Effect of immediate provisionalization using natural crowns with fiber splints on gingival contour and esthetic outcomes after immediate implant placement: a randomized clinical trial

Immediate implant placement (IIP) requires sufficient primary stability to permit implant-supported immediate provisionalization, which supports peri-implant soft tissue contour during healing, particularly in the anterior esthetic zone. This exploratory study aimed to evaluate the effect of using natural crowns combined with fiber-reinforced composite (FRC) splints on gingival contour and esthetic outcomes following IIP in the esthetic zone dental trauma over a 4–5-month follow-up period. A total of 20 participants who underwent IIP in the anterior maxilla were enrolled in this study. Participants were randomly allocated to an experimental group receiving immediate restoration using natural crowns combined with FRC splints and a control group receiving delayed restoration. Postoperative pain and swelling were assessed using the visual analogue scale (VAS). At 4–5 months postoperatively, gingival esthetics were evaluated using the pink esthetic score (PES), and changes in gingival height (mesial papilla, distal papilla, and mid-labial gingival margin) were measured using intraoral optical scans. Implant success rates were also recorded. The implant placement success rates were 100% in both groups. Postoperative pain and swelling scores were significantly lower in the experimental group than in the control group (p < 0.05). The experimental group demonstrated significantly higher PES values compared to the control group (z = 2.799, p = 0.005). No significant intergroup differences were observed in gingival height changes at the mesial papilla, distal papilla, or mid-labial gingival margin. Immediate provisionalization using natural crowns with FRC splints may reduce postoperative discomfort and improve overall esthetic outcomes while maintaining comparable gingival height stability during early healing. This randomized controlled trial was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR) prior to the enrollment of participants (ChiCTR2300068934; registered on March 1, 2023).