Performance of CAD/CAM monolithic ceramic Implant-supported restorations bonded to titanium inserts: A systematic review

Aims: This review assessed the available evidence on the performance of CAD/CAM monolithic implant-supported restorations bonded to titanium (Ti) inserts and bases, which has become a popular concept. Materials and Methods: An electronic and manual search of PubMed databases was conducted to identify studies published in English between 2000 and 2016 on the performance of monolithic ceramic implant restorations with Ti inserts. Results: The initial search revealed 505 titles. Full-text screening was carried out for 70 studies, yielding 25 articles that met the inclusion criteria. No clinical studies could be identified regarding the performance of monolithic ceramic restorations bonded to Ti inserts. Laboratory studies on selected aspects and studies on similar prosthetic designs indicate that Ti inserts improve the overall fracture strength of ceramic abutments and crowns, protect the implant connection from wear, and offer a better marginal fit when compared with all-ceramic abutments. Conclusions: While laboratory studies and evaluations of similar designs indicated promising outcomes, clinical studies that evaluate the performance of CAD/CAM monolithic implant-supported restorations bonded to Ti inserts and bases are needed. Keywords: CAD/CAM fabricated implant restorations, hybrid abutments, hybrid abutment crowns, implant hybrid restorations, resin bonding to titanium, TiBase, titanium implant insert, two piece CAD/CAM abutments