Peri-Implant Esthetics in Focus: Comparing Anodized Titanium and Zirconium Dioxide Abutments in a Randomized Clinical Trial

Abstract

Objective: Achieving optimal esthetics remains challenging due to limited comparative evidence between pink-anodized titanium and zirconium dioxide abutments. The objective of this clinical study was to evaluate the optical outcomes of pink-anodized titanium and zirconium dioxide abutments in the esthetic region. Methods: Twenty-two subjects with an edentulous site in the maxillary esthetic region with a tooth present mesially and distally were selected for implant surgery along with hard and soft tissue augmentation. Group A received a pink-anodized titanium abutment with a layered lithium disilicate single crown. Group B received a zirconium dioxide abutment with the same prosthesis material. The contralateral natural tooth served as the control group. Optical outcomes were assessed using a spectrophotometer. The CIELAB color coordinates (Commission Internationale de l'Eclairage) were recorded to calculate ΔE values. Vernier calipers, along with an endodontic file, were used to measure the peri-implant soft tissue thickness. The Pink Esthetic Score (PES) was evaluated using digital images of 22 single-tooth implant crowns to assess the surrounding soft tissue esthetics. Results: Zirconia abutments (Group A) demonstrated superior optical outcomes compared to pink-anodized titanium abutments (Group B). The ΔE values for Group A at the peri-implant soft tissue, coronal, and midfacial crown levels were significantly lower compared to Group B. Soft tissue thickness (STT) increased over time in both groups, with a slight increase in Group B. The Pink Esthetic Score (PES) also improved with recall visits at each evaluation. Conclusion: Zirconia abutments provided superior esthetic outcomes compared to pink-anodized titanium abutments, with significantly lower color differences (ΔE) and higher Pink Esthetic Scores (PES). Although pink-anodized titanium abutments showed increased soft tissue thickening with time, zirconia abutments remained the more favorable option for esthetically demanding cases. Clinical Trials Registry: (CTRI No. CTRI/2024/03/064442). © 2025 Wiley Periodicals LLC.