Systematic Review| Volume 124, ISSUE 4, P439-445, October 2020

Download started.


A clinical comparison of 1-piece versus 2-piece implants: A systematic review and meta-analysis

Published:December 19, 2019DOI:


      Statement of problem

      One-step dental implant surgery with a 1-piece implant has been introduced with the aim of simplifying and increasing the effectiveness of treatment and providing greater comfort for the patient. Whether these goals have been met compared with conventional 2-piece implants remains unclear.


      The purpose of this systematic review and meta-analysis was to compare the use of 1-piece versus 2-piece implants in terms of marginal bone loss and implant survival rate.

      Material and methods

      This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was recorded in the International prospective register of systematic reviews (PROSPERO) database (CRD 42018095721). A literature search was conducted in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases for articles published up to May 2018. The population, intervention, comparison, outcome (PICO) question was, “Do patients who received 1-piece implants show similar marginal bone loss, survival rates, and complications as those who receive 2-piece implants?”


      The meta-analysis was based on the Mantel-Haenszel and inverse variance methods. Implant survival rate was analyzed by using a dichotomous outcome, measured according to risk ratio (RR) and marginal bone loss by continuously evaluating the outcomes according to the mean difference (MD), both with a corresponding 95% confidence interval (CI). Five studies, including 270 participants with a mean age of 54.70 years and receiving 434 dental implants, were included. The mean follow-up period was 4 years. Meta-analysis did not reveal a significant difference in relation to implant survival rate (P=.85; RR: −0.89; CI: −0.27 to 2.98), as well as to marginal bone loss (P=.85; MD: −0.43; CI: −0.43 to −0.52).


      One- and 2-piece implants demonstrated effectiveness in the rehabilitation of patients requiring dental implants.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jung R.E.
        • Zembic A.
        • Pjetursson B.E.
        • Zwahlen M.
        • Thoma D.S.
        Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years.
        Clin Oral Implants Res. 2012; 23: 2-21
        • Åstrand P.
        • Ahlqvist J.
        • Gunne J.
        • Nilson H.
        Implant treatment of patients with edentulous jaws: a 20-year follow-up.
        Clin Implant Dent Relat Res. 2008; 10: 207-217
        • Lekholm U.
        • Gröndahl K.
        • Jemt T.
        Outcome of oral implant treatment in partially edentulous jaws followed 20 years in clinical function.
        Clin Implant Dent Relat Res. 2006; 8: 178-186
        • Bra˚nemark P.I.
        • Zarb G.A.
        • Albreksson T.
        Tissue integrated prostheses. osseointegration in clinical dentistry.
        Quintessence, Chicago1985: 11-76
        • Bömicke W.
        • Gabbert O.
        • Koob A.
        • Krisam J.
        • Rammelsberg P.
        Comparison of immediately loaded flapless-placed one-piece implants and flapped-placed conventionally loaded two-piece implants, both fitted with all-ceramic single crowns, in the posterior mandible: 3-year results from a randomised controlled pilot trial.
        Eur J Oral Implantol. 2017; 10: 179-195
        • Hahn J.A.
        Clinical and radiographic evaluation of one-piece implants used for immediate function.
        J Oral Implantol. 2007; 33: 152-155
        • Ericsson I.
        • Nilner K.
        • Klinge B.
        • Glantz P.O.
        Radiographical and histological characteristics of submerged and non submerged titanium implants. An experimental study in the Labrador dog.
        Clin Oral Implants Res. 2016; 7: 20
        • Ericsson I.
        • Randow K.
        • Glantz P.O.
        • Lindhe J.
        • Nilner K.
        Clinical and radiographical features of submerged and non-submerged titanium implants.
        Clin Oral Implants Res. 1994; 5: 185-189
        • Esposito M.
        • Ekestubbe A.
        • Grondahl K.
        Radiological evaluation of marginal bone loss at tooth surfaces facing single Brånemark implants.
        Clin Oral Implants Res. 1993; 4: 151-157
        • Belser U.C.
        • Buser D.
        • Hess D.
        • Schmid B.
        • Bernard J.P.
        • Lang N.P.
        A esthetic implant restorations in partially edentulous patients–acritical appraisal.
        Periodontol 2000. 1998; 17: 132-150
        • Tarnow D.
        • Elian N.
        • Fletcher P.
        • Froum S.
        • Magner A.
        • Cho S.C.
        • et al.
        Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants.
        J Periodontol. 2003; 74: 1785-1788
        • Broggini N.
        • McManus L.M.
        • Hermann J.S.
        • Medina R.U.
        • Oates T.W.
        • Schenk R.K.
        • et al.
        Persistent acute inflammation at implant-abutment interface.
        J Dent Res. 2003; 82: 232-237
        • Prithviraj D.R.
        • Gupta V.
        • Muley N.
        • Sandhu P.
        One-piece implants: placement timing, surgical technique, loading protocol, and marginal bone loss.
        J Prosthodont. 2013; 22: 237-244
        • Misch C.M.
        Immediate loading of definitive implants in the edentulous mandible using a fixed provisional prosthesis: the denture conversion technique.
        J Oral Maxillofac Surg. 2004; 62: 106-115
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Int J Surg. 2010; 8: 336-341
        • Chrcanovic B.R.
        • Albrektsson T.
        • Wennerberg A.
        Smoking and dental implants: a systematic review and meta-analysis.
        J Dent. 2015; 43: 487-498
        • Lee C.T.
        • Huang Y.W.
        • Zhu L.
        • Weltman R.
        Prevalences of peri-implantitis and periimplant mucositis: systematic review and meta-analysis.
        J Dent. 2017; 62: 1-12
        • Lemos C.A.A.
        • Verri F.R.
        • Bonfante E.A.
        • Santiago Júnior J.F.
        • Pellizzer E.P.
        Comparison of external and internal implant-abutment connections for implant supported prostheses. A systematic review and meta-analysis.
        J Dent. 2018; 70: 14-22
        • Heijdenrijk K.
        • Raghoebar G.M.
        • Meijer H.J.
        • Stegenga B.
        • van der Reijden W.A.
        Feasibility and influence of the microgap of two implants placed in a non-submerged procedure: a five-year follow-up clinical trial.
        J Periodontol. 2006; 77: 1051-1060
        • Paolantoni G.
        • Marenzi G.
        • Blasi A.
        • Mignogna J.
        • Sammartino G.
        Findings of a four-year randomized controlled clinical trial comparing two-piece and one-piece zirconia abutments supporting single prosthetic restorations in maxillary anterior region.
        Biomed Res Int. 2016; 2016: 8767845
        • Sanz-Martín I.
        • Sanz-Sánchez I.
        • Noguerol F.
        • Cok S.
        • Ortiz-Vigón A.
        • Sanz M.
        Randomized controlled clinical trial comparing two dental implants with different neck configurations.
        Clin Implant Dent Relat Res. 2017; 19: 512-522
        • Gamper F.B.
        • Benic G.I.
        • Sanz-Martin I.
        • Asgeirsson A.G.
        • Hämmerle C.H.F.
        • Thoma D.S.
        Randomized controlled clinical trial comparing one-piece and two-piece dental implants supporting fixed and removable dental prostheses: 4- to 6-year observations.
        Clin Oral Implants Res. 2017; 28: 1553-1559
        • Rinke S.
        • Lange K.
        • Roediger M.
        • Gersdorff N.
        Risk factors for technical and biological complications with zirconia single crowns.
        Clin Oral Investig. 2015; 19: 1999-2006
        • Haro Adánez M.
        • Nishihara H.
        • Att W.
        A systematic review and meta-analysis on the clinical outcome of zirconia implant-restoration complex.
        J Prosthodont Res. 2018; 18: 30082-30083
        • Needleman I.
        • Chin S.
        • O'Brien T.
        • Petrie A.
        • Donos N.
        Systematic review of outcome measurements and reference group(s) to evaluate and compare implant success and failure.
        J Clin Periodontol. 2012; 39: 122-132