SYSTEMATIC REVIEW

Magnitude of misfit threshold in implant-supported

restorations: A systematic review
Aly Abdelrehim, BDS, MSc,a Enas Abdalla Etajuri, BDS, MDSc, MClinDent,b
Eshamsul Sulaiman, BDS, MFD, MClinDent,c Hazrina Sofian, BCompSc, MCompSc, PhD,d and
Nosizana Mohd Salleh, DDS, PhDe

Reduced stress along the ABSTRACT

implant body and bone is a Statement of problem. Attaining a passive fit in implant restorations is desirable but clinically
desired feature for implant- difficult to achieve, especially in screw-retained prostheses. At a certain magnitude, this misfit
supported prostheses and is will not cause mechanical and biological complications, but the exact level has yet to be
achievable by obtaining a determined.
passive fit. Although different
1
Purpose. The purpose of this systematic review was to gather, compare, and appraise studies that
opinions exist on the definition attempted to determine the biological and mechanical tolerance of misfits.
of passive fit, a complete pas-
Material and methods. The review protocol was published in the Prospective Register for
sive fit is realized when Systematic Reviews (PROSPERO; registration no. CRD42021268399) and follows the Preferred
implant components and the Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search
framework fitting surface are was conducted through PubMed, Ebscohost, and Web of Science followed by a manual search
in spatial harmony without up to December 2021.
any strains after establishing Results. A total of 413 manuscripts were identified by electronic and manual search. After removing
the recommended preload of duplicates, nonrelevant titles, and abstract screening, 62 manuscripts were eligible for full-text
all screws.2 In contrast, misfit assessment. Finally, a total of 13 articles (1 cross-sectional study, 1 retrospective and prospective,
has been defined as dimen- 7 in vitro studies, and 4 animal studies) met the eligibility criteria and were included in this
sional space between different review. A wide range of tolerable misfits were reported. Vertical misfit up to 1 mm and
implant components that are horizontal misfit up to 345 mm were associated with no adverse outcomes.
too tight-fitting, too loose, or Conclusions. The current literature provides inadequate data to determine a clinical threshold of an
unevenly distributed,3-5 which acceptable misfit. However, this review demonstrated that the mechanical response to misfit is
may trigger biological and more critical than the biological response. (J Prosthet Dent 2022;-:---)
mechanical complications.6
Alternating finger pressure, visual assessment, tactile measurements, measuring the misfit induced strains on
examination, radiography, the 1-screw test, light micro- the framework and surrounding structures as an assess-
scopy, and scanning electric microscope are clinical and ment of passivity has also been proposed.3 The com-
laboratory methods of measuring framework misfit. 3 ,7
monest methods have been finite element analysis (FEA)
However, using any of these clinical or laboratory and strain gauge analysis. However, these methods have
methods separately has been deemed inaccurate, unre- been questioned because they are unable to simulate
producible, and unreliable.7,8 Other than direct complex models completely.9,10 Therefore, the general

a
Graduate student, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.
b
Lecturer, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.
c
Associate Professor, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.
d
Senior Lecturer, Department of Software Engineering, Faculty of Computer Science & Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia.
e
Associate Professor, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia.

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Table 1. Inclusion and exclusion criteria

Clinical Implications Inclusion Criteria Exclusion Criteria
 Articles written in English  Case reports and expert
This systematic review shows the knowledge gap opinions
when determining a clinical threshold for  Peer-reviewed dental journals  Articles on tooth-supported or
removable prosthesis
acceptable misfit. However, data indicate that
 Clinical or in vitro studies  Absence of elaborate
mechanical response to misfit is more critical than measuring maximum vertical or methodology and/or results
biological response. horizontal prosthesis misfit on misfit
 Review articles  Articles not measuring level
of misfit that will cause
complications
 Any implant-supported prosthesis.  Full text unavailable
aim has been to minimize the misfit to decrease the
complication rate.
Although desirable, obtaining a completely passive fit identified knowledge gaps regarding acceptable misfit.
is practically unachievable, especially with screw-retained The hypothesis was that biological and mechanical
prostheses,3 since misfits are caused by unavoidable er- thresholds for misfit would be found where long-term
rors during the impression making and framework adverse outcomes would not occur.
fabrication process.11,12 Moreover, distortions tend to
increase with longer span prostheses,13 resulting in the
MATERIAL AND METHODS
increased use of nonsplinted restorations.14-17 Verifica-
tion devices, casting low-fusing metals, different The protocol of this systematic review was published in
impression techniques, casting the framework in sec- the Prospective Register for Systematic Reviews (PROS-
tions, postfabrication sectioning, and soldering have been PERO) (registration no. CRD42021268399), and report-
introduced as correctional steps to decrease the misfit. ing was executed according to the Preferred Reporting for
Nevertheless, an absolute fit has not been achieved.18-21 Systematic Reviews and Meta-Analyses (PRISMA)
Inaccuracies are also present in a complete digital guidelines. A thorough literature search was performed.
workflow, and the scan body surface geometry and sharp Articles published in English in peer-reviewed journals
edges have been reported to affect the quality of scans.22 until 1 September 2021 were included. In vitro, in vivo,
Furthermore, intraoral scans of edentulous spaces for and animal studies quantitatively investigating the clini-
long-span prostheses are problematic.23-25 Even the cally acceptable misfit limit with no restriction on publi-
milling accuracy that has been documented as reliable cation date or type of restoration were included. Details
and superior is compromised when milling harder ma- on inclusion and exclusion criteria are shown in Table 1.
terials such as titanium because of vibrations and thermal PubMed, Ebscohost, and Web of Science were elec-
stresses.26,27 tronically searched using specific keywords, and an
The nonpassive fit of an implant-supported fixed individualized search strategy was used according to each
denture has been reported to cause uncontrolled strains database. A manual search of the references used in the
on the implant components, framework, and surround- eligible articles was carried out to identify additional
ing bone, triggering biological and mechanical compli- studies. The references were managed with a reference
cations.6,28 Screw loosening, screw fracture, and chipping manager software program (EndNote X9, Version 9.3.3;
of the veneering material have been the most frequently Clarivate). The search was conducted using the following
reported complications.29,30 Other less common compli- combination of keywords with Boolean terms: Implant-
cations include bone loss, gingival inflammation, pain supported, Screw retained, Cement retained, misfit,
fistula, and implant or prosthesis fracture and loss.29-32 gap, Dental Restoration Failure, Biological complication*,
A certain misfit tolerance will not cause adverse ef- “Biological failure*”, “Mechanical failure*”, “Mechanical
fects. However, the exact level has yet to be determined, complication*”, “Fracture*, “Failure*. The following
the level is debatable, and a consensus on an acceptable Medical Subject Headings (MeSH) terms were also used
fit has not been reached. Therefore, the present sys- for the PubMed database: “Dental Prosthesis; Implant-
tematic review aimed to gather, compare, and evaluate Supported”, “Prosthesis Fitting”, “Dental Restoration
studies that quantitatively investigated outcomes of Failure.” The electronic database search was completed
different levels of misfit and whether an adverse outcome on 15 November 2021, and the last update by manual
occurred to reveal if there is a tolerable magnitude of search was on 3 December 2021.
misfit. Furthermore, by categorizing outcomes into bio- The search flowchart is shown in Figure 1. A double
logical and mechanical, a reflection of which is more screening method was used. Record identification,
critical may be understood. Gathering such information screening, and quality assessment were conducted by 2
highlighted the diversity of studies exploring misfits and researchers (A.A., E.E.) independently. Then cross-

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Identification of studies via databases and registers

Records identified from

electronic search:
Records identified through
Databases (N= 395)
manual search
PubMed (n=104)
(n=18)
Identification

Web of science (n=106)

Ebscohost (n=185)

Records removed before

screening:
Total records identified Duplicate records removed
(n=413) (n=75)
Records removed due to
irrelevant titles (n=117)

Records excluded due to

Records screened
irrelevant abstracts
(n=221)
(n=159)
Screening

Reports excluded:
No details on misfit measurement or results (n=12)
Did not correlate amount of misfit to occurrence of
complications (n=13)
Full-text assessed for eligibility
Did not mention tested misfit caused complications or not
(n=62)
(n=18)
Full-text not in English (n=1)
Case report (n=2)
Non-splinted removable prosthesis (n=3)
Included

Studies included in review

(n =13)

Figure 1. Search strategy and results.

verification was performed between the reviewers. Dif- misfit, effect of different magnitudes of misfit on clinical
ferences were discussed until a consensus was reached. If outcomes, and adverse outcomes measured, and signif-
an agreement could not be reached between the icant findings were analyzed at this step.
screeners, a third reviewer (N.S.) was used. Quality and risk of bias assessments for clinical
Article identification was done in 3 stages. Initially, studies were made by using study quality assessment
screening was conducted according to title relevancy. If a tools of the National Heart, Lung, and Blood Institute of
conclusive decision could not be made from the title, the the National Institutes of Health (NIH) for quality
record was carried on to the next stage. At the following assessment of Observational, Cohort, and Cross-
stage, abstracts were gathered and screened for rele- Sectional Studies33 (Table 2). For quality assessment of
vancy. If a decision could not be made, it was appointed in vitro and experimental studies, an adapted protocol
for full-text reviewing. For all the relevant abstracts, a full was used from published in vitro systematic reviews.35,36
text was obtained and assessed for eligibility. An eligible Risk of bias was assessed according to the article
study had to report whether a certain level of misfit had description of blinding of the operator, adequate period
or had not caused adverse outcomes. Studies only of load simulation, justification of the sample size,
assessing the positive correlation between increased manner of load described, whether operators followed
misfit and complications were disregarded. Finally, manufacturer instructions for screw tightening, presence
analysis and data extraction were performed for the of control group, method of measuring misfit, and suf-
selected full texts and methodology details, amount of ficient description of the method used to measure the

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Table 2. Risk of bias for clinical studies

Author, Date Jokstad and Shokati, 201534 Jemt and Book, 199632
Other Other
Criteria Yes No (CD, NR, NA)* Yes No (CD, NR, NA)*
1. Was the research question or objective in this paper clearly stated? U d d U d d
2. Was the study population clearly specified and defined? U d d d U d
3. Was the participation rate of eligible persons at least 50%? d U d d U d
4. Were all the subjects selected or recruited from the same or similar U d d U d d
populations (including the same time period)? Were inclusion and exclusion
criteria for being in the study prespecified and applied uniformly to all participants?
5. Was a sample size justification, power description, or variance and effect d U d d U d
estimates provided?
6. For the analyses in this paper, were the exposure(s) of interest measured d U d U d d
prior to the outcome(s) being measured?
7. Was the timeframe sufficient so that one could reasonably expect to see d U d U d d
an association between exposure and outcome if it existed?
8. For exposures that can vary in amount or level, did the study examine different U d d U d d
levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure
measured as continuous variable)?
9. Were the exposure measures (independent variables) clearly defined, valid, reliable, U d d U d d
and implemented consistently across all study participants?
10. Was the exposure(s) assessed more than once over time? d U d U d d
11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, U d d U d d
and implemented consistently across all study participants?
12. Were the outcome assessors blinded to the exposure status of participants? d d U d d NR
13. Was loss to follow-up after baseline 20% or less? d d U U d d
14. Were key potential confounding variables measured and adjusted statistically d U d d U d
for their impact on the relationship between exposure(s) and outcome(s)?
Quality rating (good, fair, or poor) Poor Fair

According to National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) for quality assessment of Observational, Cohort, and Cross-Sectional Studies. *CD, cannot
determine; NA, not applicable; NR, not reported.

outcome. Each parameter recorded was marked with “Y.” simulation and blinding. Only 1 article40 reported
If the parameter was not done or missing, it was marked blinding of the assessor while measuring the outcome.
with “N.” Articles with only 1 or 2 Ys were considered However, the description of methods for measuring
high risk, 3 to 5 as moderate risk, and 6 to 8 as low risk misfit and outcome was clear. Furthermore, assessors
(Table 3). rated the quality of in vivo studies32,34 as fair and
Quality assessment was not done for in vitro studies poor (Table 2). Both studies failed to control confounding
that used FEA to evaluate the effects of the misfit. Since factors, had a high risk of detection bias, and failed to
FEA is a simulation software program, the authors agreed report any justification for sample size.
that the chance of bias is minimal and therefore con- Because of the few eligible studies, dissimilar study
ducting a risk assessment would not be required. designs, tools for measuring misfits, types of misfits, and
outcomes measured described across the eligible articles,
meta-analysis was not appropriate. A summary of find-
RESULTS
ings table (Table 4) was developed with details about
Initially, a total of 395 manuscripts were identified (104 study design, type of misfit, method of measuring misfit,
PubMed, 106 Web of Science, and 185 Ebscohost). An type of load, outcome measured, and amount of
additional 18 manuscripts were identified by manual acceptable misfit to facilitate interpretation and compar-
search. After removing duplicates (n=75), manuscripts ison among the article findings.
with irrelevant titles (n=117), and manuscripts after ab- Eight37-39,42,43,45-47 of the 13 eligible articles investi-
stract screening (n=159), 62 abstracts were eligible for gated vertical misfits, while only 2 articles41,44 assessed
full-text assessment, of which 46 were excluded after the horizontal misfits, 1 article40 investigated both horizontal
full-text analysis. A total of 13 articles (1 cross-sectional and vertical misfits, and 2 articles32,34 measured misfits
study, 1 retrospective and prospective, 7 in vitro in 3 dimensions. Of the 13 eligible articles, 9 articles32,34,37,
studies, and 4 animal studies) met the eligibility criteria 39-41,45-47
had dynamic load exerted on the frameworks,
and were included in this review (Fig. 1). while 4 articles38,42-44 assessed outcomes with preload
Most of the in vitro studies38,39,41,43,44 were of mod- forces. The adverse outcomes measured were either me-
erate risk, 1 article42 was high risk, and 2 articles37,40 were chanical (screw loosening, abutment loosening, veneering
low risk (Table 3). The common risk issues were the material cracking or chipping, and framework fracture
inadequate description of the manner or duration of load strength) or biological (peri-implant strain and marginal

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Table 3. Risk of bias for in vitro and animal studies

Adequate
Period Description Followed Presence Method of Method of
Sample Blinding of of Load of Applied Manufacturer’s of Control Measuring Measuring Risk of
Author, Year Size Operator Simulation Load Instruction Group Misfit the Outcome Bias
Löfgren, 201637 Y N N Y Y Y Y Y Low
Abduo and N N N N Y Y Y Y Moderate
Swain, 201238
Al-turki, 200239 N N N Y Y Y Y Y Moderate
Stimmelmayr, 201740 N Y Y Y N Y Y Y Low
Carr, 199641 N N N N Y Y Y Y Moderate
Duyck, 200542 N N N N Y N N Y High
Jemt, 200043 N N N N Y Y N Y Moderate
Michaels, 199744 N N N N N Y Y Y Moderate

bone loss). Five articles assessed the mechanical,37,39,40,45,47 veneering material cracking or chipping, and framework
5 articles investigated biological,32,38,41,42,44 and 3 articles fracture strength).40 However, Löfgren et al37 reported
measured both mechanical and biological outcomes.34,43,46 that a vertical misfit of 150 mm significantly increased
Both clinical studies32,34 used 3-dimensional tools to cracks in veneering porcelain after 100 000 cycles.
measure and assess misfits. Jemt and Book32 studied the Furthermore, a gap of 100 mm vertically decreased screw
biological outcome of misfits by measuring marginal torque by 90% and was considered clinically
bone loss by using a 3-dimensional photogrammetric unacceptable.39
technique. A misfit of as much as 111 mm was concluded All animal studies assessed the influence of misfit
to be clinically acceptable, showing no significant bone using preload force except Carr et al.41 Two assessed
loss across the 6 years of the study. Jokstad and Sho- horizontal misfit,41,44 and 2 assessed vertical misfit.42,43
kati,34 however, reported that a 230-mm misfit had no Tested horizontal misfit (345 mm to 466 mm) did not
long-term adverse biological or mechanical effects. affect osseointegration or bone-implant contact (BIC).
This review included 7 in vitro studies.37-40,45-47 FEA Meanwhile, vertical framework misfit between 500 mm42
was used in 3 articles.45-47 Across these 3 studies, and 1000 mm43 at the intermediate implant of a 3-unit
similar assumptions were made for the FEA model; prosthesis did not affect BIC or cause screw loosening.
similar model parameters were used, structures were
simplified as isotropic and homogenous, implant
DISCUSSION
external and internal threads were removed, and
complete osseointegration was assumed. The reported The hypothesis that a tolerable threshold for misfit could
magnitude of acceptable misfit was lower than the be identified was rejected. A clinical threshold for misfit
clinical studies. Abasolo et al45 measured screw fatigue could not be attained as data were limited and eligible
failure by using a mathematical formula and concluded articles were diverse. The purpose of this review was to
that a vertical misfit equal to or lower than 40 mm was extract and identify data on the threshold for misfit,
acceptable as screw fatigue would be infinite. Janda whether horizontal or vertical, that would cause no
et al47 reported misfits above 30 mm would cause por- adverse outcomes and subsequently could be considered
celain fractures and would be clinically unacceptable. acceptable in clinical practice. Although Brånemark once
Furthermore, stresses caused by a 50-mm misfit would suggested that 10 mm could be considered a passive fit,48
reach the yield limit of marginal bone and implant fabrication and casting inaccuracies, clinician experience,
components.46 and the inability to detect small misfits clinically have led
Laboratory studies37-40 investigated the mechanical clinicians to suggest other values.41 Furthermore, longer
outcome of misfit. Abduo and Swain38 measured peri- span restoration tends to show increased levels of
implant strain from the preload tightening force with a distortion. In contrast with common knowledge,49,50
framework with a misfit. They concluded that a vertical studies have not reported significant clinical difference
gap up to 100 mm can be closed with screw tightening in peri-implant marginal bone behavior between splin-
and would cause strains below the bone adaptive ted and nonsplinted implant restorations. Also, for
threshold. The other 3 studies37,39,40 involved load improved esthetics, more straightforward repair, and
simulation. Two studies37,40 measured the effect on decreased risk of veneer or framework fracture, more
veneering fracture or chipping. A 150-mm horizontal clinicians are opting for nonsplinted prostheses. This
misfit and 160-mm vertical misfit were reported to have change suggests that further research on the effects of
long-term stability and no increased occurrence of misfit in splinted and nonsplinted restorations is indi-
adverse outcomes (screw loosening, abutment loosening, cated.14-17

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Table 4. Summary of findings

Method of Misfit; Acceptable/
Author, Year Study Design Type of Misfit Measuring Load Applied Outcome Measured Unacceptable
Abasolo, 201845 In vitro Vertical FEA model Vertical, 200 N, at extremes Screw fatigue limit 40 mm acceptable
of framework
Abduo and Swain, In vitro Vertical 50x measuring Preload Peri-implant strain 100 mm acceptable
201238 microscope
Jimbo, 201546 In vitro Vertical FEA model Vertical, 200 N, at the center Bone yield limit, Implant 50 mm acceptable
of the implant body yield limit
Stimmelmayr, 201740 In vitro Vertical, 50x microscope Vertical, 50 N, 60 000, Screw loosening, abutment 160 ± 80 mm vertical,
horizontal 120 000, 600 000 cycles, at loosening, ceramic chipping 150 ± 80 mm horizontal
central fossa, 1000 thermal and fracture, fracture acceptable
cycles 5-55  C strength
Löefgren, 201637 In vitro Vertical Light microscope 10 , 30-300 N, 100 000 Veneering porcelain 150 mm unacceptable
cycles, at the middle pontic cracking and fracture,
retorque values
Janda, 202047 In vitro Vertical FEA model 10 , 200 N, center at occlusal Veneering ceramic fracture 30 mm acceptable
fossa of terminal implant
Jemt and Book, 199632 Prospective, 3-dimensional 3-dimensional 1-year retrospective, 5-year Marginal bone loss 111 mm and 91 mm
Retrospective photogrammetric prospective acceptable
technique
Jokstad and Shokati, Cross-sectional 3-dimensional 3-dimensional Mean 19 years (range, 12-32) Fracture of teeth/ 230 mm acceptable
201534 software program framework, Prosthetic/
abutment/screw loosening,
cracks, chipping, marginal
bone loss
Al-Turki, 200239 In vitro Vertical Microscope 20 , 267 N, 144 days Prosthetic screw loosening 100 mm, 175 mm
equivalent, 12 mm away unacceptable
from terminal screw
Carr, 199641 Animal Horizontal Microscope Not mentioned Implant mobility, peri- 345 mm acceptable
implant radiolucency, BIC (%
integration)
Duyck, 200542 Animal Vertical 12x Light Preload Crater depth, BIC, ISQ, screw 582.9 ± 204.4 mm
microscope loosening acceptable
Jemt, 200043 Animal Vertical Not Mentioned Preload Screw loosening, BIC 1000 mm acceptable
Michaels, 199744 Animal Horizontal Machinist Preload Peri-implant defects, Soft 466 ± 206 mm
microscope tissue health, BIC acceptable

BIC, bone-implant contact; FEA, finite element analysis; ISQ, implant stability quotient.

The PICO question was “What is the maximum was obsolete, and the authors did not report an analysis of
amount of clinically acceptable misfit or inaccuracy in the magnitude or direction of occlusal forces. Furthermore,
implant frameworks that will not cause mechanical or as the authors relied on records and dental history to
biological failure?” No randomized clinical trials could be assess adverse mechanical complication, there was a risk
identified during database search and screening. An of undocumented complications.
ethical prospective study to assess long-term outcomes Studies that investigated the biological threshold of
with an intentionally poor framework is not possible.2 misfit have reported that a range of 50 to 1000 mm verti-
However, retrospective, cross-sectional clinical studies, cally,38,42,43,46 345 to 466 mm41,44 horizontally, and 91 to
in vitro, and animal studies investigating at which 230 mm32,34 3-dimensional misfits will not exert strain
magnitude of misfit an adverse outcome would occur above bone tolerance or affect BIC and osseointegration.
were identified. The reasons for this wide range of results could be because
Jokstad and Shokati34 had the longest study period. of different study designs and types of misfit. Furthermore,
Implants placed up to 32 years earlier (mean 19 years) bone properties and the inherent quality of specimens in
were included, and a sophisticated 3-dimensional soft- animal studies are different from human bone and could
ware program was used to accurately measure misfits. be a misrepresentation.41 Also, several studies38,41-44 have
Marginal bone loss was measured and compared by using merely investigated the effect of misfit at a preloaded state,
a digital software program. Furthermore, an investigation while in an actual clinical setting, the dynamic load would
of a wide range of mechanical and framework outcomes be expected to greatly affect results.
was performed to give a broad and reliable conclusion Animal studies42,43 investigating screw loosening as an
about the effect of misfits. Apart from a slightly increased outcome of misfit reported that misfits of 500 mm and 1000
incidence of screw loosening, a 230-mm misfit was not mm did not cause screw loosening. However, both studies
found to cause adverse long-term outcomes. However, it only considered a preload environment, and outcomes
can be argued that the type of framework material used were because of the static load exerted by tightening an ill-

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- 2022 7

fitting prosthesis. Meanwhile, Al-Turki39 applied a 298 N 2. Concerning mechanical failure, vertical misfits
cyclic load vertically on a fixed prosthesis supported by 5 ranging from 30 mm to 160 mm and a horizontal
implants. This force was applied vertically on a cantilever misfit of 150 mm did not cause an adverse outcome.
12 mm from the terminal screw. A period of simulation of 3. For biological failure, tolerable vertical misfit of 466
144 days was designed. Data from this study showed a mm to 1 mm and horizontal misfit up to 345 mm
90% drop in prosthetic screw torque force with 100 mm have been reported.
and 175 mm misfits which were considered to be clinically 4. The mechanical response to misfit is more critical
unacceptable. This study design and simulation were than the biological response.
found closer to the actual situation, and the reported
findings should be a better representation in comparison
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systematic review and meta-analysis of in vitro studies. Oper Dent. 2014;39: Assoc Prof, Dr Nosizana Mohd Salleh
E31eE44. Department of Restorative Dentistry
36. Garcia-Sanz V, Paredes-Gallardo V, Mendoza-Yero O, Carbonell-Leal M, Faculty of Dentistry
Albaladejo A, Montiel-Company JM, et al. The effects of lasers on bond University of Malaya
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One. 2018;13:e0190736. MALAYSIA
37. Löfgren N, Larsson C, Mattheos N, Janda M. Influence of misfit on the Email: nosizana@um.edu.my
occurrence of veneering porcelain fractures (chipping) in implant-supported
metal-ceramic fixed dental prostheses: an in vitro pilot trial. Clin Implant Dent CRediT authorship contribution statement
Relat Res. 2017;28:1381e1387. Aly Abdelrehim: Conceptualization, Methodology, Formal analysis, Investiga-
38. Abduo J, Swain M. Influence of vertical misfit of titanium and zirconia tion, Resources, Writing e original draft. Enas Abdalla Etajuri: Methodology,
frameworks on peri-implant strain. Int J Oral Maxillofac Implants. 2012;27: Investigation, Resources, Formal analysis, Visualization. Eshamsul Sulaiman:
529e536. Validation, Visualization, Supervision, Writing e review & editing. Hazrina
39. Al-Turki LE, Chai J, Lautenschlager EP, Hutten MC. Changes in prosthetic Sofian: Validation, Visualization, Writing e review & editing. Nosizana Mohd
screw stability because of misfit of implant-supported prostheses. Int J Pros- Salleh: Conceptualization, Validation, Supervision, Project administration.
thodont. 2002;15:38e42.
40. Stimmelmayr M, Groesser J, Beuer F, Erdelt K, Krennmair G, Sachs C, et al. Copyright © 2022 by the Editorial Council for The Journal of Prosthetic Dentistry.
Accuracy and mechanical performance of passivated and conventional https://doi.org/10.1016/j.prosdent.2022.09.010

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