Abstract
The choice of abutment material plays a critical role in peri-implant tissue health and the esthetic outcome of fixed prosthodontics. Various materials, such as titanium, zirconia, and gold alloy, offer different mechanical and biological interactions with the peri-implant tissues, influencing clinical outcomes. However, the long-term impact of these materials on peri-implant soft tissue response and esthetic appearance remains debated. A randomized controlled trial was conducted involving 90 patients requiring single-tooth implant-supported prostheses. Patients were divided into three groups, with 30 participants each receiving abutments made of titanium, zirconia, or gold alloy. Clinical parameters such as probing depth, bleeding on probing, plaque index, and peri-implant soft tissue thickness were recorded over 12 months. Esthetic outcomes were assessed using the pink esthetic score (PES) and white esthetic score (WES). After 12 months, titanium abutments exhibited a mean probing depth of 2.2 ± 0.4 mm, with a bleeding on probing (BOP) percentage of 25%. Zirconia abutments showed significantly lower peri-implant inflammation with a probing depth of 1.9 ± 0.3 mm and BOP of 10%. Gold alloy abutments demonstrated intermediate values with a probing depth of 2.1 ± 0.3 mm and BOP of 15%. Esthetic evaluation revealed that zirconia abutments provided the highest PES/WES score (mean PES = 12.5 ± 1.1, WES = 13.2 ± 1.0), followed by gold alloy (PES = 11.8 ± 1.2, WES = 12.5 ± 1.3), and titanium (PES = 11.2 ± 1.4, WES = 11.8 ± 1.5). Zirconia abutments offer superior peri-implant soft tissue health and esthetics compared to titanium and gold alloy abutments. Clinicians should consider zirconia as the material of choice for optimal biological and esthetic outcomes in fixed prosthodontics. However, further long-term studies are needed to validate these findings.