Background: Immediate implant-based rehabilitation is a clinical challenge, especially in the esthetic area. This study evaluated the health and esthetic outcome of flapless immediately placed implants in the esthetic zone, with or without graft materials. Materials and Methods: Twenty-six implants were immediately placed in 20 patients with a thick gingival biotype, ideal gingival level/contour and post-extraction intact walls in the anterior maxilla. Patients were randomly divided into two groups after flapless immediate implantation. The buccal gap was filled with xenograft bone material in the test group, and in the control group, no bone material was used. Patients were re-called mean 30.05 ± 2.30 months after definitive crown placement for a follow-up session. Health outcomes were evaluated by clinical examination, and Esthetic outcomes were assessed using the Pink and White esthetic scores (PES; WES). Standardized radiographs were taken to measure marginal bone level changes.
Results: Two implants (one in the test and one in the control group) were lost in a patient with poor glycemic control (cumulative survival rate: 92.3%). Although there was a significant difference in mean marginal bone loss between the test and control group (test group: 0.08 ±0.14 mm and control group: 0.53 ± 0.14 mm; p-value â?? 0.04), there were no significant differences in aesthetic outcomes. (p-Value = 0.04) According to the professional’s assessments using PES/WES, 69% of implants in the test group and 82 % of cases in the control group showed acceptable mucosa esthetics, and 62% and 82% of restorations in test and control groups showed acceptable crown esthetics, respectively.