lemos CAA. Is the clinical performance of internal conical connection better than internal non-conical connection for implant-supported restorations? A systematic review with meta-analysis of randomized controlled trials. J Prosthodont. 2023;32(5):382-391.
50. 50. Sasada Y, Cochran DL. Implant-abutment connections: a review of biologic consequences and peri-implantitis implications. Int J Oral Maxillofac Implants. 2017;32(6):1296-1307.
51. 51. Hunt PR, Gartner JL, Norkin FJ. Choice of a dental implant system. Compend Contin Educ Dent. 2005;26(4):239-240.
52. 52. Sannino G, Barlattani A. Mechanical evaluation of an implant–abutment self-locking taper connection: finite element analysis and experimental tests. Int J Oral Maxillofac Implants. 2013;28(1):e17-e26.
53. 53. Bagegni A, Weihrauch V, Vach K, Kohal R. The mechanical behavior of a screwless Morse taper implant–abutment connection: an in vitro study. Materials (Basel). 2022;15(9):3381.
54. 54. Khorshidi H, Raoofi S, Moattari A, Bagheri A, Kalantari MH. In vitro evaluation of bacterial leakage at implant–abutment connection: an 11-degree Morse taper compared to a butt joint connection. Int J Biomater. 2016;2016:8527849.
55. 55. Straumann. Straumann® synOcta® [Internet]. Available from: https://www.straumann.com/tr/tr/dental-professionals/protezler/connections/straumannsynocta.html (Erişim Tarihi: 30.10.2025).
56. 56. Bicon. Bicon implants: an introduction [Internet]. Available from: https://www.bicon.com/pdf/Bicon_Intro.pdf (Erişim Tarihi: 30.10.2025).
57. 57. Saidin S, Kadir MRA, Sulaiman E, Kasim NHA. Effects of different implant–abutment connections on micromotion and stress distribution: prediction of microgap formation. J Dent. 2012;40(6):467-474.
58. 58. Coppedê AR, Faria ACL, Mattos MDGCD, Rodrigues RCS, Ribeiro RF. Mechanical comparison of experimental conical-head abutment screws with conventional flat-head abutment screws for external-hex and internal tri-channel implant connections: an in vitro evaluation of loosening torque. Int J Oral Maxillofac Implants. 2013;28(6):e254-e260.
59. 59. Nobel Biocare. NobelReplace and Replace Select tapered manual [Internet]. Available from: https://www.nobelbiocare.com/enus/system/files/gmt_import/NobelReplace%20and%20Replace%20Select%20Tapered%20ma nual%20USA_75434%20D.pdf (Erişim Tarihi: 30.10.2025).
60. 60. BioHorizons Camlog. CAMLOG and science [Internet]. Available from: https://www.biohorizonscamlog.es/fileadmin/user_upload/06_Mediacenter/EN/Science/PDF/ Science/CAMLOG_and_Science_January_2014.pdf (Erişim Tarihi: 30.10.2025).
61. 61. Camlog. Clinical evidence and science [Internet]. Available from: https://ebook.camlog.de/camlog/de/clinical-evidence-and-science/12/#zoom=true (Erişim Tarihi: 30.10.2025).
62. 62. Winter W, Karl M. Screw loading and gap formation in implant-supported fixed restorations: Procera implant bridge vs. conventionally cast screw-retained restorations. Quintessence Int. 2013;44(3):221-228.
63. 63. Schmitt CM, Nogueira-Filho G, Tenenbaum HC, Lai JY, Brito C, Doering H, et al. Performance of conical abutment (Morse taper) connection implants: a systematic review. J Biomed Mater Res A. 2014;102(2):552-574.
64. 64. Tsuruta K, Ayukawa Y, Matsuzaki T, Kihara M, Koyano K. The influence of implantabutment connection on screw loosening and microleakage. Int J Implant Dent. 2018;4(1):11.
65. 65. Steinebrunner L, Wolfart S, Ludwig K, Kern M. Implant–abutment interface design affects fatigue and fracture strength of implants. Clin Oral Implants Res. 2008;19(12):1276-1284.
66. 66. Shadid R, Sadaqah N, Al-Omari W, Abu-Naba’a L. Comparison between the butt-joint and Morse taper implant–abutment connection: a literature review. J Implant Adv Clin Dent. 2013;5(10):33-40.
67. 67. Kofron MD, Carstens M, Fu C, Wen HB. In vitro assessment of connection strength and stability of internal implant–abutment connections. Clin Biomech (Bristol, Avon). 2019;65:9299.
68. 68. Yoo HS, Kang SN, Jeong CM, Yun MJ, Huh JB, Jeon YC. Effects of implant collar design on marginal bone and soft tissue. J Korean Acad Prosthodont. 2012;50(1):21-28.