Fixed restorations for patients with implant-supported abutments frequently produce an unsatisfactory mechanical, biologic, or esthetic compromise. Pure titanium transmucosal abutments have biologic advantages, and factory-milled abutments for the comparable implant interface have mechanical advantages. The ultimate restorative objective is to satisfy the patient's desire for an esthetic restoration. This can generally be accomplished with precisely positioned implants; however, compromised locations need to be corrected with modified abutments. The use of customized copings fabricated by casting to pure titanium abutments can satisfy all three criteria, and may in some situations be the restorative procedure of choice. The clinical and laboratory procedures involved in achieving these criteria are described in detail.