Prosthetic design considerations to optimize peri-implant tissue healing and health – a narrative review

The critical prosthetic considerations that influence biological and esthetic outcomes in implant dentistry are often suboptimally translated into clinical practice. Historically, implant placement protocols treated the surgical and restorative phases as independent processes, with implant placement determined largely by the availability of existing hard tissue. The prosthetic design at the transmucosal interface has been shown to play a biologically active role in peri-implant healing and long-term tissue stability, emerging as a major area of investigation in recent studies. The transmucosal abutment effects on crestal bone remodeling, inflammatory responses, connective tissue attachment, and mucosal margin stability are important variables to consider during implant placement.As the integration between prosthodontics and implant surgery continues to advance, a more comprehensive understanding of the pivotal role of prosthetic considerations during the surgical phase is essential. This narrative review synthesizes the current evidence on how transmucosal abutments influence peri-implant healing and long-term stability. Emergence profiles of concave or straight configuration, emergence angles ≤ 30°, and mucosal tunnels ≤ 3 mm are ideal for periimplant health. Abutment material selection should be site-specific for optimal mechanical performance while preserving biological and esthetic outcomes. Excessively rough surfaces at the transmucosal interface should be avoided during surgical and prosthetic phases. Immediate provisional restorations and custom healing abutments that incorporate these factors allow for the immediate establishment of idealized emergence profiles and emergence angles through guided tissue healing. These key benefits advocate for adopting a prosthetically integrated surgical approach in implant dentistry to enhance esthetic, biologic, and patient-specific outcomes.