Home

Learning

Network

Premium

Menu

Definitive Abutments Placed at Implant Insertion and Never Removed: Is It an Effective Approach? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Marco Tallarico
Marco Tallarico
11
30 min read16 September 2025

Purpose: To assess whether repeated abutment disconnections and reconnections have any impact on peri-implant bone resorption and soft tissue healing.

Materials and Methods: Electronic and manual searches were conducted for English-language articles published up to March 2017 that identified a relation between repeated disconnections of implant abutments (PA group) and prosthetic or implant failures, complications, marginal bone loss (MBL), soft tissue healing, and esthetic evaluation (pink esthetic score [PES]) after at least 1 year of function compared with implants receiving a final abutment at the time of implant placement (DA group).

Results: Fourteen articles (535 patients with 994 implants) were selected for qualitative analysis. Six of these were included in the meta-analysis. Five prostheses failed in the PA group and 1 failed in the DA group (P = .1047). Seven biologic complications occurred in the PA group and 6 occurred in the DA group (P = .8121). MBL was significantly less in the DA group (difference, 0.279 mm; P = .000). Greater buccal recession occurred in the PA group (difference, 0.198 mm; P = .0004). The PES evaluation showed no differences between groups (P = .289).

Conclusions: Repeated abutment disconnections and reconnections considerably increased MBL and buccal recession. Further studies are needed to confirm these results.

 

Previous reports by consensus conferences and observational studies have suggested that numerous etiologic factors are specifically associated with peri-implant bone loss, including, but not limited to, surgical trauma, occlusal overload, biologic width establishment, design of the implant-to-abutment interface, and flap procedures.

After connection of the abutment and delivery of the final prosthesis, physiologic horizontal and vertical bone remodeling is observed around 2-piece implants; thereafter, minimal annual bone loss is observed. According to Papaspyridakos et al and Galindo-Moreno et al, the bone remodeling process is multifactorial and represents one of the most critical factors in evaluating implant success.

Over the years, new interface designs have been introduced to minimize microleakage and micromovements at the implant-to-abutment interface. Indeed, a design strategy including the connection of a smaller-diameter abutment relative to the platform diameter of the titanium implant (referred to as platform shifting or switching) was proved to provide peri-implant alveolar bone-level stability and avoid continuous soft tissue shrinkage up to 10 years after prosthetic loading compared with platform-matching restoration. 

In 2-piece implants, the interface between the implant and the abutment is typically placed at the alveolar crest and the abutment is disconnected several times during the prosthetic phases of treatment. The micro-gap between these 2 components and disruption of the soft tissue that occurs each time the abutment is disconnected and reconnected are supposed to cause bone resorption around the implant. 

The objective of this systematic review and meta-analysis was to assess whether repeated abutment disconnections and reconnections have any impact on peri-implant bone resorption and soft tissue healing.

 

Materials and Methods

This systematic review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (http://www. prisma-statement.org).11 The focus of the review was to identify a relation between repeated disconnections of implant abutments and peri-implant marginal bone loss (MBL) and soft tissue healing after at least 1 year of function compared with implants receiving a final abutment at the time of implant placement. Initially, the PICOS strategy (population [P], intervention [I], comparison [C], outcomes and study design [O], study type [S]) used to define the search was:

P = patients with edentulism and a single, partial, or complete prosthesis who required implant-supported restoration

I = definitive abutments placed at implant insertion and never removed after at least 1 year of function C = repeated temporary abutment disconnections and reconnections

O = prosthetic or implant failures, biological or mechanical complications, radiographic MBL, peri-implant buccal recession (BR), and pink esthetic score (PES)

S = randomized controlled clinical trials (RCTs), case-and-control studies, cohort studies (prospective and retrospective), cross-sectional studies, systematic reviews, narrative reviews, consensus statements, commentaries, and editorials

Search strategy

An initial search strategy encompassing the English-language literature from 1967 up to March 2017 was performed online to identify relevant studies that met the inclusion criteria. The following electronic databases were consulted: the PubMed database of the US National Library of Medicine, Embase (Excerpta Medica database), and the Cochrane Library. According to the AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklist, the Grey Literature database was screened at the New York Academy of Medicine Grey Literature Report to find possible unpublished works. Screening was performed independently and simultaneously by 2 calibrated examiners (E.X. and M.T.). A third reviewer (L.C.) reassessed the included and excluded studies. The electronic databases were searched using a combination of Boolean keywords, Medical Subject Heading (MeSH), and several free-text terms. The Boolean search algorithm used to find potentially relevant literature was developed by extracting the keywords of relevant literature found at preliminary scoping searches and included the following terms: (((((Dental Implant-Abutment* [Title/Abstract]) OR One-abutment*[Title/Abstract]) OR abutment dis*[Title/Abstract]) AND (Immediate Dental Implant Loading[Title/Abstract]) OR Immediate loading[Title/Abstract]) OR Immediate abutment [Title/Abstract]).

Eligibly criteria

The following inclusion criteria were defined for the selection of articles:

  • Written in English
  • Description of the protocol used for non-removal of the final abutment in at least 1 group
  • Description of a measuring technique of tissues at baseline and after a certain healing period to evaluate peri-implant tissue stability
  • RCTs of implant function after at least 1 year
  • Prospective and retrospective cohort studies of implant function after at least 1 year
  • Cross-sectional studies of implant function after at least 1 year
  • Systematic reviews, narrative reviews, consensus statements, commentaries, or editorials

Articles were excluded if they were

  • In vitro studies
  • Animal studies
  • Reports of locally or systemically compromised sites or conditions
  • Reports with fewer than 5 cases
  • Reports involving mini-implants, 1-piece implants, or blade implants
  • Reports on implant function shorter than 1 year

Data extraction

The 2 calibrated reviewers screened and collected the data from selected articles and into structured tables. Cohen k values between examiners were calculated at the second stage of the research. Discrepancies were resolved by consensus and the third examiner was consulted.

Articles without abstracts but with titles related to the objectives of this review were selected and their full texts were screened for eligibility. Reference lists of the selected articles were further screened for possible additional articles. In addition, manual searches of the bibliographies of selected systematic reviews were conducted and limited to the following journals: Clinical Implant Dentistry and Related Research; Clinical Oral Implants Research; International Journal of Oral and Maxillofacial Implants; European Journal of Oral and Implantology; Journal of Clinical Periodontology; Journal of Periodontology; The Journal of Prosthetic Dentistry; International Journal of Periodontics and Restorative Dentistry; and The International Journal of Prosthodontics.

The following information was sought and recorded by the 2 examiners independently on data extraction forms: name of author and year of publication, study design, length of follow-up, number of patients with repeated disconnections and reconnections of implant abutments (PA group; if there was a control group) and number of patients with definitive abutment at the time of implant placement (DA group; obligatory group), number of implants in the PA and DA groups, type of prosthesis (single, partial, or complete), implant type, abutment type and material, prosthetic failure, implant failure, and complications (patient level; Table 1).

Table 1. Main characteristics of included studies

The following outcome measures were analyzed: 1) prosthetic or implant failures leading to loss or removal of the prosthesis or implant; 2) biological or mechanical complications; 3) radiographic MBL; 4) peri-implant buccal recession (BR); and 5) pink esthetic score (PES).

Assessment of quality, heterogeneity, and risk of bias of individual studies

The same reviewers assessed the quality of the studies and the risk of bias in the included studies according to guidelines provided by the Consolidated Standards of Reporting Trials (CONSORT) statement for the evaluation of RCTs (http://www.consort-statement.org), the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement for observational studies (http://www.strobe-statement.org), and the modified items from the Cochrane Collaboration Tool for assessing risk of bias. 

For the adequacy of the respective studies, the items were graded and the percentage of negatively graded items was calculated to define the overall risk of bias (Table 2). Quality assessment was performed in 2 different phases: in phase I, quality assessment was based on the published full-text articles performed independently by the 2 reviewers; in phase II, disagreements were resolved with discussion. After collecting the scores of quality assessment at phase II, an overall estimation of plausible risk of bias (low, moderate, or high) was completed for each selected study. A low risk of bias was estimated when all the criteria were met, a moderate risk was considered when at least 1 criterion was partly met, and a high risk of bias was estimated when at least 1 criterion was not met (Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0; http://www.cochrane.org/resources/handbook).

Table 2. The cochrane collaboration’s tool for assessing risk of bias for studies included in meta-analysis

Measures and analysis of results

Descriptive statistics, meta-regression, and meta-analysis were performed based on comparable RCTs comparing the DA with the PA group and reporting the same outcome measurements. The meta-analysis was conducted using Comprehensive Meta-Analysis 3 for Windows (Bio Stat, Englewood, NJ). The Q heterogeneity statistic and corresponding P value for the c2 test were recorded. Fixed-effects models were applied to detect statistically relevant differences in prosthetic and implant survival rates and complication rates between groups, whereas random-effects models were applied to detect statistically relevant differences in mean MBL, BR, and PES because considerable heterogeneity among studies could be partially detected. The primary outcome was defined as the proportions of failures and complications in each treatment group. The mean peri-implant MBL present at implants in function for at least 1 year and comparison between clinical parameters, such as PES and BR, were considered secondary outcomes. For continuous variables (MBL changes, measured in millimeters), mean differences were combined using random-effects models.

Because considerable heterogeneity among studies could be partially detected, random-effects models were applied instead of fixed-effects models to detect statistically relevant differences in prosthetic survival rates and complication rates between groups. These models are used to determine pooled estimates for specific groups of estimates found in the literature. Heterogeneity among studies, subgroup analyses, meta-analysis, and forest plots were calculated using Comprehensive Meta-Analysis 3.

 

Results

Study selection

In total, 1,287 potentially relevant titles and abstracts were found after the electronic and manual searches. During the first stage of selection, 1,231 articles were excluded based on the titles and abstracts. During the second phase, complete full-text articles of the remaining 56 publications were evaluated and 42 articles were excluded because they did not fulfill the inclusion criteria (k = 0.96). Therefore, 14 articles (994 implants placed in 535 patients) that fulfilled the inclusion criteria and quality assessment required for this systematic review were selected for qualitative analysis. Nine studies reported data on 1 implant per patient and 5 studies reported data on 2 to 4 implants per patient, and 1 of these studies analyzed fully edentulous patients receiving 4 implants with immediately placed telescopic abutments. A diagram of the search strategy is shown in Figure 1.

Figure 1. Flow diagram showing phases of study selection based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

Study characteristics and risk of bias

The 14 selected studies were published from 1993 to March 2017. Of these, 6 were RCTs with a parallel-group design, 5 were prospective cohort studies, and 3 were retrospective cohort studies. Five RCTs and 1 non-RCT were included in the quantitative analysis (Table 1). None of the selected human studies fulfilled all the requisites (Table 2). Four RCTs were reported according to the CONSORT statement for improving the quality report of a parallel-group randomized trial. Two publications were associated with a low risk of bias and 5 had a moderate risk of bias. The included articles received minimum grading for submission to ethical committees (1 of 6), allocation concealment (2 of 6), and blinding of participants and personnel (0 of 6). Overall, data on 285 implants placed in 233 patients were reported. Of these, 141 implants were placed in 115 patients (DA group) and 144 implants were placed in 118 patients (PA group).

Implant and prosthesis failures and complications

Quantitative analysis from the 6 selected studies showed 5 prosthetic failures in the PA group (4 temporary restorations and 1 definitive restoration) and 1 in the DA group (temporary restoration) in 1 RCT. All restorations were remade. The difference between groups was not statistically significant (P = .1047). No implant failures by the 1-year follow- up examination were observed. Three studies reported 13 complications during the first-year follow-up examination (7 complications in the PA group and 6 in the DA group). Most complications were gingiva irritation or mucositis and pain. In all cases, the complications were resolved chairside. Nevertheless, the number of complications was similar in the 2 groups, and the differences were not statistically significant (P = .8121).

Overall, in the DA group, 1 prosthesis failed (0.19%) in 1 RCT and the other 13 studies included in the qualitative analysis reported a prosthetic survival rate of 100%. No implants failed in 10 studies; however, the other 4 studies reported 15 implant failures (1.51%).    Furthermore, 17 complications occurred in 535 patients, for a prosthetic success rate of 96.8%.

Meta-regression analysis of included rcts

Marginal Bone Loss

All included RCTs reported data on MBL at the 1-year follow-up examination. Meta-regression analysis showed a statistically significant difference between groups in favor of the DA group (0.279 mm; P = .000; Fig 2).

Figure 2. Forest plot of pooled studies and meta-analysis of differences in marginal bone loss between groups after 1 year of function. CI, confidence interval; DA, definitive abutment at time of implant placement; PA, repeated disconnections of implant abutments.

Buccal Recession

Two studies reported data on BR expressed in millimeters at the 1-year follow-up examination. Degidi et al reported mean BR values of 0.33 ± 0.12 mm in the DA group and 0.57 ± 0.17 mm in the PA group. Esposito et al, in an RCT, reported mean BR values of 0.07 ± 0.35 in the DA group and 0.12 0.65 mm in the PA group. The difference was statistically significant in favor of the DA group (difference, 0.198 mm; P = .0004; Fig 3).

Figure 3. Forest plot of pooled studies and meta-analysis of differences in buccal recession between groups after 1 year of function. CI,
confidence interval; DA, definitive abutment at time of implant placement; PA, repeated disconnections of implant abutments.

Pink Esthetic Score

One RCT reported differences in PES between groups assessed at the 1-year follow-up. Although PES scores were slightly better in the DA group compared with the PA group (difference, 0.4), no statistically significant differences were found (P = .289).

 

Discussion

The objective of this systematic review was to evaluate whether a prosthetic strategy aimed at minimizing abutment disconnection and reconnection might improve peri-implant hard and soft tissue stability.

The main limitations of the present review are the medium risk of bias of most included studies and the short-term follow-up being evaluated. Nevertheless, data on 994 implants placed in 535 patients were re- ported in qualitative analysis and 6 studies were included in the quantitative synthesis. Moreover, 1 year after loading might be sufficient to understand differences in physiologic bone remodeling patterns. In the quantitative analysis, no differences were observed for the prosthesis and implant survival and success rates and the number of complications was similar in the 2 groups. All studies reported less MBL for the DA group. In 4 studies, the difference was statistically relevant at the 1-year follow-up examination. Nevertheless, 7 studies reported data with up to 5 years of post-loading follow-up, confirming hard and soft tissue stability over time. The clinical relevance of the markedly decreased MBL and BR expected when placing definitive abutments at implant insertion and not removing them might be controversial. Soft tissue behavior was reported in only 1 article, which noted a trend for improved soft tissue maintenance and color in patients treated with definitive abutments placed at implant insertion without removal, but the data were not statistically relevant. Nevertheless, the optimization of clinical outcomes is made through small improvements.

Canullo et al compared the 3-year peri-implant MBL of immediately loaded post-extractive implants having received a provisional or a definitive platform-switched titanium abutment. The DA group exhibited significantly less MBL at the 3-year follow-up, but not after 18 months from baseline (P = .051), meaning that avoiding abutment disconnection and reconnection might improve peri-implant hard and soft tissue stability over time but will not affect the long-term implant success or survival rate. Degidi et al, using cone-beam computer tomography measurements, reported that a definitive abutment placed at the time of surgery decreases horizontal bone loss up to 2 years after loading. Nevertheless, no relevant difference between groups was found until removal of the temporary abutment at 6-month follow-up.

Platform switching was used in all but 2 studies. Instead, 3 RCTs reported on post-extractive implants, whereas 1 RCT reported on both procedures. Titanium and zirconia implants were used. It is curious that different implant placement protocols and implant designs showed similar mean MBLs of approximately 0.3 mm during the first year of function. One year after loading, less BR in the DA group also was reported in 2 studies (Fig 3). Nevertheless, in a retrospective study by Kan et al, continuing recession of the facial gingival tissue was observed at medium-term follow-up.

The placement of a stock definitive abutment at the time of implant placement should be carefully considered in cases in which more apically positioned restorative margins are needed, because of the difficulty in removing the deeply positioned residual excess cement. Computer-assisted template-surgery in combination with computer-aided design and computer-aided manufacturing technologies could allow the prefabrication of customized abutments with the cement line placed at the soft tissue level. Tallarico et al, in a prospective study, reported a mean MBL of 0.08 0.11 mm after 1 year of functional loading. In a similar study, Pozzi et al reported a mean MBL of 0.29 0.17 mm. The main difference between these studies was that Tallarico et al used platform-switched implants.

A wide array of factors can contribute to the extent of early bone loss. Of these, connection between the implant and the abutment, implant position and macro-design, and an implant placement protocol seem to have the greater influence on initial bone remodeling.

Most of the selected scientific literature confirmed that the use of a prosthetic procedure aimed at minimizing abutment disconnection and reconnection seems to decrease peri-implant bone-level changes. In fact, meta-regression analysis of the included RCTs found 0.279 mm less MBL around implants rehabilitated with definitive abutments placed on the day of surgery and 0.198 mm less BR. This result is in agreement with a recent open-cohort prospective study on sandblasted and acid-etched bone-level implants featuring an 11◦ Morse taper connection. Sublevel analysis showed that placing a definitive abutment the day of implant insertion statistically decreased marginal bone remodeling within 1 year after loading. Moreover, a recent systematic review on the same topic concluded that multiple abutment disconnections and reconnections have a modest effect of 0.19 mm on marginal bone-level changes. However, Koutouzis et al evaluated the impact of abutment disconnection and reconnection on marginal bone-level changes in studies with only 6 months of follow-up.

Several etiologic factors could explain this clinically relevant evidence. The first and probably most evident reason seems to be related to biologic aspects. After the conclusions reported by Abrahamsson et al, in another dog study, Farronato et al described the different distributions of biologic width components around implants restored using diameter-matching and platform-switching configurations. The main difference between these 2 groups was represented by the different dispositions of the connective component. In fact, according to Abrahamsson et al, in the diameter-matching restorations, the connective seal was positioned below the implant-abutment junction close to the prosthetic component. Controversially, in platform-switching restorations, the seal was positioned just over the collar not occupied by the prosthetic components and, therefore, in direct contact with it. Obviously, disconnection and reconnection of the abutment might lead to micro-damage of the connective tissue with its consequent apical repositioning and bone resorption. This event seems to be even more pronounced in thin biotypes, perhaps because of the thinner ‘biologic width.’ The second possible explanation for the improved outcome of the placement of a definitive abutment at implant insertion and never removed might be linked to biomechanics. In fact, continuous disconnections and reconnections were found to produce substantial deformation at the connection level. Abutments and pickup transfers are made of grade 5 titanium, whereas fixtures are made of grade 4 titanium, which tends to deform more compared with titanium alloys. Screwing at 20 N-cm (or more), as recommended by most manufacturers, might produce a micro-deformation of the inner portion of the implant connection and of the screw threads. Repeated abutment disconnection and reconnection might produce micro-notches and screw deformations, leading to biomechanical complications at the screw and connection level (from augmented implant abutment leakage to abutment instability). A third possible etiologic factor might be the microbiologic contamination of the connection during the prosthetic phases and try-in. In fact, during continuous disconnections and reconnections, micro-biologically contaminated fluids might infect the connection, creating the correct environment for anaerobic bacteria selection.

In this review, the possible influence of etiologic factors associated with peri-implant bone loss (surgical protocol, occlusal overload, biologic width establishment, implant-to-abutment interface design, and flap procedures) could be ruled out because of the randomized nature of the studies included in the qualitative analysis. Furthermore, the quality of the included studies appeared to be moderately acceptable as assessed by Cochrane Scale for Systematic Reviews of Interventions. Some obvious heterogeneity among studies can allow the generalization of results to a large cohort of patients treated in daily practice. Indeed, positive results were reported for stock and customized abutments and for straight and tilted abutments. 

One-year post-loading data showed that repeated disconnection and reconnection considerably increased peri-implant MBL by 0.279 mm and BR by 0.198 mm. Therefore, definitive abutments placed at implant insertion and never removed might be a critical strategy to preserve peri-implant hard and soft tissues. Owing to the short follow-up of the studies included in the quantitative analysis, further RCTs, with data reported according to the CONSORT guidelines and with at least 5 years of follow-up, are needed to confirm these preliminary results.

 

Marco Tallarico, Martina Caneva, Silvio Mario Meloni, Erta Xhanari, Ugo Covani and Luigi Canullo

References

  1. Thoma DS, Mühlemann S, Jung RE: Critical soft-tissue dimensions with dental implants and treatment concepts. Periodontol 2000 66:106, 2014
  2. Pellegrini G, Canullo L, Dellavia C: Histological features of peri-implant bone subjected to overload. Ann Anat 206:57, 2016
  3. Bishti S, Strub JR, Att W: Effect of the implant-abutment interface on peri-implant tissues: A systematic review. Acta Odontol Scand 72:13, 2014
  4. Gracis S: Prosthetic and biomechanical factors affecting bone remodeling around implants. Eur J Esthet Dent 8:314, 2013
  5. Pozzi A, Tallarico M, Moy PK: Three-year post-loading results of a randomised, controlled, split-mouth trial comparing implants with different prosthetic interfaces and design in partially posterior edentulous mandibles. Eur J Oral Implantol 7:47, 2014
  6. Papaspyridakos P, Chen CJ, Singh M, et al: Success criteria in implant dentistry: A systematic review. J Dent Res 91:242, 2012
  7. Galindo-Moreno P, Leon-Cano A, Ortega-Oller I, et al: Marginal bone loss as success criterion in implant dentistry: Beyond 2 mm. Clin Oral Implants Res 26:e28, 2015
  8. Pozzi A, Agliardi EL, Tallarico M, et al: Clinical and radiological outcomes of two implants with different prosthetic interfaces and neck configurations: Randomized, controlled, split mouth clinical trial. Clin Implant Dent Relat Res 16:96, 2014
  9. Canullo L, Caneva M, Tallarico M: Ten-year hard and soft tissue results of a pilot double-blinded randomized controlled trial on immediately loaded post-extractive implants using platform switching concept [published online ahead of print August 8, 2016]. Clin Oral Implants Res; 2016, http://dx.doi.org/10. 1111/clr.12940
  10. Abrahamsson I, Berglundh T, Lindhe J: The mucosal barrier following abutment dis/reconnection. An experimental study in dogs. J Clin Periodontol 24:568, 1997
  11. Moher D, Liberati A, Tetzla J, et al: Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ 339:b2535, 2009
  12. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ 340:c332, 2010
  13. Graziani F, Figuero E, Herrera D: Systematic review of quality of reporting, outcome measurements and methods to study efficacy of preventive and therapeutic approaches to peri-implant diseases. J Clin Periodontol 39:224, 2012
  14. Canullo L, Bignozzi I, Cocchetto R, et al: Immediate positioning of a definitive abutment versus repeated abutment replacements in post-extractive implants: 3-Year follow-up of a randomised multicentre clinical trial. Eur J Oral Implantol 3:285, 2010
  15. Degidi M, Nardi D, Daprile G, et al: Nonremoval of immediate abutments in cases involving subcrestally placed postextractive tapered single implants: A randomized controlled clinical study. Clin Implant Dent Relat Res 16:794, 2014
  16. Degidi M, Nardi D, Piattelli A: One abutment at one time: Non-removal of an immediate abutment and its effect on bone healing around subcrestal tapered implants. Clin Oral Implants Res 22:1303, 2011
  17. Esposito M, Bressan E, Grusovin MG, et al: Do repeated changes of abutments have any influence on the stability of peri-implant tissues? One-year post-loading results from a multicentre randomised controlled trial. Eur J Oral Implantol 10:57, 2017
  18. Grandi T, Guazzi P, Samarani R, et al: One abutment-one time versus a provisional abutment in immediately loaded post-extractive single implants: A 1-year follow-up of a multicentre randomised controlled trial. Eur J Oral Implantol 7:141, 2014
  19. Grandi T, Guazzi P, Samarani R, et al: Immediate positioning of definitive abutments versus repeated abutment replacements in immediately loaded implants: Effects on bone healing at the 1-year follow-up of a multicentre randomised controlled trial. Eur J Oral Implantol 5:9, 2012
  20. Berberi AN, Noujeim \N, Kanj WH, et al: Immediate placement and loading of maxillary single-tooth implants: A 3-year prospective study of marginal bone level. J Contemp Dent Pract 15:202, 2014
  21. Canullo L, Tallarico M, Penarrocha-Oltra D, et al: Implant abutment cleaning by plasma of argon: 5-Year follow-up of a randomized controlled trial. J Periodontol 87:434, 2016
  22. Degidi M, Daprile G, Nardi D, et al: Immediate provisionalization of implants placed in fresh extraction sockets using a definitive abutment: The chamber concept. Int J Periodontics Restorative Dent 43:559, 2013
  23. Degidi M, Piattelli A, Iezzi G, et al: Immediately loaded short implants: Analysis of a case series of 133 implants. Quintessence Int 38:193, 2007
  24. Pozzi A, Sannino G, Barlattani A: Minimally invasive treatment of the atrophic posterior maxilla: A proof-of-concept prospective study with a follow-up of between 36 and 54 months. J Prosthet Dent 108:286, 2012
  25. Romanos GE, May S, May D: Treatment concept of the edentulous mandible with prefabricated telescopic abutments and immediate functional loading. Int J Oral Maxillofac Implants 26: 593, 2011
  26. Tallarico M, Meloni S: Retrospective analysis on survival rate, template-related complications, and prevalence of peri-implantitis of 694 anodized implants placed using computer-guided surgery: Results between 1 and 10 years of follow-up. Int J Oral Maxillofac Implants 32:1162, 2017
  27. Hartlev J, Kohberg P, Ahlmann S, et al: Immediate placement and provisionalization of single-tooth implants involving a definitive individual abutment: A clinical and radiographic retrospective study. Clin Oral Implants Res 24:652, 2012
  28. Kan JYK, Rungcharassaeng K, Lozada JL, et al: Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: A 2- to 8-year follow-up. Int J Oral Maxillofac Implants 26:179, 2011
  29. Albrektsson T, Canullo L, Cochran D, et al: ‘Peri-implantitis’’: A complication of a foreign body or a man-made ‘disease.’ facts and fiction. Clin Implant Dent Relat Res 18:840, 2016
  30. Tallarico M, Meloni SM: Open-cohort prospective study on early implant failure and physiological marginal remodeling expected using sandblasted and acid-etched bone level implants featuring an 11◦ Morse taper connection within one year after loading. J Oral Sci Rehabil 3:68, 2017
  31. Koutouzis T, Gholami F, Reynolds J, et al: Abutment disconnection/reconnection affects peri-implant marginal bone levels: A meta-analysis. Int J Oral Maxillofac Implants 32:575, 2017
  32. Farronato D, Santoro G, Canullo L, et al: Establishment of the epithelial attachment and connective tissue adaptation to implants installed under the concept of ‘platform switching’’: A histologic study in minipigs. Clin Oral Implants Res 23:90, 2012
  33. Micarelli C, Canullo L, Iannello G: Implant-abutment connection deformation after prosthetic procedures: An in vitro study. Int J Prosthodont 28:282, 2015
Technologies in implantologyMaterials for implantologyDigital implantologyImplantation