To systematically evaluate the effects of different attachment systems (ball, bar, Locator, telescopic crown and magnetic attachments) on peri-implant health parameters in patients with mandibular implant-retained overdentures using network meta-analysis.

PubMed, Web of Science, Cochrane Library, Embase and Scopus were searched from inception to 1 February 2026. Randomised controlled trials (RCTs) comparing different attachment systems were included. Primary outcomes included implant survival rate, marginal bone loss, probing depth and plaque index, which were treated as peri-implant health parameters rather than diagnostic measures of peri-implantitis. Network evidence plots and network meta-analyses were performed using Network evidence plots were generated using Stata software (version 17.0, StataCorp LLC, College Station, TX, USA). Network meta-analyses were performed using the GeMTC package in R software (version 4.1.0, R Foundation for Statistical Computing, Vienna, Austria). Risk of bias graphs were generated using RevMan software (version 5.4, The Cochrane Collaboration, London, UK), and the certainty of evidence was considered according to Grading of Recommendations Assessment, Development and Evaluation principles adapted for network meta-analysis.

Twelve RCTs involving 511 patients were included. For marginal bone loss and implant survival rate, no significant differences were found among the evaluated attachment systems. For plaque index, ball, telescopic and Locator attachments showed more favourable plaque-control results than bar and magnetic attachments, although the rankings should be interpreted cautiously because several comparisons were supported by limited evidence. For probing depth, bar attachments showed lower values than the other attachment systems in the network estimates, followed by telescopic and ball attachments, while magnetic and Locator attachments showed less favourable results.

The available evidence suggests that all five attachment systems can achieve satisfactory implant survival rates in mandibular implant-retained overdentures, with possible differences in plaque control and probing depth. Because several networks were sparse and some confidence intervals were wide, these comparative rankings should be interpreted cautiously and integrated with patient-specific clinical factors.