What are the different implant abutment connection types?

Implant abutment connection types are primarily 3 categories.

What are the different types of implant abutment connections available?

External hex, internal hex, and tissue level are the three main groups that you can place connection types into. There is also unique connection types that are not as common and tend to be unique to individual systems. The internal hex can be broken down further into other connection types. One way method of categorization is those with less than and more than 45 degrees of internal connection. A morse taper is an example of the less than 45 degree internal connection. There is also the tissue level which performs very well in regards to bone loss and microleakage.

What is the best connection type?

Tissue level and greater than 45 degrees taper are the best connection types for most criteria. The Schoenbaum 2023 JOMI article shows tissue level and 45 degree taper systems performing the best. The downside to some of the greater taper connections is they can cold weld and they can be more difficult to deal with prosthetically. The downside to the tissue level is it can be too high in some posterior sites and it is not as esthetic and is not very useful in the anterior.

Morse taper implant connection type

There is plenty of research showing this is the best when it comes to microleakage. Silva-Neto 2012 JOMI shows that the morse taper beats the internal hexagon connection which beats the internal trilobe which beats the external hexagon in terms of microleakage. Also a morse taper certainly beats an external hex. Jaworski 2012 JOMI Therefore it is no surprise to see studies showing systems like the Ankylos Plus connection have very little leakage.

There is also research into connection material types.

Typically you are looking at titanium or zirconia. Zirconia wears against the titanium implant so titanium abutments are the standard for titanium implants and zirconia for zirconia implants. There are some instances where a PMMA or some similar product might also be the connection type for the prosthesis, but that is rare. Usually if PMMA is the abutment material the prosthesis is a temporary.