Overview
Immediate implant placement — placing the implant in the same appointment as the extraction — has become routine in selected cases. Done well, it eliminates a months-long healing phase and helps preserve the natural soft-tissue contour. Done in the wrong case, it produces visible gum recession in the aesthetic zone that is very hard to fix later.
Case selection criteria
- Intact buccal (facial) bone plate after extraction — verified, not assumed.
- No acute purulent infection at the apex.
- Sufficient bone apical and palatal to the socket for primary stability.
- Thick gingival biotype reduces the risk of recession.
- Realistic patient expectations about a possible "plan B" delayed placement.
What the evidence shows
A Cochrane review found broadly comparable implant survival between immediate, early, and delayed placement, but with a modestly higher complication rate in immediate cases — primarily aesthetic, not survival[1]. ITI consensus statements emphasise that case selection is the single strongest predictor of immediate-placement success[2].
Technique essentials
- Atraumatic extraction with periotomes; avoid spreading the socket.
- Implant placed slightly palatal and apical, engaging native bone for primary stability of ≥ 35 Ncm.
- Gap between implant and buccal plate filled with particulate graft.
- Custom healing abutment or screw-retained provisional to support the gum.
- Connective tissue graft considered in the aesthetic zone.
Frequently asked questions
Scientific references
- 1. Esposito M, Grusovin MG, Maghaireh H, Worthington HV. (2013). Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database Syst Rev. (3):CD003878. View source
- 2. International Team for Implantology. (various). ITI Consensus Conference Proceedings. ITI. View source