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Customized healing abutments have been introduced in clinical practice along with implant surgery to preserve or create natural-appearing hard and soft tissue around the implant. This provides the benefits of reducing the overall treatment time by eliminating the second stage and reducing the elapsed time of the fabrication of the final prostheses. This article aims to review the types and properties of materials used for the fabrication of customized healing abutments and their clinical applications. Articles published in English on customized healing abutments were searched in Google Scholar, PubMed/MEDLINE, ScienceDirect, and the Scopus databases up to August 2022. The relevant articles were selected and included in this literature review. Customized healing abutments can be fabricated from materials available for dental implants, including PEEK, PMMA, zirconia, resin composite, and titanium. All the materials can be used following both immediate and delayed implant placement. Each material provides different mechanical and biological properties that influence the peri-implant tissues. In conclusion, the studies have demonstrated promising outcomes for all the materials. However, further investigation comparing the effects of each material on peri-implant soft and hard tissues is required.

This study aimed to evaluate the effect of customized healing abutments compared to prefabricated healing abutments in immediate implant sites. Twelve patients requiring single immediate implant placement were divided into two groups: a prefabricated group received prefabricated titanium healing abutments, and a customized group received a polyetheretherketone (PEEK) customized healing abutments fabricated based on the individuals’ digital impressions. Outcomes, including peri-implant horizontal and vertical soft tissue alteration, bone level change, volume change, pain score, and pink esthetic score (PES) change, were evaluated at the 1-, 4-, and 6-month follow-ups compared to pre-extraction teeth. At the 1- and 4-month follow-ups, the customized group had a significantly lower buccal volume variation (BVv). At the 6-month follow-up, neither group showed any significant difference in the marginal bone change; however, the customized group had a significantly lower PES change and a lower pain score. In the anterior and premolar regions, the customized group showed the preservation of peri-implant buccal horizontal soft tissue and buccal volume, while in the molar regions, the preservation of papilla height and midfacial height was observed. The morphology of the customized healing abutment demonstrated a better trend in preservation of peri-implant soft tissue, esthetic outcomes, and lower patient discomfort in immediate implant sites.

Although novel technologies offer many opportunities, they are neither available nor easily accessible anywhere and anytime, and they are more costly. This article describes a technique for chairside fabrication and delivery of an immediate custom healing abutment utilizing both digital and conventional means.

Background: This pilot study aimed to evaluate the effectiveness of digitally crafted customized healing abutments in stabilizing peri-implant soft tissues following tooth extraction and assess the preservation of peri-implant soft tissue architecture over 5 years. Material and Methods: Forty patients (age ≥ 25 years) were divided into test (n = 20) and control (n = 20) groups. The test group received dental implants with immediate loading after tooth extraction, along with customized healing abutments fabricated using CAD/CAM technology. The control group received dental implants with immediate loading without customized healing abutments. The primary outcome was the change in distance between the peri-implant soft tissue margin and implant fixture surface from baseline to 5 years post implantation. Results: In the test group, there was a significant decrease in the distance between the peri-implant soft tissue margin and fixture surface from baseline to 5 years (p < 0.001), with pairwise comparisons showing significant differences between multiple time points (p < 0.05). The control group showed less pronounced changes over time. Conclusions: Within the limitations of this pilot study, digitally fabricated customized healing abutments appear effective in stabilizing peri-implant soft tissues and preserving soft tissue architecture around dental implants over 5 years following immediate implant placement. Randomized controlled trials are needed to confirm these findings.

Background The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Methods Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm 3 ) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. Results The midfacial gingival margin changes demonstrated a significant difference ( P  ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54 mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm 3 ) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference ( P  > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm 3 ) after 1 year and mid-facial gingival margin changes ( P  ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group ( P  = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups ( P  ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant( P  > 0.05). Conclusions This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm 3 ) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. Trial registration The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

It is an established fact that postextraction ridge resorptive changes are inevitable and are very evident in the molar areas. Resorption in the molar sites can cause a reduction in the attached gingiva and affect the long‐term success of the osseointegrated implant. To prevent significant postextraction tissue alteration, the socket shield technique (SST) was developed to preserve the buccal plate, over a decade ago. Since then, various studies showcasing modifications of the technique have been published mainly focusing on SST in conjunction with immediate implants in the anterior esthetic zone. Gluckman gave a collective term called partial extraction therapy (PET) which includes SST, pontic shield technique, and root submergence technique. He suggested using a graft material in the gap between the shield and the implant. Later, Siormpas et al. advocated a root membrane technique (RMT) and suggested that it may not be necessary to use the graft material. With the evolution of the technique, the terms SST and RMT are more similar to each other now, with the only difference in the sequence of shield preparation and implant placement. The shield is prepared first, and osteotomy is done in the former and osteotomy is done before shield preparation in the latter. The SST technique is often ignored as a possibility in the molar sites. Though technique‐sensitive, SST with immediate implants in molars with a customized healing abutment ensures the maintenance of the original hard and soft tissue volumes in the most conservative way. The following case report showcases a stepwise, graftless management approach for a nonrestorable right mandibular molar with SST and immediate implant. Long‐term randomized controlled trials (RCTs) on molar SST are encouraged to make a recommendation for routine clinical practice.

Background The morphologic and dimensional alveolar bone is significant for resorption in the first 3 months after tooth removal because they restrict treatment outcomes with respect to function and esthetic. Following teeth extraction, the width and height of the alveolar ridge contour are reduced in both the horizontal and vertical dimensions. Following implant placement, the gingival morphology should be changed minimally compared to pre-extraction. Surrounding natural-like tissue is also an ultimate goal of the dental implant treatment, which is correlated with the cervical third contour on the anatomical tooth, for comfortable cleansing, food impaction avoidance, and esthetics. Purpose To evaluate the peri-implant soft tissue changes after immediate implant placement (IIP) with the use of a customized titanium healing abutment in the posterior teeth. Method Digital impressions using the intraoral scanner (MEDIT i 500) were taken from 30 patients. Customized titanium healing abutments were designed and milled before extraction. Flapless extractions were done using surgical guides, 32 immediate implants placement were done in posterior areas, and healing abutments were placed. Soft tissues were scanned during pre-operation, and post-surgery during the 1st, 3rd, and 6th months. A 3D analysis program (Final Surface) evaluated the gingival margin distance, height, contour width, and volume in each period. SPSS was used to analyze the data with a p-value = 0.05. The between-time interval comparisons were done and the analysis was done using a Multivariate test. Results Customized titanium healing abutments used in immediate implantation maintained optimal peri-implant mucosa. In intermittent periods, there was no significant reduction in all aspects of the margin distances and heights. During the entire period, the margin height reduction on the buccal, lingual, mesial, and distal was 0.63 mm, 0.93 mm, 0.08 mm, and 0.24 mm, respectively, and contour width reduction on the buccal, lingual, and buccolingual was 0.59 mm, 0.43 mm, and 1.03 mm, respectively. There was a significant reduction in the total buccolingual contour width in the 1st month and total volume in the 3rd to 6th months. Conclusions Immediate implant placement with customized titanium healing abutment can achieve the optimal peri-implant mucosa and this protocol is an alternative for soft tissue management.