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Background Osseointegrated dental implants were traditionally placed in healed ridges. The main advantage of placing implants immediately after tooth extraction is to shorten treatment, however, immediate post-extractive implants might be at higher risk of complications and failures. As a compromise, there is the option of waiting for soft tissue healing, usually for 6 weeks. To the best knowledge of the authors, there were no RCTs comparing all three procedures at the time of initiation of this trial. Aim/Hypothesis To compare outcomes of single implants placed immediately after tooth extraction with implants placed 6 weeks after (early placement), and with implants placed after 4 months from extraction (delayed placement). Material and Methods Two hundred and ten patients requiring one single implant-supported crown to replace a tooth to be extracted were randomised to receive immediate post-extractive implants (70 patients), early implants at 6 weeks (70 patients), and delayed implants after 4 months of healing (70 patients) according to a parallel group design. Implants inserted with at least 25 Ncm torque were loaded after 4 months, whereas those inserted with less than 25 Ncm were loaded after 6 months. Temporary crowns were to be replaced by definitive ones after 4 months. Outcome measures were crown and implant failures, complications, peri-implant marginal bone level changes, aesthetics (pink esthetic score, PES), and patient satisfaction recorded by blinded assessors. Results Three years after loading, five (7.1%) patients dropped out from the immediate, nine (12.9%) from the early, and eight (11.4%) from the delayed group. Five implants (9.2%) failed in the immediate, four (6.6%) in the early, and one (1.6%) from the delayed group (P = 0.282). Eleven patients of the immediate group, twelve of the early and eight of the delayed group were affected by complications (P = 0.596). Mean peri-implant marginal bone loss was −0.33 ± 0.22 mm (CI 95% −0.39; −0.27) at immediate, −0.43 ± 0.26 mm (CI 95% −0.50; −0.36) at early, and −0.49 ± 0.30 (CI 95% −0.57 ± 0.41) at delayed implants; P < 0.001. Mean overall PES was 12.25, 11.98 and 11.17 at the immediate, early and delayed groups, respectively (P < 0.001). There were no differences in patient satisfaction regarding function (P = 0.353) and aesthetics (P = 0.531) and all patients would undergo the same procedure again. Conclusion and clinical implications No statistically significant differences for failures, complications and patient satisfaction were observed when placing single implants immediately, 6 weeks or four months after tooth extraction, nevertheless, failures were more frequent at immediate and early-placed implants. Bone loss was significantly lower at immediate implants and aesthetic evaluation showed better results at immediate and early implants.
Berti et al. (Sun,) studied this question.