Anodized Titanium Implant Abutments: Effects on Surface Properties, Peri-Implant Soft Tissue Esthetics, and Biological Outcomes—A Focused Narrative Review

Background/Objectives: To summarize evidence on whether anodization of titanium implant abutments modifies abutment surface/physical properties, peri-implant soft tissue esthetics, and biological outcomes compared with machined titanium and alternative abutment materials. Methods: This focused narrative review used a structured, reproducible literature search with dual-reviewer screening and data extraction. The study selection pathway was summarized using a PRISMA-style flow diagram for transparency. Searches of PubMed/MEDLINE, EMBASE, CENTRAL, and Google Scholar were performed, supplemented by gray literature screening and manual searching. Laboratory, animal, and human clinical studies evaluating anodized titanium abutments were eligible. Data were synthesized qualitatively across prespecified domains (surface or physical properties, esthetic outcomes, and biological outcomes). Because the work was designed as a narrative review, protocol registration and formal risk of bias appraisal were not undertaken. Results: Thirty-five studies were included (twenty-five in vitro, three animal, and seven human clinical). Anodization modified oxide layer characteristics and surface chemistry, and was commonly associated with increased hydrophilicity. Esthetically, pink or yellow anodized titanium generally reduced discoloration compared with uncolored titanium, particularly when soft tissue and restorative material thickness were sufficient, whereas zirconia most consistently produced the most favorable color outcomes. In vitro studies frequently reported improved early soft tissue cell responses and, in selected protocols, reduced bacterial adhesion. Reported clinical differences in inflammation indices and peri-implant marginal bone changes were small or inconsistent. Conclusions: Anodization can improve the optical masking of titanium and alter surface wettability and chemistry, but evidence for sustained clinical biological benefit remains limited. Current evidence supports anodization primarily as an esthetic adjunct, while long-term peri-implant biological outcomes appear to be driven by multiple clinical factors beyond surface modification.