Magnitude of misfit threshold in implant-supported restorations: A systematic review

Statement of problem. Attaining a passive fit in implant restorations is desirable but clinically difficult to achieve, especially in screw-retained prostheses. At a certain magnitude, this misfit will not cause mechanical and biological complications, but the exact level has yet to be determined. Purpose. The purpose of this systematic review was to gather, compare, and appraise studies that attempted to determine the biological and mechanical tolerance of misfits. Material and methods. The review protocol was published in the Prospective Register for Systematic Reviews (PROSPERO; registration no. CRD42021268399) and follows the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was conducted through PubMed, Ebscohost, and Web of Science followed by a manual search up to December 2021. Results. A total of 413 manuscripts were identified by electronic and manual search. After removing duplicates, nonrelevant titles, and abstract screening, 62 manuscripts were eligible for full-text assessment. Finally, a total of 13 articles (1 cross-sectional study, 1 retrospective and prospective, 7 in vitro studies, and 4 animal studies) met the eligibility criteria and were included in this review. A wide range of tolerable misfits were reported. Vertical misfit up to 1 mm and horizontal misfit up to 345 m m were associated with no adverse outcomes. Conclusions. The current literature provides inadequate data to determine a clinical threshold of an acceptable misfit. However, this review demonstrated that the mechanical response to misfit is more critical than the biological response. (J Prosthet Dent 2024;132:528-35)