This is a randomized clinical trial to compare the clinical and immunological performance of ultrasmooth versus regular-smooth zirconia abutments placed subgingivally after a period of 1 year. Sixty-two bone level platform-switched implants (NobelParallel CC) were placed epicrestally in the mandibular molar or premolar region in 62 patients. After osseointegration, implants were restored with auto polymerizing acrylic resin crowns and subsequently randomly allocated to 2 groups according to the type of screw-retained zirconia crown prescribed. The control group received custom zirconia restoration with the subgingival zirconia part conventionally polished, while the test group implants were restored with ultra-polished zirconia abutments. Periodontal parameters (PD, PI, BOP) and marginal bone level changes (MBLC) were recorded for each implant 2 months after insertion (T0), 1 month after final delivery of the crown (T2) and at the 1-year follow-up (T3). Immunological mediators from GCF (IL-1α, IL-1ra and TNF-α) were inspected at 1 month after provisional (T1) and accordingly at T2 and T3. Data was analyzed statistically, and significance level was set to α = 0.05. After 1-year, there were no significant changes in PD control - 2.18 ±0.89 mm and test - 2.5 ±0.72 mm (p = 0.073). PD between T2 and T3 dropped significantly in the test group (p = 0.037), and remained stable in the control group. PI was not different in both groups at T0 (p = 0.518) and T2 (p = 0.817). At T3, the test group (0.9 ±1.01) had a significantly lower PI than the control group (1.55 ±1.23) (p = 0.035). There was no difference in BOP positive cases between groups after 1 year (control - 61.3%, test - 51.7%, p = 0.455). The amount of IL-1ra decreased significantly in the test group (41.75 ±57.58) (p = 0.001) but not in the control group (59.59 ± 70.43) (p = 0.177). MBLC for the control and test groups after 1 year were 0.68 ±0.7 mm and 0.94 ±0.65 mm (p = 0.061). PD dynamics, PI, BOP and IL-1ra revealed better outcomes around ultra-polished zirconia abutments than around conventionally polished zirconia abutments. This article is protected by copyright. All rights reserved.