Impact of labially inclined implant axes on immediate implant placement and provisionalization in anterior maxilla: A prospective cohort study

Objectives To investigate whether a labially inclined implant axis compromises the clinical outcomes of immediate implant placement and provisionalization (IIPP) in the anterior maxilla. Materials and Methods Patients with unsalvageable central or lateral maxillary incisors were enrolled. IIPP with simultaneous connective tissue graft (CTG) was performed in all participants. In the control group, the alveolar ridge had a long axis aligned with the tooth, which ensured that the immediate implant was aimed at the incisor edge or the cingulum of future restoration. The test group had a large angle between the axes of the ridge and tooth. To avoid bone fenestration, the implants were placed labially inclined and emerged from the labial side of future restoration. Intra‐oral scanning and cone‐beam computed tomography were performed to record soft and hard tissue profiles at baseline and 1 year later. Soft tissue stability, bone remodeling, and pink esthetic score (PES) were evaluated and compared between two groups. Results Thirty‐nine participants (19 tests and 20 controls) completed the study. At 1‐year post‐surgery, the mid‐facial gingival margin migrations were 0.85 ± 0.37 mm (test) and 0.81 ± 0.33 mm (control), without significant differences. No differences were identified in buccal profile alteration, linear ridge reduction, buccal bone thickness, or PES scores. The test group demonstrated thinner buccal soft tissue at the crestal level than the control group. Conclusions When large tooth‐ridge angulation presented, labially inclined implant, avoiding buccal ridge fenestration in IIPP with CTG, did not compromise the clinical outcome in short term.