The FEA method shown in this study has also been used in other works [32-35] to investigate the effect of the connection type on stress in the implant and surrounding bone. In particular, as has been seen by [
29] the use of a screwed type of implant prosthesis retention system presented less stress than the conventional system with the use of cement. The explanation of this phenomenon is due to the fact that in the case of a screwed system, there are several separate components including: the implant, the abutment, the prosthetic screw, and the crown. The micro-gap does not guarantee a uniform stress distribution between the components and the implant. Therefore, it was concluded that in a cemented retention system, the stresses and deformations were higher. Also, photo-elastic studies [
32,
33] have shown this phenomenon and have found that the gap between the components of the implant can reduce or increase the stress that is transmitted to the bone due to micro-movements. Although the use of a retention system with screw can cause bone resorption due to the insufficiency of stress transmitted, in the case of a cemented connection, the stress generated by the masticatory load could discharge directly on the bone, rather than being dissipated between the prosthetic components. These factors can increase stress on the bone leading it to resorption. In fact, as was shown in a study [
34] when the stress generated in the crestal area of the implant exceeds the elasticity of the bone, microfractures and resorption occur. Screwed prosthetics have the advantage of being removed without damaging the denture or implant with the only negative being the execution of the hole on the crown to insert the screw creates aesthetic problems and risks of fracture. Thanks to the conometric system, dental prostheses can reduce pressure on the surrounding gum tissue, helping to prevent long-term damage or irritation. In particular, SEM analyses analyzed the interface between cap and abutment, seeing that even after the application of the load, a relevant gap was not shown [
35]. This leads to the following benefits, including a reduced risk of bacterial infiltration and more evenly transmitted stress. In the conometric connection, retention is given only by the frictional force that develops at the abutment-cap interface. The perfect fit between the two surfaces and the absence of marginal gap of the conometric connection is a fundamental requirement to avoid failures and bacterial infiltration [
36,
37]. In an attempt to further reduce inflammatory responses and maximize bone stability in the crestal area of the implant, many in vitro studies [38-40] have defined that in the conometric connection, the gap between abutment and cap (2.04-2.064 micron) was considered necessary to avoid bacterial infiltration phenomena. On the other hand, in the case of a cemented connection between abutment and cap, a gap of (145 microns) was seen [
40]. Another problem is related to the removal of the prosthesis. Through a study by Degidi et al. [
41] it was seen how prostheses that used a conometric retention system were easily removed. In fact, conometric prostheses are designed for easy removal and cleaning making the oral hygiene and prosthesis cleaning processes easier than those for cemented or adhesive dentures which had problems due to incomplete cement removal. The success rate of conometric prostheses is an important aspect of rehabilitation. Numerous studies [42-44] have described the follow-up period, noting a 97.77% success rate during a 2-year follow-up period. System retention understood as the ability of the prosthesis to remain stable and firmly in place inside the mouth during normal use is a key factor in long-term durability. As shown in the introductory part, the retention of the conometric connection depends on the first load with which the cap is inserted, the taper angle, the height, and the friction between the two surfaces [
45,
46]. Insufficient retention leads to loosening of the prosthesis with the related implant problems and bacterial infection. The influence of cap insertion-separation cycles on retention ability has been evaluated by many studies [47-49]. In particular, as shown in an in vitro study [
50], retention decreases by about 40% from 5 cycles to 15 insertion-removal cycles. This phenomenon is due to the fact that with the increase in the number of cycles, the functional characteristics of the surfaces in contact vary. In addition, retention is reduced even if the plastic limit of the material is exceeded, as the state of residual stress due retention is no longer guaranteed. However, when similar materials are used, a cold fusion can develop between the abutment-cap contact surface, thus ensuring greater retention. Conversely, with a softer material than the abutment there is greater wear on the inner surface of the cap and therefore less retention [
51]. In the oral environment, prostheses are subject to time-varying chewing forces, temperature variations and high humidity; all factors that worsen the condition of the cement causing loss of retention. In a study [
52] the retention of a cemented and conometric system was measured, highlighting how the use of the conometric system led to an increase in retention as the phenomenon of cold welding between the two components occurred. While in the case of the cemented system there was a decrease in retention due to the loss of cement performance after 5 years. The evaluation of the retention of the cap-abutment connection has always been evaluated through in vitro studies. In particular, as shown by [
53] the retention varies according to the conicity of the abutment in fact it goes from 40.46 N for 6 degrees of taper to 235 N for a taper of 1 degree. Bressan et al [
54] also used the FEA method to analyze the retention of a morse cone connection by seeing that in the case of a gold cap there was in vitro a retention of 148.22 N compared to 150 N obtained by numerical analysis. However, there are no clear data in the literature on the minimum retention necessary for the crown and cap to remain in a stable position. During chewing, the depressive muscles apply displacement forces to the prosthesis. Therefore, the minimum retention force must be greater than the contraction force of these depressor muscles which turns out to be about 113 N [
54,
55]. Thanks to a numerical study [
56] a mathematical model has been developed that allows, as a function of conicity, to qualitatively know the retention offered by the system. In particular, it can be seen that the retention increases exponentially decreasing the taper angle. The other method to evaluate system retention is through the use of numerical simulation, in particular FEA finite element analysis. This method now used in most engineering and medical applications allows to accurately simulate what happens from the point of view of mechanical behavior when the cap is inserted on the abutment. The process implemented in this study allowed to evaluate the retention of the system in the case of an abutment with a taper of 4° and define the necessary force with which the cap must be inserted to have sufficient retention. Thanks to the FEA analysis, it was also possible to evaluate the effect of the inclination of the abutment on retention. Therefore, the null hypothesis has not been confirmed because the inclined abutment supplies a hole for the insertion of the screw on the mating surface. This hole decreases the surface in contact with the cap thus obtaining a decrease in the retention ability of the connection. In addition, the retention also decreases with increasing angle of inclination of the abutment as the axial loads along the abutment are also broken down according to the components: mesial, distal, and buccal that vary with inclination. It is the non-axial components function as a lever on the cap decreasing the retention of the system.