Immediate implant placement and loading have been proposed to preserve peri‑implant tissues and optimize esthetic outcomes. However, long-term data regarding buccal bone plate stability and the association between baseline buccal bone thickness and long-term dimensional outcomes remain limited.

To evaluate 10-year changes in buccal bone thickness measured 2 mm apical to the implant shoulder (tBB_2mm) following immediate implant placement and loading, and to assess the association of surgically measured baseline buccal bone thickness with 10-year outcomes.

This retrospective cohort study included patients treated with single immediate implants and provisional restorations between 2013 and 2015. Cone-beam computed tomography (CBCT) scans obtained at mid-term evaluation (T1) and at 10-year follow-up (T2) were analyzed. Sites were divided according to surgically measured baseline buccal bone thickness into Group A (>2 mm) and Group B (≤2 mm). The primary outcome was the change in buccal bone thickness between the mid- (T1) and long-term (T2) CBCT evaluation (Δ tBB_2mm). Secondary outcomes included palatal bone thickness and vertical peri‑implant bone parameters. Nonparametric tests were used for inter- and intra-group comparisons. An ANCOVA model was performed to adjust for baseline thickness. Level of significance was set at 0.05.

Forty-seven implants were analyzed. At T1, Group A exhibited significantly greater buccal bone thickness compared with Group B (median 2.2 mm vs 0.5 mm; p < 0.001), and this difference persisted at T2 (2.0 mm vs 0.4 mm; p < 0.001). Although both groups showed slight reductions over time, the magnitude of Δ tBB_2mm did not significantly differ between groups (p = 0.138). In the adjusted model, mid-term buccal bone thickness at T1 was the only significant predictor associated with T2 thickness (p < 0.001), whereas group allocation was not independently associated with the outcome (p = 0.107). Vertical buccal bone coverage was greater in Group A at T2 (p < 0.001), while palatal parameters showed no intergroup differences.

Baseline buccal bone thickness was significantly associated with long-term buccal bone dimensions following immediate implant placement and loading. Dimensional differences between groups were established early and remained stable over 10 years, with limited additional remodeling.