Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Comparing clinical outcomes of immediate implant placement with early implant placement in healthy adult patients requiring single-tooth replacement in the aesthetic zone: a systematic review and meta-analysis of randomised controlled trials

A Correction to this article was published on 17 January 2024

This article has been updated



The aim of this systematic review and meta-analysis was to assess the clinical efficacy of the immediate implant placement (IIP) protocol in the aesthetic zone with early dental implant placement (EIP) protocol.


Electronic databases MEDLINE (via OVID), EMBASE (via OVID), ISI Web of Science core collection, Cochrane, SCOPUS, and Google Scholar were searched for the studies comparing the two clinical protocols. Randomised controlled trials were included. Cochrane Risk of Bias tool (ROB-2) was used to assess the quality of included students.


A total of six studies were selected. Implant failure was observed at 3.84%, 9.3%, and 4.45% in three studies while in the other studies, no implant failure was reported. Meta-analysis of four studies showed no statistically significant difference in the vertical bone levels between IIP and EIP (148 patients), mean difference (MD)0.10 [95% CI: –0.29 to 0.091.32] P > 0.05. Meta-analysis of two studies showed the probing depth between IIP versus EIP was not significantly different (100 patients), mean difference(MD)-0.00 [95% CI; –0.23 to 0.23]; P > 0.05. The pink aesthetic score (PES) was improved in EIP as compared to IIP with a statistically significant difference (P < 0.05).


The available evidence supports the clinical efficacy of the IIP protocol. Present findings indicate aesthetics and clinical results of immediate implant placement protocol are comparable to early and delayed placement protocols. Therefore, future research with long-term follow-up is warranted.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Change history


  1. Rieder D, Eggert J, Krafft T, Weber HP, Wichmann MG, Heckmann SM. Impact of placement and restoration timing on single-implant esthetic outcome - a randomized clinical trial. Clin Oral Implants Res. 2016;27:e80–86.

    Article  PubMed  Google Scholar 

  2. Schulte W, Heimke G. [The Tübinger immediate implant]. Quintessenz. 1976;27:17–23.

    PubMed  Google Scholar 

  3. Lazzara RJ. Immediate implant placement into extraction sites: surgical and restorative advantages. Int J Periodontics Restorative Dent. 1989;9:332–43.

    PubMed  Google Scholar 

  4. Pommer B, Danzinger M, Leite Aiquel L, Pitta J, Haas R. Long-term outcomes of maxillary single-tooth implants in relation to timing protocols of implant placement and loading: systematic review and meta-analysis. Clin Oral Implants Res. 2021;32 Supp 21:56–66.

    Article  PubMed  Google Scholar 

  5. Berglundh T, Gislason Ö, Lekholm U, Sennerby L, Lindhe J. Histopathological observations of human periimplantitis lesions. J Clin Periodontol. 2004;31:341–7.

    Article  PubMed  Google Scholar 

  6. Ramel CF, Wismeijer DA, F Hämmerle CH, Jung RE. A randomized, controlled clinical evaluation of a synthetic gel membrane for guided bone regeneration around dental implants: clinical and radiologic 1-and 3-year results. Int J Oral Maxillofacial Implants. 2012;27:435–41.

    Google Scholar 

  7. Lang NP, Berglundh T. Periimplant diseases: where are we now?—Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011;38 Suppl 11:178–81.

    Article  PubMed  Google Scholar 

  8. Karthik K, Sivaraj S, Thangaswamy V. Evaluation of implant success: a review of past and present concepts. J Pharm Bioallied Sci. 2013;5:S117–119.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sabane A. Surface characteristics of dental implants: a review. J Indian Acad Dental Special. 2011;2:18–21.

    Google Scholar 

  10. Alla RK, Ginjupalli K, Upadhya N, Shammas M, Ravi RK, Sekhar R. Surface roughness of implants: a review. Trends in Biomaterials and Artificial Organs. 2011;25:112–8.

    Google Scholar 

  11. Kotsovilis S, Karoussis IK, Trianti M, Fourmousis I. Therapy of peri-implantitis: a systematic review. J Clin Periodontol. 2008;35:621–9.

    Article  PubMed  Google Scholar 

  12. Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol. 2018;89 Suppl 1:S267–s290.

    PubMed  Google Scholar 

  13. Berridge JP, Patel NS, Dimalanta WG, Johnson TM. Clinical advantages of angled screw access channels for implant-supported restorations in the esthetic zone. Medical Journal, US Army Medical Center of Excellence (MEDCoE) 2021.

  14. Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants,(I). Success criteria and epidemiology. Eur J Oral Sci. 1998;106:527–51.

    Article  PubMed  Google Scholar 

  15. Ting M, Craig J, Balkin BE, Suzuki JB. Peri-implantitis: a comprehensive overview of systematic reviews. J Oral Implantol. 2018;44:225–47.

    Article  PubMed  Google Scholar 

  16. Lindquist L, Carlsson G, Jemt T. A prospective 15‐year follow‐up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res. 1996;7:329–36.

    Article  PubMed  Google Scholar 

  17. Cochran DL, Nummikoski PV, Schoolfield JD, Jones AA, Oates TW. A prospective multicenter 5-year radiographic evaluation of crestal bone levels over time in 596 dental implants placed in 192 patients. J Periodontol. 2009;80:725–33.

    Article  PubMed  Google Scholar 

  18. Arora H, Ivanovski S. Immediate and early implant placement in single tooth gaps in the anterior maxilla: A prospective study on ridge dimensional, clinical, and aesthetic changes. Clin Oral Implants Res. 2018;29:114S 1154.

    Google Scholar 

  19. Hof M, Pommer B, Ambros H, Jesch P, Vogl SM, Zechner W. Does timing of implant placement affect implant therapy outcome in the aesthetic zone? A clinical, radiological, aesthetic, and patient-based evaluation. Clin Implant Dent Related Res. 2015;176:1188–99.

    Article  Google Scholar 

  20. Huynh-Ba G, Hoders AB, Meister DJ, Prihoda TJ, Mills MP, Mealey BL, et al. Esthetic, clinical, and radiographic outcomes of two surgical approaches for single implant in the esthetic area: 1-year results of a randomized controlled trial with parallel design. Clin Oral Implants Res. 2019;30:745–59.

    Article  PubMed  Google Scholar 

  21. Palattella P, Torsello F, Cordaro L. Two-year prospective clinical comparison of immediate replacement vs. immediate restoration of single tooth in the esthetic zone. Clin Oral Implants Res. 2008;19:1148–53.

    Article  PubMed  Google Scholar 

  22. Soydan SS, Cubuk S, Oguz Y, Uckan S. Are success and survival rates of early implant placement higher than immediate implant placement? Int J Oral Maxillofac Surg. 2013;42:511–5.

    Article  PubMed  Google Scholar 

  23. Pilliar RM, Lee JM, Maniatopoulos C. Observations on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop Relat Res. 1986:108–13.

  24. Belser UC, Grütter L, Vailati F, Bornstein MM, Weber HP, Buser D. Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores. J Periodontol. 2009;80:140–51.

    Article  PubMed  Google Scholar 

  25. Sanz I, Garcia-Gargallo M, Herrera D, Martin C, Figuero E, Sanz M. Surgical protocols for early implant placement in post-extraction sockets: a systematic review. Clin Oral Implants Res. 2012;23 Suppl 5:67–79.

    Article  PubMed  Google Scholar 

  26. Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005;16:639–44.

    Article  PubMed  Google Scholar 

  27. Rokaya D, Srimaneepong V, Wisitrasameewon W, Humagain M, Thunyakitpisal P. Peri-implantitis update: risk indicators, diagnosis, and treatment. Eur J Dent. 2020;14:672–82.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Schwartz-Arad D, Dori S. [Intraoral autogenous onlay block bone grafting for implant dentistry]. Refuat Hapeh Vehashinayim (1993). 2002;19:35–39. 77.

    PubMed  Google Scholar 

  29. Nkenke E, Neukam FW. Autogenous bone harvesting and grafting in advanced jaw resorption: morbidity, resorption and implant survival. Eur J Oral Implantol. 2014;7 Suppl 2:S203–217.

    PubMed  Google Scholar 

  30. Jensen AT, Jensen SS, Worsaae N. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study. Oral Maxillofac Surg. 2016;20:115–22.

    Article  PubMed  Google Scholar 

  31. Wilson TG Jr, Buser D. Advances in the use of guided tissue regeneration for localized ridge augmentation in combination with dental implants. Tex Dent J. 1994;111:5. 7-10.

    PubMed  Google Scholar 

  32. Retzepi M, Donos N. Guided Bone Regeneration: biological principle and therapeutic applications. Clin Oral Implants Res. 2010;21:567–76.

    Article  PubMed  Google Scholar 

  33. Fugazzotto PA. GBR using bovine bone matrix and resorbable and nonresorbable membranes. Part 2: Clinical results. Int J Periodontics Restorative Dent. 2003;23:599–605.

    PubMed  Google Scholar 

  34. Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants. 2007;22:49–70.

    PubMed  Google Scholar 

  35. Quirynen M, Van Assche N, Botticelli D, Berglundh T. How does the timing of implant placement to extraction affect outcome? Int J Oral Maxillofac Implants. 2007;22:203–23.

    PubMed  Google Scholar 

  36. Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla—a systematic review. Int J Oral Maxillofac Implants. 2014;29:186–215.

    Article  PubMed  Google Scholar 

  37. Schropp L, Wenzel A, Stavropoulos A. Early, delayed, or late single implant placement: 10-year results from a randomized controlled clinical trial. Clin Oral Implants Res. 2014;25:1359–65.

    Article  PubMed  Google Scholar 

  38. Ramanauskaite A, Juodzbalys G. Diagnostic principles of peri-implantitis: a systematic review and guidelines for peri-implantitis diagnosis proposal. J Oral Maxillofac Res. 2016;7:e8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references



This research work was self-funded.

Author information

Authors and Affiliations



AMA: conceptualization, data extraction, methodology, software, writing, editing, and reviewing. DS: methodology, data extraction, software, and analysis. MZA: software, writing, reviewing, and editing.

Corresponding author

Correspondence to Aisha Maria Asghar.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Asghar, A.M., Sadaf, D., Ahmad, M.Z. et al. Comparing clinical outcomes of immediate implant placement with early implant placement in healthy adult patients requiring single-tooth replacement in the aesthetic zone: a systematic review and meta-analysis of randomised controlled trials. Evid Based Dent 24, 93 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links