Figure 3: Implants in extraction sockets. Note void around implant and variations in size and shape of extraction sockets.
Click here to enlarge imageImmediate implant placement into the fresh extraction socket in conjunction with bone augmentation and/or socket preservation techniques has been reported using bioabsorbable or nonbioabsorbable membranes, as well as a variety of particulate bone graft materials. These immediate implant placement techniques have shown comparable results to that observed in delayed placement. They also have the added benefit of shortening the timeline to the final restoration.
Immediate implant placement into extraction sockets should only be considered if implant stability can be achieved. When primary stability is not possible, a staged approach should be used.
Unlike dental implants, sockets are not round and the extent that an implant fills the socket will vary (Figure 3). Krauser and Hahn have developed the Socket Seal classification (Table 1) which describes the extent to which an implant fills the extraction socket.
This classification can serve as a guideline to help the clinician determine if a staged approach is indicated rather than an immediate placement.
Generally speaking, Krauser and Hahn recommend immediate implant placement into an extraction socket when there is good primary implant stability, no horizontal bone loss, and no or minimal vertical bone loss (i.e., Grades I, II, and some Grade III).
For all other situations (Grades IIb, III, and IV), a staged approach is generally recommended.