Dental implants endure complex multiaxial forces during mastication, yet current testing methods, such as ISO 14801:2016, rely on simplified uniaxial loading that fails to replicate realistic oral biomechanics. While modifications like randomized loading sequences to partially duplicate the daily activities in oral flora and CAD/CAM-printed mandibles improve stress distribution, they remain insufficient to simulate the dynamic and complex nature of masticatory forces. Similarly, chewing simulators, often used to assess material wear, especially for crown materials rarely evaluate the mechanical performance of implant-abutment connections under physiological conditions. Limitations such as biaxial loading, lack of realistic jaw movement patterns, and exclusion of dietary variations or food bolus interactions further hinder their applicability.

A systematic literature review (2010–2024) using PRISMA guidelines analyzed 155 studies, of which 12 were included. Identified methods included rotational, lateral, and torsional loading with occlusion but failed to replicate realistic jaw movements or loading sequences. This review highlights critical gaps in current methodologies and emphasizes the need for advanced testing systems that simulate multiaxial forces and realistic conditions. Addressing these challenges could lead to the development of more durable and reliable dental implants, ultimately improving patient outcomes.