## 4 Discussion
conducted a systematic review of the literature, analyzing 30 clinical studies to assess the effectiveness of immediate post-extractive implants and the peri-implant complications associated with this approach. The results highlighted that smoking is a critical risk factor, associated with an increased incidence of peri-implant mucositis and peri-implantitis, with a significantly higher prevalence in posterior regions. Furthermore, the study reported that patients with systemic conditions, such as diabetes mellitus and osteoporosis, exhibited more pronounced peri-implant inflammation and higher rates of marginal bone loss compared to systemically healthy individuals [10]. [PERSON] et al. conducted a review including 25 clinical and retrospective studies, focusing on the role of smoking in implant treatments. Their analysis revealed that smokershave a significantly higher risk of developing peri-implant inflammation compared to non-smokers. Moreover, the review indicated that marginal bone loss in smokers is, on average, 20-30% greater than in non-smokers after a 5-year follow-up [26]. [PERSON] et al. conducted a literature review on immediate loading post-extraction implants, including studies with a minimum follow-up of 12 months. Their findings emphasized that proper oral hygiene management and regular follow-up visits, as performed in the present study, can significantly reduce the risk of peri-implant inflammatory complications [1]. Specifically, in agreement with other studies, they highlighted that, in patients with inadequate oral hygiene, the risk of bleeding on probing and peri-implant mucositis increases by up to 40% compared to those with good oral hygiene [27; 28; 29]. Regarding surgical complications, no cases of postoperative pain were reported, whereas nine cases of edema were recorded, four of which were also associated with postoperative bleeding, which was observed in seven patients overall. All surgical complications occurred exclusively in patients with systemic conditions and smokers. Furthermore, a significant correlation was observed with the type of prosthetic rehabilitation, with a higher prevalence of complications in patients rehabilitated with bridges supported by two distal implants compared to those undergoing single implant-prosthetic rehabilitation. In contrast, no significant correlation was found concerning implant site. [PERSON] et al. conducted a randomized controlled trial on 210 patients, comparing three implant loading protocols in post-extraction single implants: immediate, immediate-delayed (6 weeks), and delayed (4 months). The results indicated that patients undergoing immediate loading had a significantly higher incidence of surgical complications compared to the other groups, with a greater prevalence in smokers and individuals with systemic compromising conditions such as diabetes mellitus and osteoporosis [4]. [PERSON] et al. performed an umbrella review of eight systematic reviews to assess the impact of systemic conditions on implant osseointegration. The analysis included studies with follow-up periods ranging from 1 to 10 years, evaluating conditions such as diabetes, osteoporosis, cardiovascular diseases, and bone metabolism disorders. The results indicated that uncontrolled diabetes is significantly associated with an increased risk of implant failure (OR = 2.1, \(p<\) 0.01), while osteoporosis compromises the peri-implant bone density, increasing marginal bone loss during the first 12 months post-surgery. Additionally, the review highlighted that certain medications, such as proton pump inhibitors (PPIs) and selective serotonin reuptake inhibitors (SSRIs), negatively interfere with bone regeneration, delaying healing processes and increasing the risk of early implant failure (\(p<\) 0.05) [30]. These findings underscore the importance of thorough preoperative evaluation and personalized protocols for patients with systemic conditions to minimize complications and improve implant prognosis.