Peri-implant soft-tissue responses to tooth-colored abutment materials: A systematic review.

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level

• Effect Size: Not quantified — narrative synthesis only; no pooled effect sizes reported

• Primary Outcome: Peri-implant soft-tissue responses to tooth-colored abutment materials (zirconia and PEEK) compared to titanium, assessed across in vitro, animal, and clinical study designs

• Nnt Or Sensitivity: Not calculable from available data; no NNT, sensitivity/specificity, or hazard ratio reported. Qualitative finding: zirconia associated with lower inflammatory response and superior cell attachment versus titanium; PEEK associated with limited cell attachment due to hydrophobicity requiring surface modification

• Confidence Interval: Not reported — no meta-analysis performed

Clinical Application

Zirconia abutments are commercially available and in widespread clinical use. PEEK abutments are available but less commonly used due to mechanical and biological limitations identified in this review. Surface modification of PEEK (e.g., plasma treatment, hydroxyapatite coating) is technically feasible but not yet standardised in clinical practice. Cost and laboratory fabrication requirements may limit accessibility in some settings. In Australia, zirconia and titanium implant abutments are available through TGA-registered dental device suppliers and are used routinely in specialist prosthodontic and oral surgery practice. PEEK-based abutments are available but not widely adopted. The RACGP and Australian Dental Association (ADA) do not currently publish specific guidelines on abutment material selection for peri-implant tissue management. PBS does not subsidise dental implant components. Private health insurance (Extras cover) may partially offset costs under major dental benefits, though coverage varies significantly by fund and policy tier. Australian clinicians should note that the evidence base reviewed here does not yet support a definitive material preference change from titanium to zirconia based on soft-tissue outcomes alone, pending higher-quality clinical trial data. Adult patients undergoing single-tooth or multi-unit implant restoration in esthetic zones where soft-tissue appearance and biocompatibility are primary concerns; patients with metal sensitivity or aesthetic objections to titanium abutments

Abstract

PURPOSE: This systematic review aimed to investigate and compare peri-implant soft-tissue responses to tooth-colored abutment materials frequently used in implant dentistry. STUDY SELECTION: A comprehensive electronic search was performed in three databases (MEDLINE via PubMed, Google Scholar, and Scopus) to identify relevant literature. The study-selection criteria included original research articles written in English that investigated the effects of various tooth-colored abutment materials on peri-implant soft-tissue responses. RESULTS: In total, 136 articles were included in this systematic review. Tooth-colored abutment materials, particularly zirconia and polyetheretherketone (PEEK), facilitated favorable soft-tissue adaptation, enhanced esthetics, and contributed to long-term implant success. Zirconia demonstrated excellent biocompatibility, enhanced cell viability and attachment, and lower inflammatory responses compared to titanium, suggesting improved soft-tissue integration and reduced biofilm-related risks. PEEK exhibited favorable mechanical properties and biocompatibility but limited cell attachment due to its hydrophobicity, indicating the need for surface modification. Titanium remains the clinical standard for integration but is associated with greater inflammation and biofilm formation than tooth-colored materials. CONCLUSIONS: This review highlights the effects of tooth-colored abutment materials on peri-implant soft-tissue responses and emphasizes the importance of selecting appropriate materials for successful dental implants. Zirconia represents a promising biological alternative to titanium, promoting a stable soft-tissue barrier that contributes to minimizing inflammation and maintaining long-term tissue health. Conversely, while PEEK offers strong mechanical properties, it faces challenges regarding cell proliferation and matrix production, limiting its optimal biological performance. Further research will provide deeper insights into the best options for enhancing patient and esthetic outcomes.

References

1. 1.Tiskratok, W., Limraksasin, P., Kyawsoewin, M., Intapibool, P., Jitprasertwong, P., Nattasit, P., Yamada, M., & Egusa, H. (2026). Peri-implant soft-tissue responses to tooth-colored abutment materials: A systematic review. Journal of Prosthodontic Research. Advance online publication. https://doi.org/10.2186/jpr.JPR_D_25_00125