TIMING OF IMPLANT PLACEMENT AMONG IMMEDIATE VS DELAYED APPROACHES IN THE ESTHETIC ZONE: A SYSTEMATIC REVIEW AND META-ANALYSIS
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Keywords
Immediate implant, Delayed implant, Esthetic zone, PES, Marginal bone loss
Abstract
Background and Objective: Restoring anterior teeth with implants in the esthetic zone requires a balance between functional integration and esthetic excellence. This systematic review and meta-analysis compared immediate and delayed implant placement protocols with respect to implant survival, marginal bone loss (MBL), and Pink Esthetic Score (PES).
Materials and Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar up to June 2025. Eligible studies compared immediate and delayed implant placements in the esthetic zone and reported outcomes for survival, MBL, or PES. Data from seven studies were included and analysed using a random-effects model. Risk of bias was assessed using Cochrane and Newcastle-Ottawa tools.
Results: Seven studies involving 358 implants (179 immediate, 179 delayed) met the inclusion criteria. Implant survival showed no significant difference (Risk Difference [RD] = 0.00; 95% CI: -0.04 to 0.04; p = 0.99). MBL analysis showed high heterogeneity and no statistical significance (Mean Difference [MD] = -0.05 mm; p = 0.65; I² = 97%). Immediate implant placement was associated with significantly higher esthetic outcomes based on PES (MD = +0.65; 95% CI: 0.06 to 1.24; p = 0.03).
Conclusion: Immediate and delayed implant placements have comparable survival rates. However, immediate placement may provide superior esthetic outcomes when appropriate patient selection and surgical technique are ensured. High variability in MBL outcomes underscores the need for standardized protocols in future research.
References
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Vikas Punia
Professor and Head, Department of Prosthodontic Crown & Bridge, Darshan Dental College and Hospital Udaipur, India
Jai Poonam Bhati
Post Graduate Student, Department of Prosthodontic Crown & Bridge, Darshan Dental College and Hospital Udaipur, India
Anand Porwal
Associate Professor, Department of Prosthodontic Crown & Bridge, Darshan Dental College and Hospital Udaipur, India
Palak Salgia
Assistant Lecturer, Department of Prosthodontic Crown & Bridge, Darshan Dental College and Hospital Udaipur, India
Abhijit Sethia
Assistant Professor, Department of Prosthodontic Crown & Bridge, Darshan Dental College and Hospital Udaipur, India
Saransh Malot
Professor, Department of Prosthodontic Crown & Bridge, Darshan Dental College and Hospital Udaipur, India