Implant‐abutment connection as contributing factor to peri‐implant diseases

Dental implant–supported prostheses are an established treatment modality for the functional and esthetic rehabilitation of partial and/or complete edentulous patients. One of the most essential factors for successful treatment outcomes stems from preservation of the peri‐implant bone. Early peri‐implant crestal bone loss has been a common observation, coincides with the time period where most treatment manipulations occur and has been considered as a complex multifactorial event. Microbial leakage at the implant‐abutment interface has been associated with inflammatory reactions that may jeopardize peri‐implant crestal bone stability. Prevention of microbial leakage at the implant‐abutment interface is a major challenge in the construction of two‐piece implant systems. Changes in the implant‐abutment complex design achieved reduction in the magnitude of microbial leakage and/or separation of the implant‐abutment interface from the osseous surface. However, it is still unclear if microbial leakage at the implant‐abutment interface plays a role beyond the initial crestal bone remodeling, namely on the development of peri‐implantitis. Therefore, the aim of this review is to analyze the knowledge available on the integrity of different types of implant‐abutment connections and their potential role on the development of peri‐implant crestal bone loss and peri‐implant diseases.