Custom Healing Abutments: Planning the Emergence Profile with CAD-CAM

Can a digitally designed healing abutment shape the peri-implant emergence profile before the final restoration? It can provide a patient-specific contour, but a digital plan does not guarantee healing, eliminate fabrication errors or remove every chairside adjustment. The useful question is which records, material and clinical sequence support the proposed contour, and what the evidence actually demonstrates.

Learning objectives

After reading, you should be able to:

• Distinguish an emergence-profile design from evidence of healing, tissue stability or long-term clinical benefit.
• Identify the different information supplied by surface scans, bite records, implant-position records and radiographic data.
• Compare preoperative planning and postoperative or second-stage methods without combining them into one validated protocol.
• Identify the material-specific and evidence checks needed when discussing fabrication, delivery and expected chairside adjustments.

What does the digital technique establish?

Ramadan and colleagues (2025) describe preoperative digital implant planning for a CAD-CAM custom healing abutment. Their aim is to guide the peri-implant mucosal form and reduce chairside work. This is a dental technique report, so its description of predictability should not be read as a comparative estimate of complication reduction or a guarantee for every patient.

The emergence profile is the contour through which an implant restoration or healing component passes into the surrounding soft tissue. Its design connects the intended restoration with the available tissue and implant position. An interocclusal record describes the relationship between the upper and lower arches; it does not locate an implant or describe the relationship between an arch and a missing tooth.

Digital surface models and radiographic records supply different information. In Joda and colleagues’ 2016 technique, an intraoral scan recorded the placed implant with a scan body, while cone-beam computed tomography (CBCT) data in Digital Imaging and Communications in Medicine (DICOM) format supplied the contralateral tooth contour. Those records were combined for design, and the healing component was delivered at reopening after submerged healing. This postoperative sequence is different from preoperative fabrication based on a planned implant position.

An anatomic contour also need not be a single generic shape. Vág and colleagues (2022) modeled cervical tooth cross-sections to develop prefabricated, tooth-specific healing-abutment forms. Their geometric study supports attention to anatomy; it does not establish one universally optimal concavity or prove that a particular contour prevents recession.

Which clinical records guide the design?

Published approaches use different starting records and treatment stages. Keep those pathways distinct when deciding what the dentist must record and what the laboratory can design. A preoperative plan, a scan of an already placed implant and a conventional radiograph are not interchangeable descriptions of one procedure.

Record the surface and occlusal relationship

An intraoral scan provides a digital surface model. Where a digital bite record is used, its purpose is to relate the two arches. A scanner photograph or a physical bite registration illustrates a recording method; neither establishes the accuracy, comfort or speed of a particular digital healing-abutment protocol.

STL is commonly used for three-dimensional surface geometry. The file itself does not certify scan accuracy or identify an implant connection. In the reported Joda technique, the compatible scan body supplied implant-position information after placement; the subsequent design used that captured position.

Relate the design to the actual treatment stage

Ramadan’s report describes preoperative planning. By contrast, Abdel Raheem and colleagues (2022) describe a custom polymethyl methacrylate (PMMA) healing abutment for delayed-loaded implants, using measurements from a conventional dental radiograph and diagnostic casts. The latter is placed at the second surgical stage. It should not be relabeled as the same fully digital preoperative method.

Choose a contour with a stated anatomical basis

A patient-specific shape may be derived from an existing tooth, a contralateral tooth or another source-supported design approach. Vág’s tooth-geometry research and Joda’s mirrored-tooth technique answer different design questions. Neither establishes a universal numerical emergence angle or concavity for every implant site.

The design must also be distinguished from its clinical result. Joda and colleagues emphasize that soft-tissue quantity and quality, together with the implant’s three-dimensional position, influence the outcome. Copying a tooth contour is therefore a design strategy, not assurance that the tissue will reproduce that shape in all circumstances.

Keep the manufacturing material specific

The cited methods do not all use titanium or zirconia. Joda’s reported healing component was made from PMMA-based restorative material on a bonding base; Abdel Raheem’s method also used a PMMA blank. Their material descriptions should not be replaced by a generic metal-or-ceramic recipe, and neither report establishes error-free manufacture.

Campaner and colleagues (2020) studied provisional restorative materials in mouse gingival fibroblast cultures. Differences in cell viability and inflammatory response are laboratory findings. They do not establish universal clinical biocompatibility, a processing prescription or long-term implant success for every resin or CAD-CAM component.

Deliver at the stage supported by the chosen method

Immediate placement and second-stage delivery are different clinical sequences. Akin (2016) describes an anatomic harmony abutment for immediate molar implants, whereas Abdel Raheem’s technique concerns delayed-loaded implants. Do not transfer the timing or claimed benefits from one indication to the other.

Preserving the intended contour into the definitive restoration is a separate prosthetic task. Conejo and colleagues (2020) describe a technique for a misplaced implant using copy milling, soft-tissue modification, a modified stone die and correlation with an intraoral scan. That report illustrates contour transfer; it is not evidence that all custom healing abutments follow a model-free process or need no subsequent adjustment.

How should the clinical benefits be interpreted?

Three distinctions help turn an appealing digital design into a realistic discussion with patients and the laboratory:

• Customization is a design capability. El-Danasory and colleagues (2024) describe CAD-CAM construction intended to save chairside time and provide predictable results. A technique report supports that proposed approach; it does not quantify superiority over every conventional alternative.
• Tissue shaping does not stop biological change. In a prospective study of customized titanium healing abutments at immediate molar implants, Lertwongpaisan and colleagues (2023) observed changes in peri-implant tissue dimensions during six months of healing. Their observations should not be converted into a promise of unchanged tissue contour or generalized to every material and site.
• Reduced chairside work is not zero chairside work. The reported aim of preoperative fabrication is to move part of the design and manufacturing work before surgery. The main technique abstract does not provide a comparative time estimate or establish that all intraoperative and postoperative adjustments are eliminated.

These distinctions do not mean customized healing abutments have no benefit. They define the conclusions supported by each source: a proposed technique, an anatomical model, a laboratory response or an observed clinical outcome. Long-term esthetics, tissue stability, complications and patient satisfaction require their own clinical evidence.

Clinical recommendations

For the dentist and laboratory, the practical value is a clearer link between the intended emergence profile and the records used to create it. DDS presents these methods to help readers distinguish the design decision from the outcome claim, while preserving the indication and limits of each published approach.

• Name the clinical sequence. Specify whether the component is planned before placement or designed from a recorded implant position, and whether delivery is immediate or at reopening. Do not combine stages from different technique reports into an apparently validated single protocol.
• Name the material and supporting method. Read the relevant full technique and compatible component/material instructions before choosing fabrication, bonding or clinical processing details. A paper using PMMA is not permission to substitute an unspecified titanium, zirconia or printing-resin protocol.
• Describe the expected benefit conditionally. Explain the intended contour and potential reduction in chairside contouring without promising error-free fabrication, no adjustments or guaranteed healing. Keep observed tissue changes and the limits of follow-up separate from the appearance of a design or photograph.

References

About Dr. Haitham Sharshar

Perio-Implantologist

International Digital Dentistry Speaker

Digital Occlusion Consultant

Founder of DDS

Founder of Occlusa AI Platform

Dr. Haitham Sharshar is an international digital dentistry speaker, educator, and digital occlusion consultant based in Cairo, Egypt. His work focuses on functional digital dentistry, CAD/CAM, implantology, jaw-motion analysis, and the integration of digital diagnostics into clinical treatment planning.

As Founder and Scientific Coordinator of Digital Dentistry Schoology (DDS), he has trained more than 3,270 dentists and dental technicians through university programs, international conferences, and hands-on courses. His teaching connects patient-specific diagnostic records with digital design and clinical workflows, helping clinicians and technicians understand how function and occlusion inform restorative planning.

Dr. Sharshar is a certified trainer for zebris JMA-Optic+ jaw-motion analysis and MyoWise dental EMG. His educational and consulting work brings together patient diagnostics, jaw-motion records, muscle-activity data, digital occlusion, and AI-supported workflows.

He is Founder and Clinical Director of Occlusa, an AI-supported platform for organizing clinical information and supporting clinician-led review and treatment planning. He also owns HS Dental Clinic in Cairo, where his clinical focus includes full-mouth digital rehabilitation and smile design.

His speaking and training topics include functional digital dentistry, digital occlusion, jaw-motion analysis, CAD/CAM workflows, digital implantology, and the practical integration of AI-supported tools into dental education and clinical practice.

WHERE DIGITAL MEETS CLINICAL

Happy to collaborate on spreading digital dentistry.
h.sharshar@ddschoology.com