Healed or fresh extraction socket
- Short term survival of implants placed in healed vs. fresh extraction sockets seems similar.
- Discrepancies in size between an extracted root and a more narrow immediately placed implant frequently require gaps to be filled with bone particles, aiming at bone site preservation.
- Long-term data on this subject are limited.
Single-tooth implants are often immediately placed after extraction of incisors, canines and bicuspids. Careful tooth removal with preserved bone socket walls and infection control provide for such an approach, often with immediate or early loading. Extracted molars with 2-3 roots will leave a huge bone defect behind and a staged approach is commonly used. This is due to difficulties in obtaining primary implant stability, but also due to the shortage of soft tissue volume to cover a submerged implant. In short-term follow-up studies no difference between placing implants in fresh extraction sockets vs. healed sockets was found. Recent literature shows that immediate implant placement combined with immediate loading does also not decrease survival rates of implants.
Immediate implant placement in fresh extraction sockets cannot prevent resorption of the alveolar crest, albeit guided bone regeneration using bone substitutes and a collagen membrane may improve preservation of the alveolar ridge height and width. An advantage of immediate placement of implants is however the preservation to a certain extent of the peri-implant soft tissue. After 2 years peri-implant bone resorption rates of implants placed in fresh extraction vs. healed sockets are similar.
Implants in healed extraction sockets
- Resolution of possible infections
- Healing of bone defects
- Increased soft tissue volume generated by soft tissue healing of the extraction socket
- Progressive reduction of bone volume by continuing alveolar ridge resorption. May be partly counteracted by filling the alveolus with e.g. xenogenic bone particles
- Extended treatment time
Figures 1 & 2: Root remnant in upper right central incisor position extracted. Figure 3: Alveolus filled with xenogenic bone and covered with a collagen membrane.
Figure 4: Radiograph obtained 6 months post extraction showing sufficient sagittal/vertical bone dimension. Figure 5: Placement of implant. Figure 6: Healing abutment connected 2 months post implant insertion.
Implants in fresh extraction sockets
- Reduction of total treatment time
- Reduction of patients’ discomfort
- Primary stability may be compromised
- Volume of keratinised mucosa on buccal/lingual site implant may be compromised
Figure 7: Root remnant in upper left central incisor position extracted. Figure 8: Immediate implant placement. Figure 9: Residual gap between implant and bone wall of alveolus filled with xenogenic bone. Figure 10: Covered with a collagen membrane.