Purpose: This study evaluated the clinical performance of cemented customized zirconia abutments. Additionally, the marginal fit between the selected implant components was measured and the clinical gingival response was monitored. Materials and Methods: Twenty-five patients were consecutively selected for a prospective study of 30 implant-supported single-tooth restorations. Customized titanium post and zirconia abutment complexes were prepared, and scanning electron microscopy (SEM) analysis was used to study bicomponent marginal gaps. The abutments were screwed onto the implants and restored with all-ceramic crowns. Plaque and gingival indices were recorded at 6 monthly intervals over a 36- to 44-month period. Results: SEM analysis showed mean marginal gaps of 10.161 µm (SD: 0.7) horizontally and 4.783 µm (SD: 0.67) vertically. Abutment fractures and screw loosening were neither reported nor observed throughout the clinical observation period. Mean Plaque Index scores were 0.57 (SD: 0.32) on abutments and 0.74 (SD: 0.34) on teeth, while mean Gingival Index scores were 0.54 (SD: 0.2) on abutments and 0.72 (SD: 0.3) on teeth. Conclusions: These preliminary results suggest that metallic-zirconia abutments may be comparable to currently available esthetic implant abutments.