The aim of this study was to compare customized zirconia and titanium abutments with respect to survival rates and technical, biologic, and esthetic outcomes. A total of 28 patients with single implants were randomly assigned to 12 customized zirconia (test, AC) and 16 customized titanium (control, MC) abutments. Technical, biologic, and esthetic outcomes were assessed after a mean follow-up time of 18 months. No biologic complications were observed, and no statistical difference for the bone-to-implant distance was found at 18 months (AC −0.05 ± 0.51 mm vs MC −0.28 ± 0.77 mm; P = .40). A similar discoloration of the peri-implant mucosa was observed (ΔEAC 9.6 ± 5.4, ΔEMC 7.6 ± 5.3; P = .46). The mean papilla score values evaluation presented no statistically significant differences between the test and control groups (AC 2.07 ± 0.94, MC 1.96 ± 0.84). At 18 months, reconstructions based on zirconia and titanium abutments exhibited similar survival rates and similar clinical outcomes.