Implant fixture positioning and inclination problems that result from poor osseous height, width, and ridge configuration have created difficult prosthetic tooth replacement scenarios. Options for ameliorating poor angulation are limited to the use of preangled and custom abutments. Overcoming poor angulation has been simplified by using custom vs preangled abutments because preangled abutments are limited by their standardization to a few random angles. Custom abutments can be more predictably formed to re-create the desired supporting preparation orientation and morphology. This facilitates the formation of anatomical gingival topography and coronal contours for prosthetic replacement. Cast, ceramic, and machine-milled titanium abutments have several advantages and disadvantages. A new custom abutment system that uses computer-guided manufacturing technology to machine mill custom abutments from commercially pure titanium is described. These abutments are anatomically correct, have the proper emergence anatomy, proper spatial design at the cervical margins, necessary occlusal reduction, and the proper axial angulation of ideal tooth preparations. A clinical case that illustrates implementation, with respect to the principle of stage 2 guided tissue healing, is presented.