Hundreds of millions of people have one or more missing teeth. Consequently, a substantial
number of patients undergo implant therapy each year. However, technical complications
and soft tissue inflammation associated with the implant abutment or the type of restoration
can lead to bone loss and, ultimately, implant failure. Using the methodology of network
meta‐analysis to rigorously compare and contrast the clinical performance of the three
commonly used abutment materials: titanium (Ti), zirconium (Zr), and polyetheretherketone
(PEEK) polymer. Until May 2025, a systematic search was performed in MEDLINE (PubMed),
EMBASE, Scopus, and CENTRAL to find clinical studies comparing Ti, Zr, and PEEK implant
abutments. Case reports, case series, in vitro, and in vivo studies were excluded.
The Risk of Bias Tool 2, ROBINS‐I, and GRADE approaches were used for quality and
certainty assessment. Thirty‐four articles (950 patients) were included, with various
follow‐ups. All abutments had high survival rates and no significant differences in
marginal bone loss (BL), probing depth (PD), bleeding on probing (BOP), and plaque
index (PI). There was no significant difference between Zr and Ti for papillary index
(PAP), with a general trend toward better results in Zr, which may be of clinical
significance. There was a statistically significant difference in soft tissue discoloration
(ΔE) values and technical complications of Zr versus Ti [MD: −2.03, CI: −3.89 to −0.18]
and [OR: 0.26, CI: 0.09 to 0.72], respectively, indicating better esthetics and fewer
technical complications in Zr. Both Ti and Zr are clinically successful and biologically
acceptable. PEEK abutments demonstrated comparable characteristics with both Ti and
Zr. However, more studies about PEEK and cost‐effectiveness analyses should also be
performed to find the best options for clinical applications. PEEK can be a good alternative
to Ti and Zr abutments for single‐tooth replacement in the anterior and premolar regions.
