Immediate Versus Delayed Single-Tooth Implant Placement in the Maxillary Esthetic Zone: A Systematic Review of Clinical, Esthetic, Volumetric, and Patient-Reported Outcomes

Abstract

Timing of implant placement after extraction of a maxillary esthetic-zone tooth remains debated, with immediate and delayed protocols each offering distinct clinical, esthetic, and patient-centered trade-offs. To systematically review clinical, esthetic, volumetric, and patient-reported outcomes of immediate versus delayed single-tooth implant placement in the maxillary esthetic zone. Conducted per PRISMA 2020, five databases (PubMed, Scopus, EMBASE via Ovid, EBSCO, Cochrane CENTRAL) were searched, yielding 700 records. Randomized and comparative observational studies reporting extractable immediate-versus-delayed data were eligible. We assessed risk of bias using RoB 2 and ROBINS-I. Substantial clinical and methodological heterogeneity precluded meta-analysis; findings were synthesized narratively. Eight studies (five randomized trials, three non-randomized studies; >670 patients) were included. Implant survival was high and comparable between protocols (≥93.8% at long-term follow-up). Marginal bone level changes were small in both groups, with inconsistent direction across studies. Esthetic outcomes (PES/mPES/WES) were generally similar, though observational data suggested delayed or late placement may yield more predictable esthetics in compromised phenotypes. Volumetric analyses favored delayed placement for buccal contour preservation, whereas immediate placement showed more minor complications and greater technique sensitivity. Patient satisfaction was consistently high regardless of timing. Immediate and delayed placement yield comparable survival and satisfaction, but immediate placement carries greater technical demands and outcome variability. Timing should be individualized according to tissue phenotype, buccal bone integrity, and case complexity.