Background: Immediate implant placement into fresh extraction sockets is generally considered a reliable procedure that offers several clinical advantages. Purpose: The primary aim of this study was to evaluate and compare the overall clinical outcomes of immediate and delayed restoration procedures for implants placed in fresh extraction sockets by means of a flapless technique and resorbable membrane stabilizing a xenograft. Total costs and operating times were also compared. Materials and Methods: In this prospective cohort study, changes of marginal bone level, facial soft tissue (δFST), and width of keratinized gingiva (ΔWKG), in addition to the papilla index, underwent a pairwise comparison; correlations with pristine buccal bone thickness were also investigated. Results: Although similar results were recorded for the two procedures, with a bone loss of -1.0±0.5 mm and -0.9±0.7 mm, respectively, for immediate and delayed restoration, negative remodeling in the delayed restoration procedure was seen to occur from 4 to 12 months after implant placement. No significant differences were recorded between the two procedures in terms of ΔFST and ΔWKG. A loss of the papillary soft tissues before restoration, followed by a reestablishment after restoration, seemed to be verified for the delayed group, for which the papilla index went from the minimum of 0 at 4 months to a value of 2 at 24 months. Moreover, the immediate restoration procedure seemed to be more promising in terms of healing times and costs. Conclusion: Immediate restoration of implants installed in fresh extraction sockets was at least as effective and safe as delayed restoration.
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