Comparative Evaluation of the Effect of Custom-Made Anatomic Healing Abutment on Papilla Morphology and Gingival Aesthetics With That of Conventional Type of Healing Abutment: A Randomized Controlled Trial.

Background Gingival aesthetics has become inevitable in the overall success of implant-supported restorations. The interdental papilla plays a crucial role in attaining optimal aesthetics during the restoration of anterior edentulous regions with implants. The use of customized healing abutments helps to shape and condition the gingival tissue during the healing phase, thereby preserving its natural contours for the subsequent prosthetic stage.  Objectives The primary objective is to compare the papillary morphology adjacent to implant restorations using the papilla index after the use of custom-made and conventional healing abutments at permanent crown insertion and at six months. The secondary objective is to compare the emergence profile aesthetics using the pink esthetic score (PES) at the same time points for both types of healing abutments. Methodology The study was designed as a randomized parallel group trial with an allocation ratio of 1:1. Patients who visited the Prosthodontic Department of Government Dental College, Thiruvananthapuram, for implant-retained restoration in the maxillary central incisor region were recruited for the study. Implants were placed in a delayed loading protocol. A total of 20 participants were selected for the study. The control group (n=10) included patients treated with conventional healing abutments, while the test group (n=10) consisted of patients who received customized healing abutments. After six months of healing, conventional healing abutments were placed at second-stage surgery for group I, whereas customized healing abutments were used for group II. Outcome variables, papilla index scores (PIS), and PES were evaluated and compared at the time of insertion of permanent restoration and after six months. Results The distribution of mean papilla index between group I and group II at insertion showed that there is a statistically significant improvement in both mesial and distal PIS for group II (2.00±0.00) when compared to group I (1.40±0.52). PES were compared between the two groups at the time of insertion of the final crown. The mean PES for the customized group was (11.40±0.52) while that of the conventional group was only (10.40±0.52) (P value <0.05). The PES of Group I and Group II were compared after six months of crown insertion. Mean PES for the customized group (12.40±0.52) when compared to the conventional group (11.40±0.52) was higher, and the difference was statistically significant. (P value <0.05) .Statistical analysis was done using Mann-Whitney U test. Interpretation and conclusion  This study concludes that customized healing abutments help in procuring a better emergence profile and aesthetics of the restoration. It also restores the optimum contour and papillary size at a faster rate than the conventional healing abutment. Clinical significance The study is unique in that it compares the effect of customized healing abutment on gingival aesthetics and papillary morphology with that of conventional healing abutment in a delayed implant loading protocol. In delayed loading protocols, customized healing abutments are critical tools in guiding the healing of peri-implant soft tissues. They provide superior aesthetic outcomes, especially in the anterior aesthetic zone, by promoting natural-looking gingival architecture.