Healing Abutment Classification in Implant Dentistry and Effect on Hard and Soft Tissues: A Systematic Review

PURPOSE: This systematic review introduces a novel classification of healing abutments- categorized as standard, anatomical, and customized-based on current clinical data. The primary objective is to evaluate their effects on peri-implant soft and hard tissues, while also summarizing their clinical indications, advantages, and limitations. MATERIALS AND METHODS: A comprehensive search was conducted in PubMed (MEDLINE), Scopus, and Web of Science, using MeSH terms such as 'Dental Abutment,' 'Computer-Aided Design,' 'Dental Implant-Abutment Design,' and 'Wound Healing.' The search strategy followed the PICO framework. From 1961 initial records, 11 clinical studies met the inclusion criteria after relevance screening and duplicate removal. The risk of bias was evaluated using the Cochrane Collaboration tool for randomized studies and the ROBINS-I Version 2 tool for non-randomized investigations. RESULTS: The included studies consisted of six randomized controlled trials, two prospective cohort studies, and three retrospective observational studies. Standard healing abutments were associated with increased need for provisional restorations and greater marginal bone loss. Anatomical abutments showed improved soft tissue healing and reduced postoperative discomfort. Indirectly customized abutments supported aesthetic outcomes and reduced the need for surgical reentry. Directly fabricated customized abutments enhanced soft tissue stability and minimized gingival recession. Overall, anatomical and customized abutments outperformed standard designs. CONCLUSIONS: Healing abutments with anatomical or customized features appear to promote better clinical outcomes by improving peri-implant tissue health and simplifying treatment protocols. Their use is particularly valuable in immediate implant placements, where achieving both aesthetic success and functional integration is essential.