Forecasting alterations in both hard and soft peri-implant tissues following immediate or delayed implant placement is essential, since poor prediction can result in biological and esthetic failures that may compromise long-term implant success. The present investigation aimed to analyze and contrast hard- and soft-tissue responses in immediately and delay-placed posterior implants inserted through a flapless surgical protocol. A total of 46 participants who required implant therapy in the posterior region (premolar or molar areas) were selected and randomly divided into two equal groups. Group 1 received immediate implants, while Group 2 underwent delayed placement. Clinical indices such as plaque index (PI), gingival index, modified sulcus bleeding index, probing depth, and Testori esthetic score (TS) were recorded at baseline, 3, 6, 9, and 12 months. Radiographic assessment using cone-beam computed tomography (CBCT) was performed at baseline and after 12 months to evaluate buccal bone thickness (BBT), crestal bone height (CBH), and ridge width. Intragroup comparisons indicated statistically significant time-dependent changes in PI, probing pocket depth, and TS (P = 0.00) in both groups. The average BBT at the crest in delayed implants (1.76 ± 0.24) showed a notable reduction after 12 months compared with the immediate group. Both groups demonstrated a marked increase in TS scores at 12 months. After 12 months, a significant difference in TS was observed between the two groups, revealing superior esthetic outcomes for immediate implants. However, BBT and CBH remained largely unchanged over the same period in Group 1.
