To evaluate the long-term (more than 5 years) survival rate and the difference in fracture, screw loosening and chipping between different zirconia abutments.

The electronic databases included PubMed, Medline, EMBASE, Cochrane library and China National Infrastructure. English and Chinese literature from 2010 to present limited to randomized clinical trials, prospective studies, and retrospective studies on zirconia abutments were collected. According to certain inclusion criteria, such as follow-up time of at least 5 years, mentioning survival rates of zirconia abutment, the rates of screw loosening and the rates of chipping. Two researchers searched, screened and extracted data from the literature independently.

A total of 9 English articles were included. No Chinese literature met the requirements. All literature was evaluated by ROBINS-I scale. The overall survival rate of internal full zirconia abutment was estimated to 95.9% (95% CI: 94.1%, 97.6%) , and the mechanical complication rate was estimated to 7.6% (95% CI: 5.3%, 10.0%) ; whereas the survival rate of internal zirconia abutments with titanium base was estimated to 99.8% (95% CI: 99.4%, 100%) , and the mechanical complication rate was estimated to 4.6% (95% CI: 2.7%, 6.4%) .

Zirconia abutments had a good performance on implant prosthesis. However, there were still some mechanical complications such as fracture and screw loosening. In addition, the internal zirconia abutments with titanium base had a little higher survival rate and lower mechanical complication rate than the internal full zirconia abutment.