Tissue Preservation in Immediate 1C Implants Using an Anatomical Prefabricated Healing Abutment

Immediate replacement of a severely damaged posterior tooth with a dental implant has demonstrated high long-term success rates while offering the advantages of shorter treatment time and fewer invasive procedures compared with delayed implant placement. Beyond successful osseointegration, preservation of healthy peri-implant soft tissue and development of an optimal emergence profile are critical determinants of long-term implant success, as they reduce food impaction and plaque accumulation, facilitate oral hygiene, and contribute to favorable esthetic and functional outcomes. Historically, conventional healing abutments have been used primarily during the uncovering phase to promote soft-tissue healing; however, their cylindrical design does not replicate the natural contour of the extracted tooth and provides limited support for peri-implant soft-tissue architecture. Consequently, clinicians often use temporary titanium abutments and composite resin to customize healing abutments, or fabricate provisional restorations to shape the soft tissues during healing.

Recent evidence suggests that customized healing abutments, which mimic the natural tooth morphology, particularly in the cervical third, may better preserve peri-implant soft tissue contours, maintain marginal bone height, reduce early loading of immediately placed implants, and facilitate the development of a natural prosthetic emergence profile. Conventional customization with composite resin on a temporary abutment is technique-sensitive, requires additional clinical time, and carries the risk of contamination of the extraction socket by excess composite material. Prefabricated scannable AHAs have been developed to overcome these limitations by conforming to the extraction socket anatomy, supporting the surrounding soft tissues to prevent collapse during healing, stabilizing the blood clot, preserving space for bone regeneration, and simultaneously functioning as scan bodies for digital impression workflows. In addition, AHAs accurately transfer the three-dimensional implant position, potentially reducing treatment time, minimizing complications associated with repeated component exchanges, improving patient comfort and satisfaction, and streamlining fabrication of the definitive implant-supported restoration.

Preliminary laboratory investigations, clinical case reports, and early prospective clinical studies support the feasibility of AHAs for soft tissue management and digital implant workflows. However, the current evidence remains limited, particularly regarding their effectiveness in preserving pre-extraction soft-tissue contours following immediate implant placement in posterior sites. Existing studies are characterized by relatively small sample sizes, heterogeneous methodologies, and limited longitudinal clinical data. Therefore, further clinical investigation is needed to determine whether scannable anatomical healing abutments provide measurable benefits over conventional approaches in preserving peri-implant soft-tissue architecture and optimizing the emergence profile prior to the fabrication of a definitive single-implant-supported crown. This study aims to compare the anatomical healing abutment's capacity to preserve preextraction soft tissue contours, with attention to the position of the mid-facial gingival margin, enabling the delivery of the final crown in a shorter treatment period without the need for further soft tissue conditioning. The findings of this study will address an important gap in the literature and contribute to evidence-based protocols for immediate implant therapy and digital restorative workflows.Despite these theoretical and practical advantages, the currently available scientific literature remains relatively limited. Existing investigations primarily consist of laboratory studies, technical reports, case series, retrospective analyses, and a limited number of prospective clinical investigations. Although preliminary findings suggest favorable soft tissue management, simplified digital workflows, and acceptable clinical outcomes, robust randomized controlled clinical trials directly comparing Anatomical Healing Abutments with conventional healing abutments remain scarce. The available literature is further limited by relatively small sample sizes, heterogeneous methodologies, short observation periods, and inconsistent outcome measures.

Additional randomized clinical investigations using standardized surgical protocols, digital outcome measurements, validated esthetic indices, radiographic analyses, patient-reported outcomes, and longitudinal follow-up are needed to establish evidence-based recommendations regarding their clinical effectiveness.

The present study has been designed to address this important knowledge gap. The primary purpose of this multicenter randomized controlled clinical trial is to determine whether a prefabricated scannable Anatomical Healing Abutment provides superior preservation of peri-implant soft tissue contours compared with a conventional titanium healing abutment following immediate implant placement in posterior extraction sites. Rather than focusing exclusively on implant survival, the investigation comprehensively evaluates biological, prosthetic, radiographic, esthetic, digital, patient-centered, and economic outcomes throughout one year of functional loading.