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Background: The aims of this study are to retrospectively compare the clinical, radiographic and esthetic outcomes of platform switching (PS) and platform matching (PM) dental implants in the anterior maxilla after ≥ 10 years of functional loading. Methods: Marginal bone loss (MBL) levels were recorded; furthermore, peri-implant clinical parameters (PPD, BOP, PI) were collected and the Pink and White Esthetic scores (PES/WES) were used to evaluate the esthetic outcomes. Wilcoxon signed rank tests were performed to compare collected parameters among the two groups, with a p-value < 0.05. Results: A final sample of 58 patients was enrolled in this study (PM implants = 29; PS implants = 29). PS implants showed lower MBL levels (1.02 ± 0.81 mm vs. 1.67 ± 0.99 mm, p = 0.028) and PPD values (3.69 ± 1.1 vs. 5.16 ± 1.09 mm, p < 0.001) compared to PM implants. Mean PES values were higher in the PS group compared to the PM group (8.46 ± 0.69 vs. 7.89 ± 0.78, p < 0.005), while there were no differences for WES values (7.82 ± 1.09 vs. 7.71 ± 0.85, p > 0.05) and peri-implant diseases’ prevalence (p > 0.05). Conclusions: After 10 years, PS implants showed statistically significant lower MBL and PPD values and higher PES values compared to PM implants. more...