Anodized Titanium Implant Abutments: Effects on Surface Properties, Peri-Implant Soft Tissue Esthetics, and Biological Outcomes—A Focused Narrative Review
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Study Screening and Selection
3.2. Data Extraction and Analysis
3.3. Physical Properties
3.3.1. Scanning Electron Microscopy (SEM) Imaging
3.3.2. X-Ray Diffractometry (XRD)
3.3.3. Chemical Elemental Analysis
3.3.4. Surface Characteristics
3.3.5. Water Contact Angle (WCA)
3.4. Esthetic Outcomes
3.5. Biological Properties
3.5.1. Soft Tissue Outcomes
3.5.2. Radiographic Analysis
3.5.3. Biocompatibility
3.5.4. Histometric Analysis
4. Discussion
4.1. Physical Properties
4.2. Esthetic Outcomes
4.3. Biological Outcomes
4.4. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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| Focused Question | For patients with dental implants, what are the effects of anodized titanium abutments compared with other abutment materials on the physical properties of the abutments, peri-implant soft tissue esthetics, and biological properties? |
| Population | Dental implants [MeSH] OR oral implant OR Dental Implantation, Endosseous [MeSH] |
| Implant restoration OR implant supported prosthesis OR implant supported fixed dental prosthesis OR implant supported FDP OR implant supported FPD | |
| Intervention or Exposure | Dental Implant-Abutment Design [MeSH] OR Dental Abutments [MeSH] OR titanium abutment OR implant abutment OR anodized titanium OR anodized titanium abutment OR titanium implant abutment OR titanium alloy abutment OR titanium oxide abutment OR anodized abutment OR anodized pink colored implant |
| Comparison | (Zirconium Oxide [Supplementary Concept] OR Dental Porcelain [MeSH] OR gold OR Lithia Disilicate [Supplementary Concept] OR Lithium Disilicate) Dental Implant-Abutment Design [MeSH] OR zirconium dioxide abutment OR untreated titanium alloy OR machined titanium abutments |
| Outcome | Esthetics [MeSH] OR biocompatibility OR Histometric OR Radiographic OR Physical properties |
| Search combination | (Population terms) AND (abutment and anodization terms) AND (comparison terms) AND (outcome terms) |
| Language | English |
| Electronic database | PubMed (MEDLINE) |
| Cochrane Central Register of Controlled Trials (CENTRAL) | |
| EMBASE | |
| Google Scholar | |
| greylit.org | |
| Manual journal search | Clinical Oral Implants Research |
| International Journal of Oral Maxillofacial Implants | |
| Clinical Implant Dentistry and Related Research | |
| Journal of Oral Implantology | |
| Implant Dentistry | |
| Journal of Prosthetic Dentistry | |
| Journal of Prosthodontics | |
| International Journal of Prosthodontics | |
| Personal communications on Grey Literature | |
| Dental material journals | |
| Inclusion criteria | In vitro and in vivo studies |
| Published between 2002 and 2025 | |
| Exclusion criteria | Methodology or technique papers and review articles Multiple publications on the same dataset Studies without identifiable abutment or transmucosal component information Studies not reporting extractable outcomes aligned with at least one prespecified domain Non-English language publications |
| Study (Author, Year) | Study Type | Sample Size | Materials/Groups Compared | Surface Characterization Methods | Key Material Findings |
|---|---|---|---|---|---|
| Genova et al., 2022 [21] | In vitro study | 4 Surfaces (MAC, Y-SL, Y-DM, Y-MAC) | Machined Ti (MAC), Anodized machined (Y-MAC), Anodized sandblasted/acid-etched (Y-SL), Anodized double etched (Y-DM) | SEM, EDX, Contact angle, surface free energy | EDX analysis was interpreted as showing a higher oxide-related oxygen signal after anodization; anodization also reduced apparent hydrophilicity and mostly eliminated the polar SFE component; roughened anodized surfaces (Y-SL, Y-DM) showed greater hydrophobicity compared with MAC. |
| Golalipour et al., 2025 [22] | In vitro materials study | 16 Ti abutments | Anodized Ti Abutments (63 V) vs. Unanodized Abutments | Profilometer (Ra); FE-SEM | Anodization did not significantly change surface roughness, FE-SEM displayed altered pore morphology with smaller pore diameter. |
| Gulati et al., 2020 [23] | In vitro materials study | TI Foil Substrates and abutments, multiple per group | Rough-Ti, Micro-Ti, TNP-40, TNP-60, TNP-80 | FE-SEM, AFM, XPS/chemistry, WCA | Anodization produced aligned titania nanopores with increased roughness, altered chemistry (TiO2 + F), higher hydrophilicity, and mechanically robust nanoporous layer (higher modulus/hardness vs. conventional nanotubes). |
| Hulka et al., 2022 [24] | In vitro materials study | Ti-Ta alloy specimens (Ti5Ta, Ti15Ta, Ti25Ta, Ti30Ta), multiple per group | Ti–Ta alloys: 5%, 15%, 25%, 30% Ta | Color mapping, microscopy, XRD, oxide mass via Faraday’s Law, current density | Higher voltages produced thicker oxide layers and distinct color changes. Ti-25Ta showed highest hardness and most compact oxide layer; 70 V produced a reddish color with potential esthetic application |
| Kim et al., 2014 [25] | In vitro laboratory study | 240 disks | SM Ti, Co-Cr-Mo, TiN coating, Anodized Ti (AO), Resin-coated Ti, Zirconia | Sa, Sdr (3D optical profilometer), WCA | All surfaces had Sa < 0.5 µm; Zirconia had extremely low roughness (Sa = 0.019 µm) and lowest Sdr; Ti-N, AO, and Zr showed lower contact angles |
| Kim et al., 2014 [26] | In vitro | 60 specimens | SM Ti, Co-Cr-Mo, TiN, Anodized Ti, Resin-coated Ti, Zirconia | Sa, Sq, Sz, Sdr, Sdq, Sal, Str), WCA | Zr showed lowest roughness and WCA, resin had highest roughness and WCA, WCA, Sdr, and Sdq were significantly correlated with fibroblast attachment |
| De Lima et al., 2024 [27] | In vitro | 99 Ti disks | Machined Ti (MACH), Acid-etched Ti (AA), Anodized Ti (AN) | SEM, EDS, Ra, Rq, wettability, water droplet base width | AA had the highest roughness, anodized surfaces were smoother and more hydrophilic, MACH surfaces were the smoothest and least wettable |
| Liu et al., 2025 [28] | In vitro | 117 Ti disks | Unanodized Ti-6Al-7Nb, Gold-anodized, Pink-anodized, each with 3 instrumentation protocols (none, air-polishing, titanium scaling) | Ra, WCA, SEM (surface morphology pre/post instrumentation) | Gold and pink anodization decreased roughness and increased hydrophilicity compared with un-anodized Ti, titanium scaling produced the greatest surface roughness in all groups |
| Mühl et al., 2022 [29] | In vitro | 8 Ti6Al4V disks (4 Anodized, 4 Turned) | Turned Ti6Al4V vs. Yellow-anodized Ti6Al4V | SEM, AFM (Ra), XPS (elemental chemistry + Ti oxidation states), EDS (chemical depth profiles), Dynamic contact angle | Anodization increased TiO2 thickness, created a more homogeneous nanostructured surface, raised hydrophilicity, and produced higher Ti4+ surface states compared to turned Ti |
| Mussano et al., 2018 [30] | In vitro | 8 Ti-Al-V Cylinders | Machined Ti vs. Pink-anodized Ti (Ti-Al-V alloy cylinders) | SEM, XPS, Contact angle (water and diiodomethane), Surface free energy (Owens–Wendt) | Anodization increased TiO2 surface oxide, shifted oxidation state distribution, lowered contact angle, and increased surface free energy compared to machined Ti |
| Pan et al., 2024 [31] | In vitro | 36 specimens | Turned, SB, DAE, SLA, TiN, Anodized | Sa, Sq, Ssk, Sku, Sdr | SLA and DAE showed the highest roughness, turned and TiN surfaces were the smoothest, anodized surfaces displayed intermediate roughness values |
| Pour et al., 2023 [32] | In vitro | 26 abutments | Anodized Ti abutments vs. Non-anodized Ti abutments | SEM, Ra | Anodized abutments showed significantly rougher surfaces and significantly higher tensile bond strength between crown and abutment after thermocycling |
| Selamet et al., 2025 [33] | In vitro | 49 disks (7 per group) | Cast Cr–Co, Laser-sintered Cr–Co, Milled Cr–Co, Milled Ti, Anodized Ti, Stock Ti abutments (control), Milled Zirconia | Ra, Rq, Rmax, SEM (1000× morphology) | Laser-sintered Cr–Co displayed lowest roughness values, milled zirconia had the highest, anodized and stock Ti displayed intermediate roughness. Surface roughness differences significantly influenced microbial retention patterns |
| Sirawuttipong et al., 2024 [34] | In vitro | 48 Ti disks and 28 Zr disks | UT (untreated), AN (anodized), SBAN (sandblasted + anodized), ANSB (anodized + sandblasted), HFAN (HF-etched + anodized), ANHF (anodized + HF-etched) | SEM at ×500 magnification (qualitative surface morphology) | Surface morphology differed visibly among groups- SBAN and ANSB showed rougher, irregular topography, AN produced a smoother, uniform oxide morphology, HF-involved groups showed micro-etching patterns |
| Squier et al., 2002 [35] | In vitro | 80 implants paired with abutments in 4 groups of 20 | Standard implant and non-anodized abutment, Standard implant and anodized abutment, synOcta implant and non-anodized abutment, synOcta implant and anodized abutment | Not reported | synOcta and non-anodized abutment had the highest removal torque (37.16 Ncm). Anodization reduced removal torque by ~20%, suggesting a lubricating effect |
| Traver-Mendez et al., 2023 [36] | In vitro | 42 Ti disks | Titanium disks: MAC, AA, AC; Implants: machined vs. anodized body/collar/abutment | SEM, Confocal 3D optical profilometry (Sa, Sz, Ssk, Sdr), EDS | Anodized surfaces showed increased O, Ca, P, Na and altered roughness across implant regions; abutment/collar surfaces smoother (Sa 0.11–0.25 μm) than body regions (Sa 0.95–1.68 μm) |
| Wang et al., 2023 [37] | In vivo animal | 6 beagle dogs, 36 implants | TC4-M (machined Ti-6Al-4V), TC4-Nano (anodized nanotubes), TC4-H/Nano (hydrogenated nanotubes; superhydrophilic) | SEM, AFM (Ra), XPS, EDS, WCA | Nanotube layers formed on TC4-Nano and TC4-H/Nano, hydrogenation increased Ti-OH content; roughness higher for nanotube surfaces; hydrophilicity improved (contact angle ↓ from ~94° → ~38° → ~3.8°). |
| Wang et al., 2019 [7] | In vitro | 153 Ti6Al4V disks and 33 Zr disks | Untreated Ti6Al4V vs. Anodized Ti at 60 V (yellow) vs. 65 V (pink) vs. Zirconia | SEM (grain formation, cracks), AFM (Ra), EDS, WCA | Anodization produced yellow and pink colors, increased grain formation, higher surface roughness, and greater hydrophilicity, anodized Ti altered O/P content, zirconia showed lowest ΔE under gingiva |
| Study (Author/Year) | Study Type | Sample Size | Abutment/Materials Compared | Esthetic Outcomes Evaluated | Biological Outcomes Evaluated | Key Esthetic/Biological Findings |
|---|---|---|---|---|---|---|
| Bas et al., 2022 [38] | In vitro study | 30 zirconia disks, 3 Ti abutment backgrounds (yellow-anodized, gray, pink anodized) | Yellow anodized Ti vs. Gray Ti vs. Pink anodized Ti | Spectrophotometric measurements (CIELab), color measured through Zr substructures of different thickness (0.7, 0.9, 1.1 mm) with pink Ti, gray Ti, yellow Ti, and Zr backgrounds | Not Reported (N/R) | Thickness of Zr significantly affected ΔE (p < 0.001), thicker Zr showed lowest ΔE. Abutment color did not affect ΔE |
| Dib-Zaitum et al., 2022 [39] | In vivo study | 10 patients/40 abutments | Slim Anodized (SA) vs. Slim Machined (SM) vs. Regular Machined (RM) vs. Regular Anodized (RA) abutments | N/R | Biological width, epithelial sulcus depth, epithelium height, connective tissue thickness, collagen fiber density, presence of inflammatory cells, vascularization, attached gingiva, ISQ, bone level changes | Slim abutments had better soft tissue response including most epithelial and connective tissue attachment, lower inflammation, and highest collagen. Morphology had greater effect than surface tx while ISQ values and bones levels were similar across all groups. |
| Farrag et al., 2023 [40] | Prospective in vivo, split-mouth study | 28 patients/60 Implants | Unanodized Ti Abutments vs. Pink anodized Ti Abutments | Modified Pink Esthetic Score (mPES) at 1, 12, and 18 month | Recession, probing depth, modified sulcus bleeding index, modified plaque index, modified gingival index | No significant differences or improvement between all groups |
| Farrag et al., 2022 [41] | In vitro study | 40 Ti backgrounds and 20 LD ceramic disks | Un-Anodized Ti under lithium disilicate vs. Yellow anodized Ti | CIE Lab* coordinates, ΔE color difference, evaluation at 1 mm and 2 mm LDS thickness, comparison to control (4 mm LDS) | N/R | Yellow anodized Ti had lower ΔE than unanodized Ti at both thicknesses. |
| Genova et al., 2022 [21] | In vitro study | 4 Surfaces (MAC, Y-SL, Y-DM, Y-MAC) | Machined (MAC), Yellow Anodized Machined (Y-MAC), Anodized Sandblasted/Acid Etched (Y-SL), Anodized Double Etched (Y-DM) | N/R | Bacterial adhesion (S. sanguinis, E. faecalis), protein adsorption, fibroblast adhesion, fibroblast proliferation | All anodized surfaces displayed significant reduction in bacterial adhesion compared to unanodized Ti. Roughened anodized surfaces (Y-SL and Y-DM) had the highest protein adsorption, greater fibroblast adhesion, and increased proliferation. Anodization alone did not enhance fibroblast response (MAC ≈ Y-MAC), but roughness and anodization improved biological performance |
| Gil et al., 2017 [14] | Prospective RCT | 40 Patients | Pink Neck implants/pink anodized Ti abutment vs. Gray implant/gray abutment | CIELAB L*, a*, b* values; ΔE for gray → pink abutment; cervical/middle/incisal measurements | N/R | Pink abutments increased a* (redness) significantly (p = 0.01) and produced ΔE ≈ 4.22, above perceptibility threshold, improved soft tissue color regardless of implant neck color |
| Golalipour et al., 2025 [22] | In vitro study | 16 Ti abutments | Anodized vs. Non anodized Ti | N/R | Ra, bacterial adhesion (S. aureus CFU log counts) | Anodization significantly reduced bacterial adhesion (mean log CFU 10.59 vs. 12.90; p < 0.001) with no significant change in Ra |
| Gulati et al., 2020 [23] | In vitro study | TI Foil Substrates and abutments, multiple per group | Micro Ti, Rough Ti, anodized nanoporous Ti (40 V/60 V/80 V) | N/R | Fibroblast proliferation; adhesion and filopodia formation, cell morphology, alignment to nanopores; gene expression (COL-1, COL-3, FN, integrin β1, VEGF, ICAM-1) | Nanoporous surfaces significantly enhanced GF adhesion, proliferation, alignment, and wound-healing gene expression, indicating improved soft tissue integration potential |
| Hall et al., 2019 [16] | RCT | 35 patients | Nanostructured anodized Ti vs. machined Ti Abutments | N/R | Biofilm CFU, proteolytic activity; bleeding index, keratinized mucosa height, plaque index, inflammation index, suppuration, peri-implant probing depth, marginal bone levels, PICF gene expression | No significant differences in biofilm load. Test abutments showed significantly lower bleeding on removal at 6 weeks (p = 0.006) and consistently greater keratinized mucosa height at all follow-ups (6 weeks, 6 months, 2 years). No differences in plaque, inflammation, probing depth, or bone levels. Gene expression markers (tPA ↑, Collagen IV ↑ at test sites) suggested improved soft tissue healing |
| Khorshidi et al., 2024 [42] | In vitro study | 19 abutments | Non-Anodized Ti vs. Anodized under 2mm LDS crown | L*, a*, b*, C*, h*, ΔE00 between crown over anodized vs. non-anodized Ti | N/R | Anodized abutments displayed significantly lower ΔE00 (2.26 vs. 2.98) compared to non-anodized Ti with improved color masking and more favorable crown esthetics |
| Kilinc et al., 2024 [43] | In vitro study | 60 abutments (240 total crown/abutment units) | Gold-anodized Ti, Pink-Anodized Ti, Non Anodized Ti, hybrid Ti-Zirconia, PEEK Ti, Composite | L*, a*, b*, C*, h* and ΔE00 measurements of final crown color over each abutment type | N/R | Abutment material significantly affected ΔE00 (p < 0.001). Pink-anodized Ti and hybrid abutments produced the lowest color change (ΔE00 ~0.98–1.31), while non-anodized Ti produced the highest (ΔE00 ~2.77). Cement thickness had minimal effect except for VE (0.1 mm caused higher ΔE00). VS masked underlying abutments better than VE |
| Kim et al., 2014 [25] | In vitro study | 240 disks | Co-Cr-Mo, Machined Ti, TiN, Anodized Ti, Resin-coated Ti, Zirconia | N/R | HGF-1 attachment at 1 h; proliferation at days 3 and 7, OD measurements, correlation with surface roughness (Sa), Sdr, and WCA | AO, TiN, and Zr showed the highest fibroblast proliferation at day 7 (≈2× vs. other materials). CCM had the lowest attachment. Surfaces with lower WCA generally supported higher fibroblast response |
| Kim et al., 2014 [26] | In vitro study | 60 specimens | Co-Cr-Mo, TiN, resin coated Ti, Zirconia, SM Ti | N/R | HGF-1 attachment via OD at 590 nm; correlation with Sa, Sq, Sz, Sdr, Sdq, Sal, Str, WCA | Fibroblast attachment highest on SM, TiN, and Zr; lowest on CCM. WCA was the strongest predictor—lower WCA → higher cell attachment. Surfaces with Sa ≤ 0.2 µm showed fibroblast attachment driven primarily by WCA. Developed area ratio (Sdr) and RMS slope (Sdq) also showed secondary correlations |
| Liu et al., 2025 [28] | In vitro study | 117 Ti disks | Gold-Anodized vs. Un- Anodized vs. Pink Anodized Ti and Instrumentation (Ti scaling vs. air polishing) | N/R | Biofilm viability (CFU/mL), biofilm mass (crystal violet absorbance), wettability (hydrophilicity), SEM visualization of biofilm morphology | Gold- and pink-anodized surfaces showed reduced biofilm viability compared with un-anodized Ti, air-polishing significantly decreased biofilm viability and mass for all groups, titanium scaling increased roughness and biofilm formation, hydrophilicity moderately correlated with reduced CFU |
| Martinez-Rus et al., 2017 [8] | Prospective RCT | 20 Patients | Ti, Gold -Anodized Ti, Pink Anodized Ti, Zirconia Abutments | CIELAB L*, a*, b*, ΔE of peri-implant soft tissue and coronal crown, effect of soft tissue thickness on ΔE | N/R | Zr and gold-anodized Ti displayed the lowest soft tissue ΔE, titanium and pink-anodized Ti displayed highest ΔE, soft tissue thickness negatively correlated with ΔE for Ti and pink-anodized abutments |
| Mussano et al., 2018 [30] | In vitro study | 8 Ti-Al-V CYLINDERS | Machined Ti vs. Anodized Ti | N/R | Fibroblast and epithelial cell adhesion, cell viability at 24–72 h, focal adhesion density, cell morphology, cytoskeletal organization, wettability | Anodized Ti showed significantly increased fibroblast and epithelial adhesion and viability vs. machined Ti, higher focal adhesion density and more favorable early soft tissue cell response |
| Pan et al., 2024 [31] | In vitro study | 36 specimens | Ti, Ti ALD, Ti AO, ZrO2 | N/R | Single-species and mixed-species bacterial adhesion assays (S. mutans, S. aureus, P. gingivalis); CFU counts; MTT metabolic activity; SEM biofilm morphology | ALD-TiO2 reduced bacterial adhesion by ≥50% vs. uncoated Ti and performed similarly to ZrO2, AO-TiO2 showed no antibacterial advantage, ALD maintained smooth anatase-phase coating and demonstrated the lowest biofilm activity across assays |
| Selamet et al., 2025 [33] | In vitro study | 49 disks (7 per group) | Milled Cr-Co, Cast Cr-Co, Laser Sintered Cr-Co, Milled Ti, Stock Ti, Milled Zirconia, Anodized Milled Ti | N/R | Biofilm formation by Streptococcus mutans and Candida albicans at 8 h and 24 h, CFU (log10) counts | Milled zirconia showed the highest S. mutans colonization (log10 ≈ 5.87 at 24 h); cast and milled Cr–Co showed the lowest bacterial counts, C. albicans colonization was highest on stock Ti and lowest on anodized milled Ti. Roughness did not fully predict biofilm formation, indicating material composition also influences microbial adhesion |
| Sen et al., 2025 [44] | In vitro study | 50 simulated gingival specimens | Zirconia Abutments under 5 gingival colors (1.0 mm and 2.0 mm thickness vs. Ti | CIELAB L*, a*, b*; ΔE*ab and ΔE00 color differences, comparison with perceptibility and acceptability thresholds | N/R | Titanium abutments with lighter gingival colors (light pink, orange) at 1.0 mm showed moderately unacceptable ΔE (above AT). Zirconia abutments yielded ΔE below AT for all gingival colors and both thicknesses. Increasing gingival thickness (2.0 mm) significantly reduced ΔE in LP, DP, and Or groups with Ti abutments. Abutment material significantly affected ΔE00 at 1.0 mm but not at 2.0 mm. |
| Senkiw et al., 2024 [45] | In vitro study | 60 Zr crowns and 6 Ti Abutments | 3Y vs. 4Y vs. 5Y Zr over Ti anodized at 0 V, 11 V, 31 V, 54 V, 64 V, 76 V | Spectrophotometric L*, a*, b* values and ΔE00 for each zirconia material over each anodization color | N/R | Significant differences in ΔE00 across anodization voltages (p < 0.0001). Blue (31 V) had the highest ΔE00 for all zirconia types. Lowest ΔE00 was unanodized Ti for 3Y and yellow (64 V) for 4Y and 5Y. Yttria content (3Y vs. 4Y vs. 5Y) showed no significant effect on ΔE00. Anodization voltage was the dominant factor influencing final crown shade |
| Seyidaliyeva et al., 2022 [46] | In vitro study | 192 TI alloy specimens | Polished and Anodized (PA) vs. Sandblasted (S) vs. Sandblasted and Anodized (SA) vs. Polished Etched Anodized (PEA) | CIELAB L*, a*, b* values; ΔE00 between surface treatment groups (optical color of titanium only, not soft tissue or crown color) | N/R | Anodizing produced the brightest and most chromatic colors (highest L*, a*, b*). Sandblasting produced the darkest, grayest, and most predictable color with the least variability. All groups showed large ΔE00 differences (>16), indicating strong optical changes from surface treatment alone. |
| Seyidaliyeva et al., 2024 [47] | In vitro study | 192 Ti Substrates and 192 Zr disks | Titanium (Polished, Etched, Anodized, Sandblasted) and Zr Thickness (0.7/1.0 mm) cement type (translucent vs. opaque) | CIELAB L*, a*, b* values of zirconia and titanium, ΔE00 (zirconia vs. total assembly), effect of substrate, zirconia thickness, and cement opacity on final zirconia color | N/R | Opaque cement masked the titanium substrate (ΔE00 ≈ 5.5–6.2) with minimal color shifts. Translucent cement caused large color changes (ΔE00 up to 11.7), making zirconia darker, more reddish, and more yellowish; zirconia thickness had only a minor effect. Substrate color strongly affected outcomes only with translucent cement |
| Sirawuttipong et al., 2024 [34] | In vitro study | 48 Ti disks and 28 Zr disks | Untreated Ti vs. Anodized Ti vs. ANSB vs. SBAN vs. ANHF vs. HFAN | CIELAB L*, a*, b*; ΔE* relative to perceptibility/acceptability thresholds for each zirconia thickness–cement–titanium surface combination | N/R | Zirconia thickness, cement shade, and Ti surface treatment significantly affected ΔE*. Only 2.5 mm HT zirconia + clear cement produced ΔE* < 2.7 (clinically acceptable) over AN, UT, or SBAN surfaces. Thinner zirconia and opaque cement resulted in unacceptable color differences, regardless of surface treatment. |
| Susin et al., 2019 [17] | In vivo animal study | 12 mini-pigs, 72 Implants | Machined Ti Abutments vs. Anodized Abutments | N/R | Histologic soft tissue healing (inflammation scores, epithelium length, mucosal height, junctional epithelium position), peri-implant bone parameters (crestal bone level, first BIC, %BIC; bone density) | No significant differences between anodized and machined abutments for inflammation, epithelial length, mucosal height, BIC, or bone density. Radiographically, 6-week crestal bone loss was lower for anodized abutments (0.8 mm vs. 2.1 mm; p = 0.046), but no differences at 13 weeks |
| Susin et al., 2019 [48] | In vivo animal study | 24 Yucatan Mini-Pigs, 96 implants | Commercially available anodized implant/machined abutment vs. gradually anodized implant/anodized abutment with a protective layer | N/R | MicroCT and histology, inflammation scores; mucosal height; epithelium length; epithelium–platform distance, buccal/lingual crestal bone levels, BIC, trabecular thickness/spacing, BDWT/BDOT | No significant differences in soft tissue inflammation, epithelial length, BIC, bone density, or crestal bone levels at any timepoint. A small early mucosal-height difference at 3 weeks was transient. Trabecular spacing was borderline better in the test group at 3 weeks. The gradually anodized system showed equivalent biological performance to the predicate anodized implant/machined abutment |
| Traver-Mendez et al., 2023 [36] | In vitro study | 42 Ti disks, | Anodized abutment-type Ti vs. Anodized collar type Ti vs. Machined Ti | N/R | HaCat + BM-MSC adhesion (SEM), proliferation at days 1, 3, 7 (resazurin assay), qualitative cell morphology and spreading | Both cell types showed significant proliferation over time, with no statistical differences among machined vs. anodized surfaces. SEM showed good adhesion on all surfaces, with enhanced HaCat attachment on anodized collars and BM-MSC adhesion on both anodized and machined abutments. Anodization introduced Ca, P, Na, and increased surface complexity. Overall, positive biocompatibility but no superiority vs. machined. |
| Vazouras et al., 2022 [49] | Prospective RCT | 25 Patients | Pink- Anodized Ti vs. Gray Anodized Ti vs. Hybrid Zr Abutments | Peri-implant mucosal ΔE (CIELAB) vs. contralateral tooth, Pink Esthetic Score (PES), Patient satisfaction (VAS) | N/R | Zirconia showed lowest ΔE, followed by pink anodized, then gray Ti. PES was significantly higher for zirconia and pink anodized only in thin biotype. At 1 year, no difference in patient satisfaction between Zr and pink anodized |
| Wang et al., 2023 [37] | In vivo | 6 beagle dogs, 36 implants | Machined Ti-6Al-4V vs. Anodized nanotubes vs. super-hydrophilic nanotubes | N/R | Histology and histometry of sulcular epithelium length (SE), junctional epithelium (JE), connective tissue (CT) length, biological width (BW), collagen fiber orientation (SHG microscopy), inflammatory cell levels | All abutments showed similar soft tissue dimensions at both timepoints. SHG imaging showed partially perpendicular collagen fibers adjacent to the TC4-H/Nano surface vs. parallel in TC4-M and TC4-Nano. Overall, nanotubular/superhydrophilic surfaces demonstrated comparable soft tissue healing with potential improvement in CT functional attachment. |
| Wang et al., 2019 [7] | In vitro study | 153 Ti6Al4V disks and 33 Zr disks | Anodized Ti (65 V Pink and 60 V Yellow) vs. untreated Ti vs. Zr Disks | Gingival color change (ΔE) under 1 mm pig gingiva for pink and yellow anodized Ti6Al4V vs. untreated Ti and zirconia | HGF morphology (SEM), proliferation (CCK-8), viability (live/dead stain), contact angle and surface roughness effects on fibroblast behavior | Pink and yellow anodized Ti showed significantly lower ΔE than untreated Ti but higher than zirconia, anodization increased roughness and hydrophilicity, HGFs showed normal morphology, adhesion, and viability similar to untreated Ti, zirconia had highest proliferation and lowest cell death |
| Wang et al., 2021 [50] | Clinical study | 11 participants | Gold-Anodized Ti vs. Un-Anodized Ti vs. Pink-Anodized Ti vs. Zr | Peri-implant mucosal ΔE (CIE Lab)* vs. contralateral natural gingiva; evaluation of L*, a*, b* values, assessment of soft tissue thickness | Gingival thickness (transgingival probing with endodontic file) | All abutments produced ΔE > 3.7 (visible discoloration). ΔE ranking (best → worst): zirconia (6.81), pink Ti (7.63), gold Ti (7.90), unanodized Ti (8.74). Pink and gold anodized Ti improved esthetics vs. uncolored Ti, but zirconia had the best overall match. Mean gingival thickness was 2.41 ± 0.52 mm. |
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Laks, E.Y.; Al-Faraj, A.; Yang, C.-C.; Kirkup, M.L.; Levon, J.A.; Lin, W.-S. Anodized Titanium Implant Abutments: Effects on Surface Properties, Peri-Implant Soft Tissue Esthetics, and Biological Outcomes—A Focused Narrative Review. Dent. J. 2026, 14, 403. https://doi.org/10.3390/dj14070403
Laks EY, Al-Faraj A, Yang C-C, Kirkup ML, Levon JA, Lin W-S. Anodized Titanium Implant Abutments: Effects on Surface Properties, Peri-Implant Soft Tissue Esthetics, and Biological Outcomes—A Focused Narrative Review. Dentistry Journal. 2026; 14(7):403. https://doi.org/10.3390/dj14070403
Chicago/Turabian StyleLaks, Elana Y., Amal Al-Faraj, Chao-Chieh Yang, Michele L. Kirkup, John A. Levon, and Wei-Shao Lin. 2026. "Anodized Titanium Implant Abutments: Effects on Surface Properties, Peri-Implant Soft Tissue Esthetics, and Biological Outcomes—A Focused Narrative Review" Dentistry Journal 14, no. 7: 403. https://doi.org/10.3390/dj14070403
APA StyleLaks, E. Y., Al-Faraj, A., Yang, C.-C., Kirkup, M. L., Levon, J. A., & Lin, W.-S. (2026). Anodized Titanium Implant Abutments: Effects on Surface Properties, Peri-Implant Soft Tissue Esthetics, and Biological Outcomes—A Focused Narrative Review. Dentistry Journal, 14(7), 403. https://doi.org/10.3390/dj14070403

