This study compared the superficial tissue responses to titanium and ceramic surfaces of transmucosal elements of established IMZ implants. In a split-mouth study on 14 patients with two mandibular implants and a bar-retained complete mandibular denture, a conventional titanium and a newly developed ceramic-coated transmucosal element were placed. A range of clinical parameters were recorded before transmucosal-element replacement and at 1, 4, and 12 we eks postplacement. A comparison of the recorded soft tissue responses revealed no significant differences between a group of implants fitted with ceramic-coated transmucosal elements and a group of contralateral implants fitted with titanium transmucosal elements. Further analysis suggested that the peri-implant soft tissues adjacent to titanium and ceramic surfaces may differe in features that are not apparent when routine clinical parameters are used. The plaque accumulation scores for ceramic-coated transmucosal elements were significantly lower than those recorded in titanium transmucosal elements. These results suggest that the further development of a ceramic implant transmucosal collar may assist plaque control at the soft tissue-implant interface and may favourably influence the tissues in this region. This investigation should be considered a pilot study in view of the duration of the observations and a number of patients involved.