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Titanium Base-Free Multi-Unit Abutment Connections: A Critical Review of Prosthetic Screw Design, Biomechanical Behavior, and Clinical Performance.

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Title: Titanium Base-Free Multi-Unit Abutment Connections: A Critical Review of Prosthetic Screw Design, Biomechanical Behavior, and Clinical Performance.
Authors: Mosaddad, Seyed Ali1,2 (AUTHOR), Rodríguez-Pérez, Iker1,2 (AUTHOR), Pieralli, Stefano3 (AUTHOR), Beuer, Florian3,4 (AUTHOR), Molinero-Mourelle, Pedro1,4,5 (AUTHOR), Çakmak, Gülce3,4,6 (AUTHOR)
Source: Materials (1996-1944). Jun2026, Vol. 19 Issue 11, p2212. 37p.
Subjects: Prosthetics, Biomechanics, Treatment effectiveness, Fatigue limit
Abstract: Highlights: Titanium base-free MUA systems increase dependence on prosthetic screw biomechanics. Preload maintenance and screw design are key to joint stability and fatigue resistance. Conical and modified head screws may improve load distribution and reduce loosening. Rigid materials like zirconia intensify stress at the screw–abutment interface. Clinical success depends on passive fit, torque control, and occlusal management. Titanium base-free multi-unit abutment (MUA) restorations have been introduced to simplify implant prosthetic workflows by eliminating intermediate titanium bases and bonding interfaces. However, this approach modifies the biomechanical behavior of the prosthesis–abutment–implant complex and increases reliance on prosthetic screw performance. Despite growing clinical and commercial interest in these systems, the available evidence remains limited and fragmented, and the biomechanical consequences of removing the titanium base have not been clearly synthesized. Therefore, this critical review evaluated the influence of prosthetic screw design on the biomechanical behavior of titanium base-free MUA restorations, focusing on preload maintenance, load transfer, and mechanical stability. The evidence indicates that preload loss, screw loosening, and fatigue behavior are primary determinants of mechanical performance. Screw material, surface characteristics, and head geometry may affect preload generation, load distribution, and resistance to micromovement, although current evidence remains limited and heterogeneous. Short-term clinical outcomes appear acceptable when appropriate biomechanical and prosthetic protocols are followed; however, long-term comparative data are lacking. Titanium base-free MUA restorations should be considered a technique-sensitive approach requiring optimized screw selection, accurate prosthetic fit, and controlled occlusal loading. Further well-designed long-term studies are needed to establish their predictability. [ABSTRACT FROM AUTHOR]
Copyright of Materials (1996-1944) is the property of MDPI and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Titanium Base-Free Multi-Unit Abutment Connections: A Critical Review of Prosthetic Screw Design, Biomechanical Behavior, and Clinical Performance.
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  Data: <searchLink fieldCode="JN" term="%22Materials+%281996-1944%29%22">Materials (1996-1944)</searchLink>. Jun2026, Vol. 19 Issue 11, p2212. 37p.
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  Data: <searchLink fieldCode="DE" term="%22Prosthetics%22">Prosthetics</searchLink><br /><searchLink fieldCode="DE" term="%22Biomechanics%22">Biomechanics</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Fatigue+limit%22">Fatigue limit</searchLink>
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  Label: Abstract
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  Data: Highlights: Titanium base-free MUA systems increase dependence on prosthetic screw biomechanics. Preload maintenance and screw design are key to joint stability and fatigue resistance. Conical and modified head screws may improve load distribution and reduce loosening. Rigid materials like zirconia intensify stress at the screw–abutment interface. Clinical success depends on passive fit, torque control, and occlusal management. Titanium base-free multi-unit abutment (MUA) restorations have been introduced to simplify implant prosthetic workflows by eliminating intermediate titanium bases and bonding interfaces. However, this approach modifies the biomechanical behavior of the prosthesis–abutment–implant complex and increases reliance on prosthetic screw performance. Despite growing clinical and commercial interest in these systems, the available evidence remains limited and fragmented, and the biomechanical consequences of removing the titanium base have not been clearly synthesized. Therefore, this critical review evaluated the influence of prosthetic screw design on the biomechanical behavior of titanium base-free MUA restorations, focusing on preload maintenance, load transfer, and mechanical stability. The evidence indicates that preload loss, screw loosening, and fatigue behavior are primary determinants of mechanical performance. Screw material, surface characteristics, and head geometry may affect preload generation, load distribution, and resistance to micromovement, although current evidence remains limited and heterogeneous. Short-term clinical outcomes appear acceptable when appropriate biomechanical and prosthetic protocols are followed; however, long-term comparative data are lacking. Titanium base-free MUA restorations should be considered a technique-sensitive approach requiring optimized screw selection, accurate prosthetic fit, and controlled occlusal loading. Further well-designed long-term studies are needed to establish their predictability. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of Materials (1996-1944) is the property of MDPI and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.3390/ma19112212
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        Text: English
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      – SubjectFull: Treatment effectiveness
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      – SubjectFull: Fatigue limit
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      – TitleFull: Titanium Base-Free Multi-Unit Abutment Connections: A Critical Review of Prosthetic Screw Design, Biomechanical Behavior, and Clinical Performance.
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            NameFull: Mosaddad, Seyed Ali
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              M: 06
              Text: Jun2026
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              Y: 2026
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