Current use of zirconium oxide (ZrO(2))-based screw-retained restorations does not guarantee maximum contact of soft peri-implant tissues with ZrO(2), because veneering porcelain usually covers the major subgingival part of the restoration. Ceramics preclude direct interaction between zirconia and soft tissue cells, thus reducing biocompatibility and benefit to the patient. The four case reports discussed in this article describe the new design modality of the ZrO(2) screw-retained restorations, in which zirconia is exposed to the tissues and no veneering porcelain is located below the gingival margin. The article also shows the impact of this treatment on soft peri-implant tissues after 3 years of follow-up. Soft tissue recession, vestibular contour, bleeding on probing, and probing depth were evaluated.
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