Objective To explore the effect of immediate implantation combined with CAD/CAM customized zirconia abutment on periodontal indicators in patients with single maxillary anterior tooth loss. Methods A total of 93 patients with single maxillary anterior tooth loss receiving implant restoration treatment in the Department of Stomatology, Dongguang County People’s Hospital from January 2023 to June 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group (n=46) and the observation group (n=47). The control group received delayed implantation combined with prefabricated zirconia abutment restoration, and the observation group received immediate implantation combined with CAD/CAM customized zirconia abutment restoration. The restoration efffcacy, periodontal indicators, quality of life and adverse event rate were compared between the two groups. Results The excellent and good rate of restoration in the observation group (91.49%) was higher than that in the control group (76.09%) (P<0.05). After treatment, the mSBI and PD in the observation group were lower than those in the control group, and the PES score was higher than that in the control group (P<0.05). After treatment, the scores of physiological function, physiological role, body pain and general health in the observation group were higher than those in the control group (P<0.05). The incidence of adverse events in the observation group (4.26%) was lower than that in the control group (13.04%) (P<0.05). Conclusion Immediate implantation combined with CAD/CAM customized zirconia abutment restoration achieves favorable effects for patients with single maxillary anterior tooth loss. It can effectively improve the aesthetic effect of peri-implant soft tissues, optimize periodontal indicators, reduce the incidence of adverse events, and enhance patients’ quality of life.