Comparative Evaluation of Immediate Versus Delayed Implant Placement in the Anterior Maxilla Regarding Buccal Bone Thickness and Pink Esthetics Score (PES): An Original Research Study

Aim: This study aims to evaluate immediate versus delayed implant placement in the anterior maxilla regarding buccal bone thickness and Pink Esthetics Score (PES) Materials and Methods: The study evaluates rehabilitation strategies for adults aged 18 to 60 who have lost a single tooth in the aesthetic zone of the anterior maxilla due to trauma, caries, or endodontic failures. It compares immediate versus delayed implant placement in restoring aesthetics and functionality with fixed dental prostheses. The prospective, randomised controlled trial will include 60 participants: 30 in the Immediate Group (receiving implants right after extraction) and 30 in the Delayed Group (undergoing a healing period). Clinical protocols will include diagnostic wax-ups, intraoral scans, and Cone-Beam Computed Tomography (CBCT). The surgical phase will include atraumatic extraction and implant placement, while the prosthetic phase focuses on single-unit implant-supported crowns. Evaluations will occur at baseline and at 3, 6, and 12 months post-loading, measuring buccal bone thickness and, at 12 months, aesthetic outcomes using the Pink Esthetic Score (PES). Statistical Analysis and Results: We found no statistically significant differences (p > 0.05) between the Immediate and Delayed placement groups at baseline, confirming comparable demographic and clinical characteristics. The Immediate group had a mean age of 42.5 years (SD 8.1) and included 18 males and 12 females, while the Delayed group had a mean age of 43.8 years (SD 7.4) with 16 males and 14 females (p = 0.52, p = 0.60). Both groups also had balanced anatomical distribution of tooth sites (Immediate: 14 central incisors, 10 lateral incisors, 6 canines; Delayed: 13, 11, 6, respectively; p = 0.94), and no significant differences in smoking status (5 smokers in Immediate, 6 in Delayed; p = 0.74) or initial bone density (Immediate: 650.4 ± 85.2 HU; Delayed: 662.1 ± 79.8 HU; p = 0.58). Radiographic Evaluation: At the 12-month follow-up, the Immediate group had greater cumulative buccal bone thickness (1.15 ± 0.31 mm) than the Delayed group (0.98 ± 0.28 mm), which was statistically significant (p = 0.03). Esthetic Evaluation: The Immediate group achieved a notably higher Pink Esthetic Score (12.1 ± 1.8) compared to the Delayed group (11.1 ± 2.1; p = 0.05), driven primarily by better preservation of facial mucosal level (Immediate: 1.9 ± 0.3; Delayed: 1.6 ± 0.6; p = 0.02). Other esthetic parameters showed trends favouring the Immediate group but did not reach statistical significance (p > 0.05). Conclusion: The study concluded that immediate implant placement offers aesthetic benefits by preserving the mid-facial mucosal level (p=0.02) and enhancing PES (p=0.05), but it significantly decreases buccal bone thickness over 12 months (p=0.03) compared to delayed placement.