In every clinical situation, which is scheduled for an implant placement, a decision needs to be taken in regards to the right time after tooth extraction to insert the implant. In this module you are going to learn all the important decision-making factors (anatomical, esthetical, clinical, radiographical and patient centered) to chose the correct timing for implant placement after tooth extraction.

Objectives:A recent, significant breakthrough in oral implantology was immediate implantation following tooth extraction, which reduces the number of surgical procedures required. The aim of this study was to test whether or not machine-surfaced implants, used for immediate loading of single-implant crowns in post-extraction sites, yields different results from conventional submerged two-stage implant positioning in healed sites with rough implants, in terms of implant survival after 6 months. Methods: Patients over 18 years of age requiring a single immediate post-extraction implant in the aesthetic area were enrolled in the study. The two adjacent teeth were required to be present. After gentle tooth extraction, a machine-surfaced implant (iMAXpro[TM]) with internal hexagonal connection was used. Different implant lengths and diameters were selected depending on the patient’s anatomy. Each implant was immediately loaded with a screw-retained provisional restoration. Implant insertion torque was also assessed with a manual wrench and reported as > 35 N/cm. The extraction socket had at least three intact walls, with partial dehiscence allowable on the fourth wall. If there was a residual gap of > 1mm between the implant surface and the buccal bone wall, it was filled with bone substitute (BioOss[tm] deproteinised bovine bone granules). After 6 months of follow-up, final prosthetic restoration was performed. Results: A total of 63 immediate loading post-extraction implants were positioned. All implants had uneventful healing, but five failed within 6 months. The implant success rate at 6 months was 92%. According to a defined standard, 58 implants fulfilled all the criteria of implant success: absence of persistent subjective complaints, such as pain, foreign body sensation, and/or dysaesthesia; absence of a recurrent peri-implant infection with bleeding and/or suppuration; absence of mobility; and absence of continuous radiolucency around the implant. No patients needed any additional surgical or pharmacological therapy. No implants showed signs of damage, such as fracture or bending. In 55 cases, the gap between the implant surface and buccal bone wall was > 1mm and was filled with BioOss[tm] granules, and in all cases there was a wound healing without complication, comparable to cases with no graft. Conclusion: Immediate implant placement with immediate loading provides good treatment outcomes and allows good functional and aesthetic results. It also addresses the psychosocial aspects of dental extraction. However, to achieve satisfactory results it is necessary to carefully select clinical cases and strictly apply the surgical and prosthetic protocols, with a well-trained team capable of controlling the surgical and prosthetic problems that can arise. In this study, the machine-surfaced fixture was shown to be effective for immediate loading of post-extraction implants, but it is necessary to follow-up all implants for a longer period. All patients will be checked again at 1, 2, 3, 4 and 5 years after implantation, using intraoral radiographs and aesthetic evaluation to confirm whether outcomes are comparable with conventional two-stage surgical techniques and other implant surfaces.