It is important to prognosticate the hard‑ and soft‑tissue alterations in immediate and delayed implants, as inadequacy can lead to complications affecting the long‑term survival of the implant. Therefore, the purpose of this study was to evaluate and compare the hard‑ and soft‑tissue changes in immediate and delayed posterior implants with a flapless approach. With an equal allocation ratio, the study included 46 patients requiring implant treatment in the posterior segment, including the premolars and molars. Group 1 consisted of patients with immediate implants, whereas Group 2 consisted of patients who received delayed implants. The clinical parameters, including plaque index (PI), gingival index, modified sulcus bleeding index, probing depth, and soft‑tissue assessment using the Testori esthetic score (TS), were evaluated at baseline, 3, 6, 9, and 12 months. Hard‑tissue parameters, such as buccal bone thickness (BBT), crestal bone height (CBH), and ridge width, were evaluated radiographically with cone‑beam computed tomography at baseline and 12 months posttherapy. Intragroup comparisons in both the groups showed significant differences in PI, probing pocket depth, and TS over time (P = 0.00). The mean BBT at the crest in delayed implants (1.76 ± 0.24) significantly reduced after 12 months compared to immediate implants. A significantly higher TS score was observed after 12 months in both the groups. A significant difference in TS scores after 12 months was found between the two groups, with better esthetics in Group 1 compared to Group 2. However, no significant changes in BBT or CBH were observed after 12 months in Group 1.
