For many modern oral health treatments, it’s possible to deliver successful results quickly. A filling may be placed to repair a carious lesion in just a few minutes, before the patient continues their day mostly unimpacted.
When it comes to dental implants, this can be more difficult. An invasive treatment, clinicians must manage soft and hard tissue, surrounding dentition, and the restoration for success. Conventionally, a delayed placement procedure will see an implant and restoration be provided over the course of months, but immediate implant dentistry has turned this on its head.
There are many cases where the extraction of a tooth and the placement and loading of an implant can now be completed in one sitting. It’s important that clinicians keep up with the latest findings concerning immediate implant placement. The literature and effective educational courses should be used as sources of support when looking to implement such a procedure into their practice.
A viable solution
The first question that clinicians must ask is how viable is the immediate implant procedure in 2025? Recent reviews of the literature note that it is typically extremely successful, even in comparison to a conventionally delayed placement. A 2022 retrospective study on 4519 implants found that 98.5% of implants placed immediately following extraction survived, which was comparable to the 98.9% success rate of those placed in healed sockets.[i] A similar 2023 systematic review declared no significant statistical difference in implant survival or complications between either approach but noted that case selection is important.[ii]
Immediate implant placement can be used alongside effective socket preservation techniques,[iii] creating a clinically advantageous approach for some patients. For a clinician to consider any implant placement, one must be confident that there is sufficient bone surrounding the extraction socket. This tissue begins to resorb immediately upon extraction, which is at odds with the healing period associated with a delayed protocol.[iv] The result may be that the conditions at implant placement are no longer ideal if waiting months post-extraction for restorative surgery.
The placement of an implant immediately into the socket can reduce bone resorption, though this is typically most effective in conjunction with graft materials.[v] A 2022 systemic reviewiv found that when compared to conventional alveolar ridge preservation, immediate implants had a lower success rate (in this sample of 915 cases, survival rates were 98.68% against 95.21%). However, hard and soft tissue analysis found no significant difference in preservation, aesthetic outcome, and patient satisfaction. This suggests that where success can be maximised, the approach is appropriate when targeting improved socket preservation and an accelerated final treatment outcome.
Case selection
Clinicians must be aware of the treatment aspects that mean immediate implant protocols are not optimal in all clinical situations.
Current clinical recommendations include the need for a strict criteria when placing immediate implants. This means that dental professionals must not only prioritise survival rates, but the possibility of avoiding aesthetic, biological, mechanical and technical complications.[vi] Studies routinely use connective tissue grafting in conjunction with immediate implant placement, improving soft tissue results in a number of cases. A study into immediate implant placement in the maxillary aesthetic zone cited such complications as a thin facial bone, thin soft tissue phenotype, and minor gingival recession.vi
Contraindications to immediate implant placement may include extensive gingival recession, obvious inadequacies in bone height or width, limited restorative space (for example, if a patient has a deep bite), adverse nerve location, and class III and IV sagittal root positions.[vii]
Broaden your horizons
To be able to deliver clinical success with immediate implant placement, clinicians must use what we know about current abilities and contraindications of the treatment, optimising case selection. The coming years may present new grafting solutions to use in conjunction with the protocol, or new approaches to utilise.
No matter the case, it is essential to delve into up-to-date education whenever possible. Clinicians could find out more about immediate implant placement protocols with the Postgraduate Diploma in Implant Dentistry from One to One Implant Education. The course, led by One to One founder Dr Fazeela Khan-Osborne and Dr Nikolas Vourakis, delves into immediate implant placement and loading techniques, as well as clinical aspects such as full arch implant dentistry, bone grafting, and peri-implantitis management. It is the ideal course for clinicians looking to pave their way in the field.
As of today, immediate implant placement is an effective and widely applicable treatment protocol. Whilst it is not suitable for every indication of edentulism, clinicians should keep note of the progress made in the coming years to understand how it can be implemented for aesthetic, functional and overall successful results.
To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.
[i] Chatzopoulos, G. S., & Wolff, L. F. (2022). Survival rates and factors affecting the outcome following immediate and delayed implant placement: a retrospective study. Journal of Clinical Medicine, 11(15), 4598.
[ii] Patel, R., Ucer, C., Wright, S., & Khan, R. S. (2023). Differences in dental implant survival between immediate vs. delayed placement: a systematic review and meta-analysis. Dentistry Journal, 11(9), 218.
[iii] Iannello, G., Fiorillo, L., D’Amico, C., Minervini, G., Terranova, A., & Cervino, G. (2023). Presenting a Protocol for Dental Implant Restorations. Prosthesis, 5(4), 1153-1170.
[iv] Yu, X., Teng, F., Zhao, A., Wu, Y., & Yu, D. (2022). Effects of post-extraction alveolar ridge preservation versus immediate implant placement: A systematic review and meta-analysis. Journal of Evidence-Based Dental Practice, 22(3), 101734.
[v] Bungthong, W., Amornsettachai, P., Luangchana, P., Chuenjitkuntaworn, B., & Suphangul, S. (2022). Bone dimensional change following immediate implant placement in posterior teeth with CBCT: a 6-month prospective clinical study. Molecules, 27(3), 608.
[vi] Hamilton, A., Gonzaga, L., Amorim, K., Wittneben, J. G., Martig, L., Morton, D., … & Wismeijer, D. (2023). Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta‐analysis. Clinical oral implants research, 34, 304-348.
[vii] Carpentieri, J., & Greenstein, G. (2024). Guidelines for immediate vs delayed dental implant placement in the esthetic zone. Compend Contin Educ Dent, 45, 340-47.
