Patient-Centered Outcomes in Immediate vs Delayed Implant Placement: A Randomized Controlled Trial

Abstract

Background:
Dental implants are a widely accepted method for replacing missing teeth, but the timing of implant placement—whether immediate (at the time of tooth extraction) or delayed (after a healing period)—remains a debated topic. Immediate implant placement is believed to preserve alveolar bone and soft tissue contours, potentially improving aesthetic outcomes. However, concerns persist about increased postoperative pain and complications. Delayed implants, on the other hand, are considered more predictable in terms of osseointegration, but they require longer treatment times and multiple surgical interventions. This study aimed to compare patient-centered outcomes, including pain, aesthetic satisfaction, quality of life, implant stability, and bone loss, between immediate and delayed implant placement.

Objectives:
This randomized controlled trial sought to evaluate and compare the patient-centered outcomes of immediate versus delayed implant placement in terms of pain, aesthetics, quality of life, implant stability, and peri-implant bone loss.

Materials and Methods:

A total of 60 patients requiring single-tooth implants in the anterior or premolar region were randomly allocated to either the immediate implant placement group (n=30) or the delayed implant placement group (n=30). Two patients were lost to follow-up, resulting in 58 participants. Pain levels were assessed using a Visual Analog Scale (VAS), aesthetic satisfaction using the Pink Esthetic Score (PES), and quality of life using the Oral Health Impact Profile (OHIP-14). Implant stability was evaluated using resonance frequency analysis (RFA), and peri-implant bone loss was measured radiographically at six months. Data were analyzed using SPSS 25.0 version

Results:
Patients in the immediate implant group experienced significantly higher pain on the first postoperative day (VAS score = 5.8 ± 1.4) compared to the delayed group (VAS score = 4.1 ± 1.2, p = 0.002), but pain levels equalized by day seven. The immediate implant group had significantly higher aesthetic satisfaction at six months (PES = 10.6 ± 1.1) compared to the delayed group (PES = 9.3 ± 1.5, p = 0.01). Quality of life scores were also better in the immediate group (OHIP-14 score = 5.1 ± 2.8) compared to the delayed group (OHIP-14 score = 7.2 ± 3.0, p = 0.03). Both groups demonstrated comparable implant stability and minimal peri-implant bone loss at six months (p > 0.05), with no implant failures, resulting in a 100% survival rate.

Conclusions:
Immediate implant placement provided superior aesthetic outcomes and enhanced quality of life compared to delayed placement, although it was associated with higher early postoperative pain. Both approaches achieved high implant stability, minimal bone loss, and excellent implant survival. Immediate implant placement may be preferred when aesthetics and rapid restoration are priorities.