This retrospective cohort study evaluates clinical, surgical, and prosthetic factors associated with early and mid-term outcomes of immediate implant placement in the anterior maxilla. The primary objective is to identify predictors of implant survival and complications (e.g., infection, soft-tissue dehiscence, esthetic failure) within 12 months following placement. Secondary objectives include assessment of peri-implant marginal bone loss, prosthetic complications, and esthetic outcomes (pink esthetic score).

Study design:

Retrospective observational cohort study using existing patient records and radiographs from IDCE between September 2022 -March 2026. Data extraction will be performed blinded to outcome assessment.

Participants:

Subjects who received immediate implant placement in the anterior region (canine to canine) during the study period with at least 12 months follow-up. Expected sample size: approximately 500 patients/implants

Inclusion Criteria:

• flapless immediately placed implants in esthetic zone with 3 years follow up CBCT,
• presence of immediate postoperative CBCT,
• initial intact thick gingival biotype with at least 2 mm band of keratinized tissue
• thin intact labial bone plate (< 1mm) extending 7 mm apically assessed by CBCT with good apical bone
• patients who had provided an informed consent.

Exclusion Criteria:

• patients with medical conditions that would compromise the surgical procedures, uncontrolled diabetes mellitus, taking IV bis-phosphonates for treatment of osteoporosis
• patients with active infection related at the site of implant and patients with untreated active periodontal diseases.

All patients were treated with flapless immediate implants with no grafting procedures in the esthetic zone.