Aims: To evaluate the effect of implant abutment materials (zirconia and titanium) on peri-implant soft and hard tissues changing level after superstructures were placed. Materials and methods: The patient a healthy, 27 year old female, had four congenital missing teeth of 13, 23, 35 and 45. Besides both mandibular second primary molars were prolonged retention. Four camlog K-Series SCREW-LINE Promote plus implants (13, 23: ∅3.8mm, length 11mm, 35, 45: ∅4.3mm, length 11mm) have been placed. After uneventful healing, impressions were taken to fabricate the screw-retained provisional crowns. After three months, final impression was taken using custom impression post with the emergence profile of the temporary crown. Zirconia (23, 35) and titanium abutments (13, 45) with but joint were placed. All ceramic crowns were cemented adhesively on each abutment. Digital standardized peri-apical radiographs using customized film holders were taken at the placement of all ceramic crowns, and at 1, 2 and 3 years after. At once, an impression was taken for making diagnostic model of evaluating soft tissue. Marginal peri-implant bone levels were measured at the mesial and distal surfaces of each implant using digital image software. Also soft tissue levels were measured midbuccal line of the prosthetic by using diagnostic models with silicon keys. Results: There was no difference between zirconia and titanium abutments regarding bone level around implant after 3 years (zirconia abutment 0.12 ± 0.23 mm, titanium abutment − 0.03 ± 0.19 mm). The soft tissue levels were 0.04 mm and 0.19 mm recession from a reference line after, respectively. Conclusions: There is limited clinical information regarding the effect to hard and soft tissue around implant abutment between titanium and zirconia. Results of this study suggest that both abutment materials may be effective in reducing bone loss and in preserving esthetics around dental implants. Keywords: peri-implant soft and hard tissues, zirconia and titanium abutments