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).