Instant provisionalization of immediate single-tooth implants is essential to optimize esthetic treatment outcome

The immediate single-tooth implant has become a viable treatment option. However, the impact of the restorative procedure on esthetics is currently unclear. The goal of this study was to compare the soft tissue outline at immediate implants following two restorative protocols: immediate connection of a temporary crown or submerged healing during which a removable partial denture is used. A 1-year single-blind randomized clinical study was performed in 49 patients. Twenty-four patients were assigned to the immediate restoration group and 25 to the delayed restoration group. Clinical and radiographic evaluations of soft and hard tissues were carried out after 3, 6 and 12 months. Implant survival, bone remodeling, probing depth and bleeding tendency were not influenced by the restorative protocol. Delayed restoration resulted in initial papilla loss taking up to 1 year to attain comparable height as for immediate restoration. Midfacial recession was systematically 2.5-3 times higher following delayed restoration pointing to a 0.75 mm additional loss in comparison with immediate restoration after 1 year. If the primary implant stability permits it, immediate single-tooth implants should be instantly provisionalized in the interest of optimal midfacial esthetics