180 COMPLICATIONS RELATED TO CROWN TO IMPLANT RATIO  QUARANTA ET AL

Technical and Biological Complications

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Related to Crown to Implant Ratio: A

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Systematic Review
Alessandro Quaranta, DDS, PhD,* Matteo Piemontese, MD, DDS,† Giorgio Rappelli, MD, DDS,‡
Gilberto Sammartino, MD, DDS,§ and Maurizio Procaccini, MD, DDSjj
ental implants are a largely Aim: To review the occurrence Results: Six articles were con-

D accepted therapeutic approach

to rehabilitate partial and fully
edentulous patients. High survival
rates have been reported by many au-
thors using implants with different
geometries, surfaces, and implant-
abutment connections.1–3 However,
the occurrence of biological and tech-
nical complications is still high.4–7
There are 2 main categories of compli-
cations that occur in implant therapy:
biological and technical (mechanical).8
Biological complications refer to dis-
turbances in the function of the
implant characterized by biological
processes that affect the tissues sup-
porting the implant. Implant loss is
classified as a biological complication
and can be distinguished into early and
late losses. However, a biological
complication may also indicate an
increased risk for failure, which can
be of temporary significance or amena-
ble to treatment.9 The Sixth European
Workshop on Periodontology (2008)
has confirmed that “periimplant
*Adjunct Professor, School of Dentistry, Universita’ Politecnica
delle Marche, Ancona, Italy.
†Associate Professor and Director of the Master in Periodontics,
School of Dentistry, Universita’ Politecnica delle Marche,
Ancona, Italy.
‡Associate Professor, Universita’ Politecnica delle Marche,
Ancona, Italy.
§Full Professor and Dean of School of Dentistry, Universita’
Politecnica delle Marche, Ancona, Italy.
jjAssociate Professor, Director, Post-Graduate Program in Oral
Surgery, Universita’ Federico II, Napoli, Italy.
Reprint requests and correspondence to: Alessandro
Quaranta, DDS, PhD, School of Dentistry, Universita’
Politecnica delle Marche, Polo Murri, Room No. 47, Via
Tronto 10, Torrette di Ancona, Ancona 60020, Italy,
Phone: +393381770918, Fax: +390712206221, E-mail:
alessandro.quaranta@univpm.it
ISSN 1056-6163/14/02302-180
Implant Dentistry
Volume 23  Number 2
Copyright © 2014 by Lippincott Williams & Wilkins
DOI: 10.1097/ID.0000000000000026
of prosthetic failure and biological
complications with respect to the
crown to implant (C/I) ratio.
Methods: Accurate search was
made on the subject C/I ratio with the
following criteria: (1) studies on
humans with data on prosthetic fail-
ure and/or biological complications
related to C/I ratio; (2) partial eden-
tulous patients; (3) randomized clin-
ical trials, prospective, longitudinal,
retrospective, and multicenter studies
with a minimum of 48 months mean
follow-up; (4) language: English; (5)
radiographic measurements by peri-
apical x-ray; (6) implant material:
titanium; and (7) no implant type
selection was applied.
diseases are infectious in nature and
can be considered as biological com-
plications of the periimplant tissues.”
Periimplant mucositis describes an
inflammatory lesion that resides in
the mucosa, whereas periimplantitis
affects the supporting bone.10 Techni-
cal complications denote mechanical
damage of implants, implant compo-
nents, and/or the suprastructures.
Among these, fractures of the im-
plants, screws, or abutments, fractures
of the luting cement (loss of retention),
fractures or deformations of the frame-
work or veneers, loss of the screw
access hole restoration, and screw or
abutment loosening are usually
included.11 Because most of these
sidered eligible for full-text analysis.
Unfavorable C/I ratio can be con-
sidered a potential risk factor for
single crown and abutment loosen-
ing (C/I ratio $1.46) and abutment
fractures in posterior areas (C/I
ratio $2.01).
Conclusions: Despite the limited
data, high C/I ratio may be related to
some prosthetic failures. Unfavorable
C/I ratio does not affect biological
complications and implant failure.
(Implant Dent 2014;23:180–187)
Key Words: crown to implant ratio,
implant failure, prosthetic failure,
bone resorption, perimplantitis,
radiographic assessment
complications imply the need for
a new implant-supported restoration
in the present review, the collective
term prosthetic failure will be adopted
to denote all the technical complica-
tions that included implant fracture,
abutment, and screw fracture. The
crown to implant (C/I) ratio is the rela-
tion between the length of the restora-
tion (ie, crown) and the length of the
implant embedded in bone. The crown
is measured from the most coronal
bone contact to the most coronal sur-
face of the restoration, and the implant
is measured from the implant apex to
the most coronal bone contact.12
Crown to root ratio extrapolates the
biomechanical concept of a class I

lever in which the fulcrum lies in the
middle portion of the root located in
the bone. As progressive bone occurs,
the fulcrum moves apically, and as
a result the tooth is more susceptible
to harmful lateral occlusal forces.13
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This relationship can increase over
the time, primarily, as a result of the
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loss of supporting alveolar bone. Sub-
sequently, the crown portion will
increase (force point) and the radicular
portion will decrease (resistance
point). The center of rotation will then
move towards the apex, causing the
tooth to become more vulnerable to
harmful lateral forces. McGuire and
Nunn14 in a prospective study of
8 years on predicting tooth loss for
100 periodontal patients concluded that
an unfavorable crown to root ratio is
a significant factor for clinicians to con-
sider when predicting the long-term
prognosis for a tooth. In a similar
way, C/I ratios between 0.5 and 1 were
proposed to prevent periimplant bone
stress, crestal bone loss, and eventual
implant failure.15–18 This recommenda-
tion was, of course, based on prostho-
dontic and periodontal principles
extrapolated from tooth-supported
reconstructions.19,20 However, contrary
to Ante’s Law, clinical studies have
demonstrated that fixed dental prosthe-
ses with an unfavorable crown to root
ratio can be successfully maintained,
provided that adequate periodontal
and prosthetic principles are fol-
lowed.21–23 The recent increasing adop-
tion of short implants (according to
Renouard and Nisand,24 implants with
an intraosseous length #8 mm) for
prosthetic solution of severe resorbed
posterior areas is greatly related to the
increasing concern of the scientific
community regarding the C/I ratio
issue.25–27 In fact, when using short
implants, a very outsized implant-
supported rehabilitation is needed
because of the previous remodeling
processes of the alveolar bone and this
causes a higher ($1) C/I ratio.28 In the
present review, a preliminary PubMed
search of any review available regarding
the topic C/I ratio has been performed.
The following search details have been
adopted: ((“tooth crown”[MeSH
Terms] OR (“tooth”[All Fields]
IMPLANT DENTISTRY / VOLUME 23, NUMBER 2 2014
AND “crown”[All Fields]) OR “tooth
crown”[All Fields] OR “crown”[All
Fields] OR “crowns”[MeSH Terms]
OR “crowns”[All Fields]) AND
implant[All Fields] AND (“Ratio
(Oxf)”[Journal] OR “ratio”[All Fields]))
AND Review[ptyp]. This literature
search resulted in only 1 systematic
review29 on the influence of C/I ratio
on implant technical complications.
This review was published in 2009
and evaluated all the studies that ful-
filled strict inclusion criteria that were
published between the 1985 and 2007.
In addition, this review did not assess
the impact of C/I ratio on biological
complications. Therefore, the purpose of
this article was to systematically review
the occurrence of prosthetic failure and
biological complications with respect to
the C/I ratio of dental implants.
MATERIALS AND METHODS
Electronic search (MEDLINE) has
been performed to identify scientific
articles on the subject C/I ratio. The
search was restricted to the following
inclusion criteria: (1) studies on human
with data on prosthetic failure and/or
biological complications related to C/I
ratio; (2) partial edentulous patients
restored with implant-supported single
crowns and/or fixed partial dentures; (3)
randomized clinical trials (RCTs), pro-
spective, longitudinal, retrospective, and
multicenter studies with a minimum of
48 months mean follow-up; (4) lan-
guage: English; (5) radiographic mea-
surement of the C/I ratio by peri-apical
x-ray; (6) dental implant material: tita-
nium; and (7) no implant type selection
was applied. Exclusion criteria were the
following: (1) studies concerning treat-
ment of patients with systemic condi-
tions that may even potentially affect
osseointegration and success rates of
implant treatment30; (2) studies concern-
ing treatment of patients with nontreated
periodontal disease; (3) language differ-
ent from English; (4) dental implant
material different from titanium; and
(4) implants placed with bone regenera-
tive procedures. After the electronic
research, a further manual search limited
to the main scientific journals on Pros-
thodontics and Implant Dentistry (Clin-
ical Oral Implants Research, The
International Journal of Oral &
181
Maxillofacial Implants, The Interna-
tional Journal of Prosthodontics, Jour-
nal of Prosthetic Dentistry, Clinical
Implant Dentistry and Related
Research, International Journal of Peri-
odontics and Restorative Dentistry,
Journal of Periodontology, European
Journal of Prosthodontics and Restor-
ative Dentistry, Journal of Oral Maxil-
loFacial Surgery, Journal of Oral
Surgery, Journal of Clinical Periodon-
tology, Clinical Oral Investigations;
European Journal of Oral Implantol-
ogy, and Implant Dentistry) and cover-
ing the period 1985 to 2011 has been
made. Another additional electronic
search has been made among all the pro-
spective, longitudinal, retrospective, and
multicenter studies on short implants
with an abstract that described data on
C/I ratio. One reviewer (A.Q.) per-
formed all the screening and data
abstraction. The following outcomes
were evaluated: occurrence of pros-
thetic failures (all the prosthetic compli-
cations and failures related to implant
components and suprastructure included
implant fracture and abutment fracture),
biological complications (mucositis and
periimplantitis), and implant failure.
Among the biological complications, all
the data available on periimplant crestal
bone loss were also investigated. Implant
failure was considered as the need of
removing it because of mobility, discom-
fort, the lack of osseointegration, or
implant fracture. For a complete and
accurate analysis, the following data
were collected: C/I ratio measure-
ments, prosthetic procedure and
modalities, and radiographic assess-
ment. After the primary evaluation of
the selected articles, a great heterogeneity
among the different articles regarding
study design, methods, and data collection
was detected. Consequently, the authors
decided not to perform a quantitative data
and meta-analysis and to adopt a descrip-
tive analysis approach.
RESULTS
The MEDLINE search for “crown
to implant ratio OR crown implant
ratio” identified a total of 54 scientific
articles.29,31–83 The detailed search
MeSH terms were the following:
(“tooth crown”[MeSH Terms] OR
 182 COMPLICATIONS RELATED TO CROWN
(“tooth”[All Fields] AND “crown”[All
Fields]) OR “tooth crown”[All Fields]
OR “crown”[All Fields] OR “crowns”
[MeSH Terms] OR “crowns”[All
Fields]) AND implant[All Fields] AND
ratio[All Fields]) AND (“humans”
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[MeSH Terms] AND English[lang]).
The manual search performed on the
aforementioned main scientific journals
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in implant dentistry identified another
additional article that was included in
the review (Table 1).84 Although the
MEDLINE search resulted in 54 ar-
ticles,29,31–83 the careful evaluation of
the abstracts showed 11 articles that
potentially could fulfill the inclusion cri-
teria.73–75,77–84 Five of 11 articles were
excluded, 3 because of a mean follow-
up lower than 48 months,74,78,80 1
because alumina dental implants were
used,73 and a final one because the crown
to root ratio measurement was made on
diagnostic casts and not on peri-apical
radiographs81 (Table 2). The manual
search including the search on short im-
plants identified 1 additional article.84
The remaining 5 articles75,77,79,82,83 and
the 184 found with the manual search
were considered eligible for full text
analysis. Among these articles, only 1
article was a prospective study,82 whereas
all the other articles were retrospective
articles. No RCTs were found. The 6
studies showed different categories of
C/I ratios with values ranging from 0.5
to 4.95. Table 2 shows the articles
included and the data obtained in the pres-
ent review. Data from each article were
analyzed, and information about C/I ratio,
bone remodeling process, survival rates,
prosthetic failure, and biological compli-
cations have been displayed. When some
of the aforementioned data were missing,
the corresponding author of the article
was contacted through an e-mail using
the address found in the publication
corresponding author’s data to assess
Table 1. List of All the Studies That Were Excluded at the Abstract Evaluation and the
Reasons for Exclusion
Authors Type of Study
73
Brose et al Case series
Rokni et al81 Prospective study
Rossi et al74 Retrospective cohort study
Schulte et al80 Prospective clinical study
Birdi et al78 Retrospective cohort study
TO IMPLANT RATIO  QUARANTA
whether the lacking information had
been collected during the study and
were available for the descriptive analysis.
Unfortunately, none of the authors replied
to the reviewer’s e-mail.
C/I Ratio Measurements
The articles analyzed in the present
review measured the C/I ratio with
different reference points. In fact, some
articles evaluated the anatomical C/I (aC/
I) ratio,77,82 whereas others evaluated the
clinical C/I ratio (cC/I) (Fig. 1).75,79,83,84
Moreover, some authors calculated both
the aC/I and cC/I ratios but used only the
cC/I ratio in the evaluation of its relation
with dental implant complications.79
However, Schneider et al84 used the
aC/I ratio when assessing the occurrence
of technical complications and the cC/I
ratio to evaluate the incidence of biolog-
ical complications.
Prosthetic Procedures and Modalities
Two of the articles included in the
present review evaluated the prosthetic
failure and biological complications
related to C/I ratio in single crowns
supported by dental implants in anterior
and posterior areas. 75,84 Four au-
thors77,79,82,83 analyzed both single
crown and fixed partial dentures sup-
ported by dental implants and placed
in different anatomical areas. Among
these studies, the authors of 1 article79
evaluated several types of prosthetic
modalities such as implant-to-implant
supported fixed partial dentures, tooth-
to-implant supported fixed partial den-
tures, half-tooth, and 1 tooth distal
cantilever extension. In 3 of the 6
articles,75,77,83 cement retained restora-
tions were adopted, whereas in the re-
maining 3 studies79,82,84 no restriction
was made regarding the mode of reten-
tion, and screw retained restorations
were also included. Overall, the differ-
ent prosthetic modalities, restoration
Reasons for Exclusion
Alumina implants
C/I measurements performed on
dental casts
MFP lower than 48 mo
MFP lower than 48 mo
MFP lower than 48 mo
ET AL
types (single or splinted restorations),
and mode of retention did not influence
the implant survival and the occurrence
of complications. Moreover, unfavor-
able C/I ratios did not seem a risk factor
for any of the aforementioned pros-
thetic modalities.
Radiographic Assessment
As mentioned in the inclusion
criteria, all the studies analyzed in the
present review featured a radiographic
measurement of C/I ratio based on peri-
apical radiographs. Different anatomi-
cal landmarks on the marginal bone and
the implants were selected to calculate
the C/I ratios and periimplant bone
resorption. Standardized peri-apical ra-
diographs using a long-cone paralleling
technique were made at the baseline and
at different observation times in all the
studies.
Influence of C/I Ratio on Implant
Survival Rate
In the present review, it was not
possible to find any correlation between
the implant failure and the C/I ratio. The
mean follow-up observation period was
at least 48 months, and the cumulative
success rates reported by the various
authors were between 95% and 100%.
Increased C/I ratio does not seem to
negatively influence the implant cumu-
lative survival rates (CSRs). All the
articles included in the present review
showed very high survival rates with
the exception of Schneider84 that re-
ported a CSR of 95.8% at 5 years. In
this study, 6 implants were lost, respec-
tively, after 1.1, 4.6, 5, 5.7, and 9.2
years in function, and it was not possi-
ble to observe any relation between
the implant failure and C/I ratio. In
the study by Sohn et al,77 there were
no failed cases when the C/I ratio was
,1.0. When the C/I ratio was
between 1.0 and 1.4, the failure rate
was 6.7% and statistically significant
(P ¼ 0.0048). However, no failures
were detected with the C/I ratio between
1.5 and 2.0.
Influence of C/I Ratio on
Prosthetic Failure
Only 375,79,82 of the 6 studies re-
ported data on the effect of C/I ratio
on prosthetic failure. The study from
Tawil82 was made on internal-hex
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Table 2. List of All the Studies That Were Included in the Present Review and All the Data and Parameters That Were Collected for Each Single Study
Study Type N n MFUP Implant Design C/I Ratio
82
Tawil et al P 109 262 53 (12–108) External hex machined screw type implants aC/I ratio: 1.1–2.0:1
Brånemark, Nobel Biocare
Urdaneta RC 81 326 70.7 6 23 Locking taper plateau design implants, Bicon cC/I: 1.6 (0.79–4.95)
et al75
Gomez et al83 RC 85 69 67 6 8 aC/I ratio: 0.82 6 0.21 (range, 0.43–1.5)
Blanes et al79 RC 83 192 120 Hollow cylinder, hollow screw implants Straumann cC/I: 1.77 6 0.56 (range, 0.99–2)

Schneider RC 100 70 74 (range, 4.73–11.7 y) Brånemark, Nobel Biocare, Straumann Standard or cC/I: 1.04 6 0.26, (range, 0.59–2.01) aC/I: 1.48
et al84 Standard Plus 6 0.42 (range, 0.82–3.24)
Sohn et al77 RC 122 43 55.8 (range, 5–108 mo) Sintered porous-surfaced Endopore aC/I: 1.0 (range, 0.8–2.0)

CSR,
Study % TC BC MBL Notes

IMPLANT DENTISTRY / VOLUME 23, NUMBER 2 2014

Tawil et al 82
95.50 7.8% screw loosening 1 implant fracture nr 0.74 6 0.65 ns
Urdaneta et al75 98.10 Loosening of crowns (21) and fracture of 2 mm nr 0.33 ns High C/I ratios related to significant increase
abutments (3) in posterior areas of prosthetic complications and deep
probing depth values
Gomez et al83 na nr nr 2.11 6 1.30
Blanes et al79 97.90 nr nr 0.34 6 0.27 (cC/I # Implant restorations with high C/I ratio
0.99) display less crestal bone loss
0.03 6 0.15 (cC/I: 1–2)
0.02 6 0.26 (cC/I $ 2)
Schneider et al84 95.80 18.6% loss of retention (5.7%) occlusal screw 11% ns 6% 0.008 6 0.74 (range, aC/I ratio used for technical complications
and abutment screw loosening (5.7%) implants lost −2.13 to −2.62) assessment cC/I ratio used for biological
chipping of veneering (5.7%) ns for complications assessment
periimplantitis
Sohn et al77 97.50 nr nr nr All the implants were lost in the intermediate
C/I ratio group (1.0–1.4)
MFUP indicates mean follow-up (in months); MBL, mean bone loss (in millimeters); P, prospective study; RC, Retrospective cohort study; N: number of patients; n: number of implants; TC, percentage of technical complications; BC, percentage of biological
complications; nr, data not reported by the authors; ns, not statistically significant correlation.

183
 184 COMPLICATIONS RELATED TO
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Fig. 1. The present figure displays the different types of C/I ratio. The cC/I ratio is displayed in
black on the distal implant. In this case, the fulcrum of the lever arm is located at the bone
crest. The (aC/I) ratio is displayed in red on the mesial implant. In this case, the fulcrum of the
lever arm is located at the implant shoulder.
implant system and reported a 7.8%
screw loosening and 5.2% porcelain
fracture. Although C/I ratio was found
to be increased by 2 to 3 times in nearly
87% of cases, increased C/I ratio did not
prove to be a major complicating factor
for prosthetic failure. In the study by
Schneider et al, several technical com-
plications were investigated. Technical
complications were observed in 13
(18.6%) of the patients and 13 in
implant reconstructions. Two implants
in 2 (2.9%) patients experienced 2 types
of technical complications and 1
implant in 1 (1.4%) patient experienced
3 types of technical complications.
Although logistic regression analysis
showed a lower technical C/I ratio to
result in more technical complications,
this relationship was not statistically
significant. When adjusted for the tech-
nical C/I ratio, none of the following
parameters were significantly associ-
ated with an increased occurrence of
technical complications. Urdaneta
et al75 analyzed the effect of increased
C/I ratio on locking taper plateau design
implants replacing single tooth.
Increased C/I ratios had a statistically
significant effect in the loosening of
maxillary anterior crowns, as well as
a significant effect in the fracture of
2-mm-wide implant abutments used to
restore posterior areas. In fact, the aver-
age mesiodistal C/I (avC/I) ratio of the
maxillary anterior crowns that loosened
was 2.01, whereas the avC/I ratio of the
crowns that remained stable was 1.55.
The avC/I ratio of the 3 failed
CROWN TO IMPLANT RATIO  QUARANTA
restorations was higher (1.47) than the
avC/I ratio of the 58 remaining poste-
rior implant restorations with similar
abutments that did not fracture (1.26).
However, increased C/I ratio did not
contribute to a statistically significant
increase in crown fractures (P ¼ 0.21)
nor crown failures (P ¼ 0.41).
Influence of C/I Ratio on Implant
Biological Complications
Explicit and clear data on the effect
of the C/I ratios on implant biological
complications were not reported by any
of the studies included in the present
review with the exception of the one
published by Schneider et al.84 In this
study, biological complications were
defined as signs of periimplant mucosal
inflammation (swelling, redness, bleed-
ing on probing, and suppuration) and
increased probing depths of more than
4 mm in connection with structured
parts of the implant as implant threads
or surface accessible by probing. The
analysis of 70 patients with a total of
100 implants showed the occurrence
of biological complications at 11 im-
plants (11%) in 11 patients (15.7%).
Logistic regression revealed no signifi-
cant association between C//I ratios and
biological complications. Moreover, in
the study by Urdaneta et al,75 soft tis-
sues parameters (Modified Plaque
Index, Sulcular Bleeding Index, and
Gingival Index) were recorded on the
facial surfaces for each implant site.
Probing depths were assessed on 6 dif-
ferent surfaces for each implant. The
ET AL
authors observed that increased C/I
ratios were related to increased probing
depth values, but even if this data were
statistically significant they did not con-
sidered it as clinically relevant. As a mat-
ter of fact, no data on the incidence of
biological complications were reported
in this study. However, in the table in
which the reasons for implant failures
are summarized, the authors reported
that in all the cases in which the implants
were lost after prosthetic loading, bone
loss was the cause (putative periimplan-
titis). No correlation between the C/I
ratio and the marginal bone resorption
was observed in all the 6 studies
included in the present review. On the
contrary, Blanes et al79 found a positive
correlation between increasing C/I ratios
and increasing first bone to-implant-
contact over 1 year. In 1 study,77 although
data on CSR were displayed and peri-
apical radiographs taken, no data on
marginal bone resorption were reported.
DISCUSSION
This review analyzed all the studies
present in the literature about the C/I
ratio topic and fulfilling strict inclusion
and exclusion criteria. Because of the
great heterogeneity among the articles,
a descriptive analysis method was
applied. The influence of C/I ratio on
biological complications and prosthetic
failure was analyzed in different
implant systems with a great variety of
implant design, surface, type of con-
nection, and prosthetic modalities. The
results of the present review show that
C/I ratio could be considered a risk
factor for some mechanical complica-
tions of implant-supported rehabilita-
tions as screw loosening, porcelain
fractures loosening of maxillary ante-
rior crowns, fractures of 2-mm-wide
implant abutments supporting single
crowns in posterior areas.75,84 It is inter-
esting to underline that most of the pros-
thetic failures are reported by the
studies with higher C/I ratio values.75,84
In all the other studies,77,79,82,83 C/I
ratio, even when increased by 2 to 3
times, did not seem to represent a pros-
thetic risk factor, especially, in cases of
favorable force orientation and load dis-
tribution.82 Although most of the stud-
ies did not clearly analyze the relation

between C/I ratio and biological com-
plications, the available results tend not
to consider C/I ratio as a putative risk
factor for bone loss, mucositis, and peri-
implantitis around osseointegrated den-
tal implants and their consequent
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failures. The mean bone loss in all the
studies was minimal and similar to that
reported by many authors in the litera-
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ture using standard implants.85–87 Con-
trary to what expected and supposed by
some authors13–15 that considered C/I
ratios between 0.5 and 1 necessary to
prevent periimplant bone stress and
consequent bone resorption, 1 study79
found a positive correlation between
increasing C/I ratios and increasing first
bone to-implant-contact over 1 year.
Moreover, some of the articles included
in the present review considered the
aC/I ratio,77,82 whereas others calcu-
lated the cC/I ratio.75,79,83,84 A recent
review29 suggested that cC/I ratio is
a more reliable parameter when evalu-
ating its relation with dental implant
complications. Although the adoption
of cC/I ratio is highly suggested in
future studies, the data from our review
do not show great differences when
using cC/I or aC/I ratio as a prognostic
factor for the occurrence of prosthetic
failure and biological complications
included bone resorption. Finally, it is
essential to stress that the studies eval-
uated in the present review consider
different implant designs (eg, plateau
design, solid screw, hollow screw, and
hollow cylinder), implant-abutment
connections, and surface textures (eg,
machined, titanium plasma sprayed,
sintered porous, and SLA). This diver-
sity may influence the effect of C/I ratio
on the parameters analyzed as techni-
cal complications, bone remodeling,
and biological complications.
CONCLUSIONS
The articles retrieved from scien-
tific literature show that increased C/I
ratio cannot be considered a risk factor
for biological complications around
dental implants and implant failure.
Unfavorable C/I ratio can be considered
a potential risk factor for some pros-
thetic failures as single abutment and
crown loosening (C/I ratio $1.46) and
2-mm-wide abutment fractures in
IMPLANT DENTISTRY / VOLUME 23, NUMBER 2 2014
posterior areas (C/I ratio $2.01). Based
on these data, clinicians should be very
cautious with the implant-abutment
connection when restoring dental im-
plants with unfavorable C/I ratios. This
is very important especially on single
unit restorations to avoid screw loosen-
ing and an eventual prosthetic failure.
However, the limited data about this
topic suggest that further studies with
a randomized controlled clinical trial
design are needed to obtain more defin-
itive information. Eventually, the future
studies should be designed with more
homogeneous samples with regard to
implant design (macrotopography,
thread design) and type of connection.
DISCLOSURE
The authors claim to have no
financial interest, either directly or
indirectly, in the products or informa-
tion listed in the article.
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