Systematic Review of CAD/CAM-Fabricated Customized Healing Abutments and Their Effect on Soft Tissue Esthetics

Introduction:

Immediate implant placement provides clear clinical benefits, including reduced treatment time and preservation of alveolar bone structure [1,2]. Despite these advantages, achieving predictable and esthetic soft-tissue outcomes remains a consistent challenge. Customized healing abutments (CHAs), fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM), are intended to better support peri-implant soft tissue compared to standard stock components [3,4]. Although initial findings are encouraging, the available evidence remains limited and inconsistent across studies [2]. This systematic review aims to assess soft-tissue esthetic outcomes associated with CAD/CAM-fabricated CHAs following immediate implant placement.

Methods:

A systematic search was conducted in PubMed, Springer Nature Link, and Wiley Online Library following PRISMA guidelines. Studies published in English within the past five years assessing soft tissue esthetic outcomes of CAD/CAM CHAs after immediate implant placement were included. Out of 145 articles screened, 5 met the inclusion criteria.

Results:

All five studies reported improved peri-implant soft tissue esthetics with CAD/CAM CHAs. High Pink Esthetic scores were consistently observed, with Elgendi et al. reporting a mean score of 9.64 ± 0.50 and full papilla fill at 12 months using PEEK CHAs [5]. Increases in mucosal thickness and keratinized tissue width were statistically significant in multiple studies (p < 0.05) [2,3]. Long-term data from Akin and Chapple demonstrated preserved emergence profiles and no mucosal recession over 8 years in 115 posterior implants, indicating durable soft tissue outcomes. Buccal volume loss was significantly reduced (–4.76% ± 5.29%, p = 0.043) and overall dimensional stability was maintained, with minimal soft tissue changes reported across studies [1,3,6]. While sample sizes and methodologies varied, all studies demonstrated favorable esthetic outcomes with CHAs compared to conventional approaches.

Conclusion:

CAD/CAM-fabricated CHAs improve soft tissue esthetics in immediate implant placement by preserving volume, enhancing contours, and maintaining emergence profiles. Despite promising results, further standardized, long-term clinical trials are needed to validate these outcomes.