Immediate implantation involves placing an implant into the extraction socket during the very same visit in which the tooth is removed. In appropriately qualified patients, it shortens treatment time and reduces the number of surgical procedures. The success of the procedure depends, among other factors, on the condition of the tissues, the absence of infection, and the feasibility of achieving stable placement of the implant in the correct position.
If a tooth qualifies for extraction, planning the implant procedure prior to the extraction is crucial. The standard guaranteed by an individual implant treatment plan at Malo Clinic is to perform digital CBCT tomography even before the root is removed.
What is an immediate implant and how does it differ from a delayed procedure?
Following tooth extraction, an implant can be placed immediately or after a period of tissue healing. The choice of timing depends on the condition of the socket, the soft tissues, and the bone, as well as the need to treat infection or regenerate tissues. Delaying implantation means separating the extraction and implant placement into distinct stages.
Immediate implantation means placing the implant into a fresh socket directly after extraction. It is not synonymous with the immediate placement of a crown or the ability to bite on the implant. A provisional restoration is chosen separately, depending on the implant's stability, tissue conditions, and occlusion.
Qualification for the procedure: when is immediate implantation safe?
Qualification requires an individual clinical and radiological assessment. The clinician considers, among other things:
Feasibility of achieving primary stability: an adequate volume of bone is necessary to ensure stable placement of the implant in the position planned for the future crown. The anchorage site depends on anatomy; there is no single universal requirement for the number of millimetres of bone or insertion torque across all cases.
Condition of the socket walls: an intact buccal wall favours treatment. A minor defect does not always rule out immediate implantation, but it may require regeneration and increase the risk of aesthetic complications. In the event of extensive damage, a delayed procedure may be more advantageous.
Presence of infection: acute purulent inflammation may favour delaying the procedure. A chronic periapical lesion does not always preclude immediate implantation, provided that thorough debridement of the socket and stable implant placement can be achieved. The decision depends on an evaluation of the entire surgical site.
Soft tissue phenotype: thicker tissues are a favourable factor, but they do not guarantee the absence of recession. A thin phenotype requires a careful assessment of aesthetic risks and potential soft tissue augmentation.
Assessment of occlusion and parafunctions: bruxism and occlusal overload influence the treatment plan, particularly the feasibility of using an immediate provisional crown on the implant.
Step-by-step procedure
The success of the procedure relies on maximum protection of the surrounding tissues. The procedure is performed by specialised oral surgery in the following stages:
As atraumatic an extraction as possible: the doctor extracts the tooth, minimising damage to the socket walls and soft tissues. The choice of instruments and potential root separation depend on the clinical situation. Following extraction, the preservation of the socket walls is assessed.
Debridement and disinfection of the socket: removal of inflammatory granulation tissue and thorough disinfection of the bed.
Implant placement: the implant is placed in the position planned for the prosthetic restoration, achieving stability in the available bone. The direction and site of anchoring depend on the anatomy of the socket.
Potential tissue regeneration: depending on the gap between the implant and the socket wall, bone defects, and aesthetic needs, the doctor may use a bone graft material, a membrane, or a soft tissue procedure. This is intended to limit contour changes, but it does not stop bone remodelling.
Securing the implant: depending on the conditions, a cover screw, a healing abutment, or a temporary crown is used.
Immediate crown: can it always be fitted?
Placing an implant on the day of tooth extraction does not automatically mean that a temporary crown can be fitted onto it. The doctor makes this decision after evaluating the primary stability of the implant, bone conditions, soft tissues, and the bite.
If the conditions are suitable, a temporary crown free from occlusal contacts can be made. When this is not possible, an alternative temporary restoration is selected that does not load the healing implant. Dietary guidelines must be followed, and biting on hard foods with the temporary crown should be avoided for the period indicated by the doctor. In the first few days, an appropriate diet after implant surgery is crucial.
Comparison of dental implant protocols
Parameter | Immediate implantation | Early implantation | Delayed implantation |
|---|---|---|---|
Timing of placement | Immediately after extraction (the same day) | After 4–8 weeks (soft tissue healing) or 12–16 weeks (partial bone healing) | After full bone healing, usually more than 6 months after extraction |
Number of surgical procedures | Extraction and implantation in a single session; additional procedures as needed | Extraction and implantation performed separately; regeneration as needed | Extraction and implantation performed separately; regeneration as needed |
Preservation of the gingival contour | Favourable outcome possible; a risk of recession and contour changes remains | Dependent on the tissues and procedures used | Dependent on the tissues; soft tissue surgery as indicated |
Primary stability requirement | Essential; requirements depend on the loading protocol | Essential; requirements depend on the loading protocol | Essential; requirements depend on the loading protocol |
Risk of complications in the presence of infection | The presence of infection requires individual assessment and site debridement, or postponing the implant procedure | Soft tissue healing does not guarantee eradication of infection | Dependent on local conditions and the patient’s overall health status |
Total time to definitive crown | Individual; often several months | Waiting period for implantation plus implant osseointegration time | Waiting period for implantation plus implant healing time |
Advantages and limitations of the immediate procedure
Key advantages
Potential reduction in treatment time by eliminating the waiting period between extraction and implantation.
Combining extraction and implant placement in a single appointment. Additional procedures may still be required; antibiotic therapy is tailored to specific indications.
Opportunity to achieve a favourable aesthetic outcome with proper patient qualification and soft tissue management. A risk of contour changes and gingival recession remains, but it is lower than with delayed implantation.
Possibility of using a provisional restoration; an immediate crown on the implant requires separate qualification.
Potential limitations and risks
Requires meticulous planning, as atraumatic an extraction as possible, and expertise in implant placement and potential tissue regeneration.
Inappropriate patient qualification in the presence of active infection can lead to osseointegration failure.
Implant loading restrictions and dietary guidelines depend on the healing mode and the type of provisional restoration.
What makes up the cost of an immediate implant?
The cost of immediate implantation depends on the individual treatment plan. Combining extraction with implant placement does not guarantee a lower price. Factors influencing the cost include bone or soft tissue regeneration, the chosen implant, and the type of provisional and definitive restoration.
The cost estimate should cover the extraction, implant placement, any tissue regeneration, the provisional restoration, and the definitive crown once healing is complete. Not all of these procedures are required for every patient. Transparent pricing terms are presented in the implantology price list.
Bibliography
Tonetti MS, Jung RE, Avila-Ortiz G, et al. Management of the extraction socket and timing of implant placement: Consensus report and clinical recommendations of group 3 of the XV European Workshop in Periodontology. J Clin Periodontol. 2019;46 Suppl 21:183–194. Available online
Donos N, Van Asche N, Akbar AN, et al. Impact of timing of dental implant placement and loading: Summary and consensus statements of group 1—The 6th EAO Consensus Conference 2021. Clin Oral Implants Res. 2021;32 Suppl 21:85–92. Available online
Cosyn J, Eghbali A, Hermans A, Vervaeke S, De Bruyn H, Cleymaet R. A 5-year prospective study on single immediate implants in the aesthetic zone. J Clin Periodontol. 2016;43(8):702-709. Available online
Chu SJ, Salama MA, Garber DA, et al. Flapless Postextraction Socket Implant Placement, Part 2: The Effects of Bone Grafting and Provisional Restoration on Peri-implant Soft Tissue Height and Thickness—A Retrospective Study. Int J Periodontics Restorative Dent. 2015;35(6):803-809. Available online
Ragucci GM, Elnayef B, Criado-Cámara E, Suárez-López Del Amo F, Hernández-Alfaro F. Immediate implant placement in molar extraction sockets: a systematic review and meta-analysis. Int J Implant Dent. 2020;6:40. Available online
