Objective To explore the effect of customized zirconia abutment combined with all-ceramic crown restoration on periodontal health and restoration aesthetics in patients with anterior tooth loss. Methods A total of 68 patients with anterior tooth loss treated in Changshu Yuhui Dental Hospital from January 2023 to December 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 34 patients in each group. The control group received conventional titanium abutment combined with all-ceramic crown restoration, and the observation group received customized zirconia abutment combined with all-ceramic crown restoration. The implant stability, marginal adaptation of restorations, periodontal health and restoration aesthetics were compared between the two groups. Results The implant stability of the observation group at 3, 6 and 12 months after restoration was better than that of the control group (P<0.05). The excellent and good rate of marginal adaptation of the restorations in the observation group (97.06%) was higher than that in the control group (79.41%) (P<0.05). The GI, PD and AL of the observation group at 6 and 12 months after restoration were lower than those of the control group (P<0.05). The aesthetic score of the observation group at 12 months after restoration was higher than that of the control group (P<0.05). Conclusion Customized zirconia abutment combined with all-ceramic crown for anterior tooth loss can not only improve periodontal health status, but also enhance restoration aesthetics, implant stability and marginal adaptation of the restorations.