Immediate Single‐Tooth Implant Placement in Bony Defects in the Esthetic Zone: A 1‐Year Randomized Controlled Trial

Background: This study aims to assess, with regard to marginal bone level (MBL), whether the outcome of immediate implant placement in bony defects in the esthetic zone was non‐inferior to delayed implant placement after 1 year. Methods: Forty patients with a failing tooth in the esthetic zone and a labial bony defect of ≥5 mm after removal of a tooth were randomly assigned for immediate (n = 20) or delayed (n = 20) implant placement. Second‐stage surgery and provisionalization occurred after 3 months of healing. Follow‐up was at 1 month and 1 year after definitive crown placement. The study was powered to detect a difference in MBL of >0.9 mm. Buccal bone thickness, soft tissue peri‐implant parameters, esthetic indices, and patient satisfaction were also assessed. Results: One year after definitive crown placement, MBL loss was 0.56 ± 0.39 mm mesially and 0.74 ± 0.51 mm distally for the immediate placement group and 0.51 ± 0.43 mesially and 0.54 ± 0.45 distally mm for the delayed placement group, respectively (not significant). Regarding differences in means, non‐inferiority was observed after 1 year (difference in mean for immediate versus delayed: mesially 0.04 mm [95% confidence interval (CI) = −0.22 to 0.30 mm, P = 0.40]; distally 0.21 mm [95% CI = −0.10 to 0.51 mm, P = 0.58]). No significant differences in the other outcome variables were observed. Conclusions: Immediate implant placement with delayed provisionalization was non‐inferior to delayed implant placement with delayed provisionalization in labial bony defects of ≥5 mm regarding change in MBL. Although not powered for other outcome variables, no clinically relevant differences were observed in these variables.