Progressive Gingival Digital Workflow with Chairside Abutment Customization for Cement-Retained Implant Restorations: A Pilot Comparative Clinical Study of Two Treatment Concepts

Background: Digital workflows in implant prosthodontics continue to evolve, yet standardized protocols integrating clinician-driven abutment customization and peri-implant soft-tissue conditioning remain limited. This pilot study aimed to present and evaluate a progressive gingival digital workflow for cement-retained implant-supported restorations based on chairside adjustment of prefabricated abutments according to gingival maturation. Methods: A retrospective comparative study included 39 patients rehabilitated with 161 implants and followed for 24–48 months. The experimental group comprised 87 bone-level implants restored using a progressive digital workflow involving staged healing, chairside abutment customization, provisional tissue conditioning, and digital fabrication of definitive restorations. Outcomes were compared with 74 tissue-level implants restored using a conventional protocol with healing abutments and prefabricated prosthetic abutments. Clinical and radiographic outcomes included plaque index, bleeding on probing (BOP), peri-implant sulcus depth, marginal bone resorption, complications, and patient satisfaction. Results: Both groups demonstrated favorable clinical outcomes, with no significant differences in plaque index, gingival condition, BOP (28.74% vs. 21.62%), sulcus dimensions, or marginal bone resorption (11.49% vs. 12.16%) (p > 0.05). Logistic regression identified plaque accumulation, vestibular sulcus depth, and implant duration as predictors of BOP, whereas implant type was not associated with BOP or bone resorption. Patient satisfaction, assessed using a visual analog scale, was uniformly high. Most patients reported maximum scores across all domains, with only minor esthetic concerns reported by a few participants. No major prosthetic complications or screw loosening occurred during follow-up. Conclusions: The proposed workflow demonstrated favorable clinical performance and appears to be a feasible restorative approach. However, because implant design and restorative workflow differed simultaneously, findings should be interpreted cautiously. Larger prospective studies are needed to confirm these results.