Dynamic Abutments in Implant Prosthetic Rehabilitation: A Review of Design, Performance, and Clinical Utility
DOI:
https://doi.org/10.55995/tecn3c28Keywords:
Angulated abutments, Dynamic abutments, Implant in esthetic zone, Prosthetic complicationsAbstract
Non-ideal implant angulation remains a frequent challenge in implant prosthodontics, compromising esthetics, screw access positioning, and retrievability of implantsupported restorations. Dynamic abutment systems have emerged as an alternative solution, enabling redirection of the screw access channel while maintaining a coaxial implant–abutment interface. This narrative review evaluates the design principles, biomechanical performance, clinical applications, and limitations of dynamic abutment systems in implant-supported rehabilitation. Evidence from in vitro studies, finite element analyses, clinical reports, and systematic reviews indicates that, within manufacturer-recommended angulation limits, dynamic abutments demonstrate torque preload, screw stability, and microgap behaviour comparable to conventional screw-retained systems. Clinically, they provide versatility in anterior esthetic zones, posterior areas with limited access, and full-arch restorations, while facilitating digital workflows. Although current evidence supports their short- to medium-term reliability, long-term clinical studies are required to establish definitive treatment guidelines.
References
1. Gurgel BCDV, Pascoal ALDB, Souza BLM, Dantas PMC, Montenegro SCL, Oliveira AGRC, et al. Patient satisfaction concerning implant-supported prostheses: an observational study. Braz Oral Res. 2015;29(1):1-6.
2. Pjetursson BE, Brägger U, Lang NP, Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses and implant-supported fixed dental prostheses. Clin Oral Implants Res. 2007;18 Suppl 3:97-113.
3. Sahin S, Çehreli MC. The significance of passive framework fit in implant prosthodontics: current status. Implant Dent. 2001;10(2):85-92.
4. Yüksel Baysal A, Hayran Y. Biomechanical evaluation of implant-supported three-unit bridge designs and retention types in the atrophic posterior maxilla using finite element analysis. Appl Sci. 2025;15(21):11793.
5. Javiya P, Sawhney A, Gandhi R, Mansuri AH, Patel S, Mohanty R, et al. The influence of implant placement angulation on biomechanical stability: an in vitro study. J Pharm Bioallied Sci. 2025;17(Suppl 2):S1226-S1228.
6. Berroeta E, Zabalegui I, Donovan T, Chee W. Dynamic abutment: a method of redirecting screw access for implant-supported restorations: technical details and a clinical report. J Prosthet Dent. 2015;113(6):516-519.
7. Chatterjee E, Nasha A, Mustafa M, Chinthalapudi SL, Padavala S, Lakshmipuram AK, et al. The impact of implant angulation on the stress distribution and survival rate of implant-supported fixed dental prostheses: a retrospective study. Cureus. 2023;15(10):e47892.
8. Atieh MA, Shah M, Hakam A, Albalushi A, Abdulmunim A, AlAli F, et al. Angled screw channel-retained vs cement-retained implant crowns in nonmolar sites: a systematic review and meta-analysis. J Esthet Restor Dent. 2025;37(7):1706-1720.
9. Kim ES, Shin SY. Influence of implant abutment types and dynamic loading on initial screw loosening. J Adv Prosthodont. 2013;5(1):21-28.
10. Krekmanov L, Kahn M, Rangert B, Lindström H. Tilting of posterior mandibular and maxillary implants for improved prosthesis support. Int J Oral Maxillofac Implants. 2000;15(3):405-414.
11. Binon PP. The effect of implant/abutment hexagonal misfit on screw joint stability. Int J Prosthodont. 1996;9(2):149-160.
12. Schwarz MS. Mechanical complications of dental implants. Clin Oral Implants Res. 2000;11(Suppl 1):156-158.
13. Dynamic Abutment Solutions. Dynamic abutment: angled screw channel system. Lleida (Spain): Talladium International Implantology.
14. Goldberg J, Lee T, Phark JH, Chee W. Removal torque and force to failure of non-axially tightened implant
abutment screws. J Prosthet Dent. 2019;121(2):322-326.
15. Al-Thobity AM. Titanium base abutments in implant prosthodontics: a literature review. Eur J Dent. 2022;16(4):1023-1032.
16. Aldhuwayhi S. Zirconia in dental implantology: a review of the literature with recent updates. Bioengineering (Basel). 2025;12(5):543.
17. Gürpınar B, Yalçın Ülker GM, Tak Ö. The use of angulated screw channel abutment system for anterior single-implant restorations: a clinical report. Eur J Res Dent. 2020;4(1):40-44.
18. Swamidass RS, Kan JYK, Kattadiyil MT, Goodacre CJ, Lozada J. Abutment screw torque changes with straight and angled screw-access channels. J Prosthet Dent. 2021;125(2):299-304.
19. Wei CX, Saglik B, Sung Hsieh HH, Guram PSJ. Effects of screw channel angulation on fracture resistance of one-piece zirconia crown with titanium base. J Prosthodont. 2025;34(2):167-173.
20. Opler R, Wadhwani C, Chung KH. The effect of screwdriver angle variation on the off-axis implant abutment system and hexalobular screw. J Prosthet Dent. 2011;105(2):67-72.
21. Haack JE, Sakaguchi RL, Sun T, Coffey JP. Elongation and preload stress in dental implant abutment screws. Int J Oral Maxillofac Implants. 1995;10(5):529-536.
22. Clelland NL, Lee JK, Bimbenet OC, Brantley WA. A three-dimensional finite element stress analysis of angled abutments for an implant placed in the anterior maxilla. J Prosthet Dent. 1995;74(6):585-591.
23. Sadrimanesh R, Siadat H, Sadr-Eshkevari P, Monzavi A, Maurer P, Rashad A. Alveolar bone stress around implants with different abutment angulation: an FE-analysis of the anterior maxilla. J Oral Implantol. 2012;38(4):353-360.
24. Huang HL, Hsu JT, Fuh LJ, Tu MG, Ko CC, Shen YW. The influence of abutment angulation on micromotion level for immediately loaded dental implants: a three-dimensional finite element analysis. J Dent. 2010;38(2):121-129.
25. Baggi L, Cappelloni I, Di Girolamo M, Maceri F, Vairo G. The influence of implant diameter and length on stress distribution of osseointegrated implants related to crestal bone geometry: a three-dimensional finite element analysis. J Prosthet Dent. 2008;100(6):422-431.
26. Pitta J, Spies BC, Pieralli S, Hämmerle CHF, Sailer I. Mechanical stability of screw-retained monolithic zirconia restorations bonded to titanium bases after artificial aging: an in vitro study. J Mech Behav Biomed Mater. 2018;87:304-312.
27. Mukhopadhyay P, Khalikar A. The microbial neck: a biological review of the various implant-abutment connections. J Adv Oral Res. 2022.
28. Ferreira JR, Song N, Machado M, Machado L, Correia A, Reis A. Fatigue and microgap behaviour of a three-unit implant-fixed dental prosthesis combining conventional and dynamic abutments. Clin Oral Implants Res. 2023;34(6):610-620.
29. Nakka C, Kollipara S, Ravalika KN. Graftless solution for multiple unfavorably placed implants using dynamic abutment solutions: a case report with a 3-year follow-up. J Indian Prosthodont Soc. 2020;20(3):331.
30. Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study. J Periodontol. 2009;80(9):1388-1392.
31. Júnior RAV, Aranha LC, Elias CN, Martinez EF. In vitro analysis of prosthetic abutment and angulable frictional implant interface adaptation: mechanical and microbiological study. J Biomech. 2021;119:110313.
32. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JYK. Clinical complications with implants and implant prostheses. J Prosthet Dent. 2003;90(2):121-132.
33. Rasaie V, Shadmehr E, Geramipanah F. Angulated screw channel implant restorations: a systematic review of mechanical and clinical outcomes. J Prosthodont. 2022;31(7):589-600.
34. Tallarico M, Caneva M, Meloni SM, Xhanari E, Covani U. Screw-retained versus cement-retained implant prostheses: clinical considerations for full-arch restorations. Int J Oral Implantol. 2018;11(1):13-22.
35. Joda T, Ferrari M, Gallucci GO, Wittneben JG, Brägger U. Digital technology in fixed implant prosthodontics. Periodontol 2000. 2017;73(1):178-192.
36. Papaspyridakos P, Lal K. Computer-assisted design/computer-assisted manufacturing zirconia implant fixed dental prostheses: clinical results and complications. Int J Prosthodont. 2013;26(1):9-16.
37. Pakhshan G, Zahra B. Multi-unit abutment: why, where, when? J Oral Med Dent Res. 2016;6(2):1-8.
38. Bulaqi HA, Mashhadi MM, Safari H, Samandari MM, Geramipanah F. Finite element study of the effect of retightening on the settling effect. J Prosthet Dent. 2015;113(6):526-534.
39. Watanabe F, Hata Y, Komatsu S, Ramos TC, Fukuda H. Finite element analysis of implant inclination and stress distribution. Odontology. 2000;88(1):33-39.
40. Hu E, Petrich A, Imamura G, Hamlin C. Effect of screw channel angulation on reverse torque values of dental implant abutment screws. J Prosthodont. 2019;28(6):e918-e924.
41. Clelland NL, Gilat A. The effect of abutment angulation on stress transfer for an implant. J Prosthodont. 1992;1(1):24-28.
42. Sakamoto S, Ro M, Al-Ardah A, Goodacre C. Esthetic abutment design for angulated screw channels: a technical report. J Prosthet Dent. 2018;119(6):912-915.
43. Varshney N, Kusum CK, Trivedi A, Kaushik M, Dubey P, Bali Y. Comparative evaluation of biological, mechanical, and patient-reported outcomes of angulated screw channel abutments versus multi-unit abutment-retained single-unit implant restorations in the anterior esthetic zone: an in vivo study. J Indian Prosthodont Soc. 2023;23(3):244-252.
44. Albakri A. The mechanical complications and behavior of angulated dental implant abutment systems versus conventional abutments: a narrative review. Saudi Dent J. 2024;36(8):1072-1077.
45. Rella E, De Angelis P, Papetti L, Damis G, Gasparini G, D’Addona A, Manicone PF. Comparison of aesthetic, mechanical outcome, and bone loss in angulated screw channels (ASCs) and cement-retained implant-supported prosthesis: a case-control study. Dent J (Basel). 2024;12(8):233.
46. Khaledi AA, Shalileh S, Hejazi M, Giti R. Influence of screw channel angulation on reverse torque value and fracture resistance in monolithic zirconia restorations after thermomechanical cycling: an in vitro study. BMC Oral Health. 2024;24(1):389.
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