Individualized healing significantly improves pink esthetics around immediate single implants: A systematic review and meta-analysis.
AIM This systematic review and meta-analysis aimed to compare soft and hard tissue outcomes of applying anatomic healing abutments (AHA) and provisional restorations (PR) versus cylindrical healing abutments (CHA) on immediately placed single implants. MATERIALS AND METHODS Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched on September 8, 2025, for two-armed studies comparing AHA/PR to CHA on immediate single-tooth implants. Outcomes included implant survival (IS), marginal bone loss (MBL), pink esthetic score (PES), patient satisfaction, as well as buccal bone and mucosal changes. Random-effects meta-analyses were performed. RESULTS Twenty studies were included; 12 contributed to quantitative synthesis, showing no difference in IS (over 99% in all groups), MBL, or patient satisfaction. Pooled analysis of seven studies (340 implants) showed higher PES with AHA and PR than CHA group at 1 year (MD: 2.54; 95% CI: 1.12-3.96). Descriptive evidence suggested a trend toward improved horizontal tissue preservation with individualized healing. CONCLUSION Within the limitations of this study, PR significantly improved PES without compromising IS or MBL. Their use may be beneficial, especially in the esthetic region, but further studies are needed to investigate their cost-effectiveness and long-term effect, especially on horizontal tissue changes. CLINICAL IMPLICATIONS Anatomically shaped healing abutments and provisional restorations provide higher pink esthetics around immediately placed single implants, which is especially relevant for restorations in the anterior region.