Scalloped Implant-Abutment Connection Compared to Conventional Flat Implant-Abutment Connection: a Systematic Review and Meta-Analysis

OBJECTIVES: The objective was to test the hypothesis of no difference in implant treatment outcome after installation of implants with a scalloped implant-abutment connection compared to a flat implant-abutment connection. MATERIAL AND METHODS: A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. No language or year of publication restriction was applied. RESULTS: The search provided 298 titles. Three studies fulfilled the inclusion criteria. The included studies were characterized by low or moderate risk of bias. Survival of suprastructures has never been compared within the same study. High implant survival rate was reported in all the included studies. Significantly more peri-implant marginal bone loss, higher probing depth score, bleeding score and gingival score was observed around implants with a scalloped implant-abutment connection. There were no significant differences between the two treatment modalities regarding professional or patient-reported outcome measures. Meta-analysis disclosed a mean difference of peri-implant marginal bone loss of 1.56 mm (confidence interval: 0.87 to 2.25), indicating significant more bone loss around implants with a scalloped implant-abutment connection. CONCLUSIONS: A scalloped implant-abutment connection seems to be associated with higher peri-implant marginal bone loss compared to a flat implant-abutment connection. Therefore, the hypothesis of the present systematic review must be rejected. However, further long-term randomized controlled trials assessing implant treatment outcome with the two treatment modalities are needed before definite conclusions can be provided about the beneficial use of implants with a scalloped implant-abutment connection on preservation of the peri-implant marginal bone level.