Clinical and In Situ Oral Biofilm Formation on Dental Implant Abutment Materials: A Systematic Review.
Level 1 - systematic review of randomized trials
Systematic review of 19 clinical and in situ comparative studies.
PubMed 35904820 · doi:10.11607/jomi.9352
What was done
A systematic review was conducted across nine databases (PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, LIVIVO, BVS, ProQuest, and OpenGrey) through November 2020. Eligible studies included clinical and in situ investigations comparing oral biofilm formation on metallic, ceramic, or polymeric abutment materials against titanium or titanium alloys. Primary outcomes were microbial counts/profile, cell viability, and biofilm coverage/thickness; clinical parameters were secondary outcomes. Risk of bias was assessed using RoB 2 and ROBINS-I tools.
What was found
A total of 19 studies were included (10 clinical, 9 in situ), evaluating polytetrafluoroethylene, gold alloy, gold-platinum alloy, cobalt-chromium, alumina, and zirconia. Meta-analysis was not performed due to study heterogeneity. No qualitative or quantitative microbiologic differences between alternative materials and titanium were found in 6 of 10 clinical studies (60%) and 4 of 9 in situ studies (44%). When significant differences were detected, results were conflicting. All investigated materials demonstrated clinical outcomes consistent with healthy tissue conditions.
Why it matters
This review demonstrates that alternative abutment materials, such as zirconia or cobalt-chromium, perform comparably to titanium regarding biofilm accumulation and peri-implant health.
Limits
High heterogeneity precluded quantitative meta-analysis, leaving the synthesis qualitative. Total participant counts, follow-up durations, and specific risk-of-bias ratings for individual studies are not reported in the abstract. In situ models showed conflicting tendencies compared to clinical observations.
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