Immediate vs delayed implant after extraction

Body

According to the classification proposed by Hämmerle and colleagues, immediate dental implants refer to implant placement at the time of tooth extraction, while delayed dental implants involve implant placement after complete healing of the extraction socket, typically 3 months or more post-extraction.9 Delayed dental implants give sufficient healing time to the extraction wound to ensure complete healing of soft and hard tissues for successful osseointegration.9 However, studies have shown that the need for complete post-extraction healing prior to implant placement is not essential,3,40 and furthermore, while waiting for the socket to heal, physiologic resorption of the alveolar bone may occur, which affects the long-term stability of the implant, and the patient will have to tolerate aesthetic and chewing limitations during the period of missing teeth.41 In contrast, immediate dental implantation has the advantages of reducing the number of patient visits and shortening the treatment period by virtue of its ability to place the implant immediately after tooth extraction, and it can preserve the original structure and blood flow of the alveolar bone to a certain extent, which is theoretically favourable for the early integration of the implant with the alveolar bone.37,43 Immediate dental implants have been reported to minimise post-extraction bone resorption, thereby preserving periodontal structure and bringing better aesthetic treatment results.7,8,46 Despite the fact that these two implant modalities have been used in clinical practice for a long time, there is still controversy about their effects on implant survival, patient satisfaction, and quality of life.

Impact of Immediate vs Delayed Dental Implants on Survival, Patient Satisfaction, and Quality of Life. © 2026 by Quintessence Publishing Co Inc. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Introduction

A comprehensive review of the literature reported that although both immediate and delayed implants have high survival rates, immediate placement may lead to a slightly higher risk of complications, including early failure (Chen and Buser 2009). A recent meta‐analysis that compared the survival of implants placed immediately and delayed following tooth extraction reported no significant differences, whereas a focused analysis showed that slightly more failures occurred in the immediate dental implant placement group (Patel et al. 2023). Another meta‐analysis showed that immediate implants placed in fresh extraction sockets show significantly lower survival rates than delayed implants, whereas no differences were detected in terms of marginal bone loss, implant stability, and probing pocket depths (Mello et al. 2017). Moreover, a meta‐analysis that included only randomized clinical trials concluded that immediate implants in the anterior area showed better results, whereas molar sites showed more favorable outcomes with delayed implants (Canellas et al. 2019).

Assessing the Long‐Term Survival of Dental Implants in A Retrospective Analysis: Immediate Versus Delayed Placement. © 2025 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

DISCUSSION

This randomised controlled trial demonstrates that within 1 year, immediate and delayed implants achieve similar survival rates, while immediate implantation yields significantly better peri-implant health indices and patient-reported outcomes. The findings of this study support the null hypothesis regarding 1-year survival but reveal important differences in secondary outcomes that have substantial clinical relevance for patient care and treatment planning. Dental implants have become a reliable treatment for replacing missing teeth with aesthetic and functional benefits and have a favourable long-term prognosis.7,32 Historically, delayed implantation was the most common surgical approach for patients with missing teeth treated with implant restorations, which was mainly performed after the patient had undergone extraction with a healing period of more than 3 months to allow for complete socket healing.3,27 In contrast, immediate implantation is an evolving technique in which the implant is placed immediately after tooth extraction, thus effectively shortening the duration of implant restoration and potentially reducing the occurrence of alveolar bone atrophy or resorption.8,42

Impact of Immediate vs Delayed Dental Implants on Survival, Patient Satisfaction, and Quality of Life. © 2026 by Quintessence Publishing Co Inc. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Introduction

Immediate implant placement is an alternative technique to the conventional one-stage and two-stage techniques [1, 2]. Immediate implant placement minimizes bony contour and soft tissue alteration, preserves bone volume, allows for greater ease in determining the implant position for rehabilitation of the final restoration, minimizes the extent of alveolar bone loss after extraction [3–5], decreases the number of surgeries, reduces treatment time, and provides faster recovery of dental functions [6, 7]. However, case selection must be done for the immediate implant placement. The considerations for immediate implant placement are as follows: (1) medical status of the patient; (2) bony plates remaining in the socket; (3) intraradicular septum in multiple root sockets; (4) amount of apical bone; (5) diagnosis of the tooth, and (6) soft tissue health [8, 9].

Clinical outcomes of 3–5 years follow-up of immediate implant placement in posterior teeth: a prospective study. © The Author(s) 2024. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Introduction

Dental implants are an important treatment for restoring function in total or partially edentulous patients. For many years, the standard procedure for dental implant treatment has been to place the dental implant in the healed bone and make it functional after a certain healing period [1]. With the changes observed in implant surgery over time, immediate placement of dental implants in extraction sockets has proven to be a viable and safe treatment option [2–4]. Immediate implant placement has some distinct advantages, such as reducing the number of surgical procedures, shortening the healing process, reducing stress on the patient, and better preservation of soft tissue morphology and alveolar morphology [5–7]. In addition to the advantages, some disadvantages such as the need for the application of regenerative methods can be observed. In addition, the need for the use of bone grafts and barrier membranes may increase due to the incompatibility between the extraction socket and dental implant morphology.

Retrospective analysis of dental implants immediately placed in extraction sockets with periapical pathology: immediate implant placement in infected areas. © The Author(s) 2023. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Abstract

Implant placement in post-extraction sites of single teeth in the esthetic zone has been a topic of great interest in the field of implant dentistry since 1990. Triggered by the development of guided bone regeneration, the concept of immediate implant placement became quite popular in the 1990s. In the past 12 years, however, the dental community has begun to focus increasingly on the esthetic outcomes of post-extraction implant placement and several studies indicated a significant risk for the development of mucosal recessions with immediate implants. Parallel with this, significant progress has been made in the understanding of tissue biology in terms of hard and soft tissue alterations post extraction, based on preclinical, clinical and radiological studies. This knowledge has helped better to understand the etiology of these esthetic complications with immediate implant placement. The present review first analyzes the various phases of the development of therapeutic strategies over the years for post-extraction implant placement in single tooth sites in the esthetic zone. It presents the current knowledge concerning the terminology with immediate, early and late implant placement, the risk factors for the development of esthetic complications, and the selection criteria for the various treatment options. In the second part, clinical recommendations are given, since a clinician active in this field of implant therapy can use all treatment options depending on the preoperative analysis including a 3D cone beam computed tomography. The selection criteria for all four treatment options are presented and documented with typical case reports to illustrate the current treatment approaches applied in daily practice.

Abstract

BACKGROUND: Traditionally, before placing dental implants, the compromised teeth are removed and the extraction sockets are left to heal for several months. To preserve the alveolar bone level from the collapse caused by healing and to reduce treatment time in situations in which tooth extraction precedes implant placement, some clinicians began to install the implant immediately into the postextraction socket without waiting for the site to heal. PURPOSE: The purpose of this study was to review the literature regarding treatment outcomes of immediate implant placement into sites exhibiting pathology after clinical procedures to perform the decontamination of the implant's site. The following questions were raised: Does the presence of periodontal or endodontic infection affect immediate implant placement success? What is suggested to address the infection in the socket prior to immediate placement? MATERIALS AND METHODS: An electronic search in PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) was undertaken in March 2013. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included both animal and human studies, and excluded any review and case reports articles. The publication's intervention had to have been implant placement into a site classified as having an infection (periapical, endodontic, perioendodontic, and periodontal). RESULTS: The search strategy initially yielded 706 references. Thirty-two studies were identified within the selection criteria, from which nine were case reports and review articles and were excluded. Additional hand-searching of the reference lists of selected studies yielded five additional papers. CONCLUSIONS: The high survival rate obtained in several studies supports the hypothesis that implants may be successfully osseointegrated when placed immediately after extraction of teeth presenting endodontic and periodontal lesions, provided that appropriate clinical procedures are performed before the implant surgical procedure such as meticulous cleaning, socket curettage/debridement, and chlorhexidine 0.12% rinse. However, more randomized controlled clinical trials with a longer follow-up are required to confirm this procedure as a safe treatment. Moreover, the outcome measures were not related to the type of infection; the classification of infection was often vague and varied among the studies. The benefits of antibiotic solution irrigation and systemic antibiotic administration in such conditions are not yet proved and remain unclear.

Abstract

OBJECTIVES: To compare the impact of immediate and delayed implant placement upon the survival of implants and to investigate the differences in implant survival between immediate and delayed placement in adults. METHODS: A search for the relevant literature was performed using the databases of CENTRAL, MEDLINE and Scopus. The studies found were limited to publications between 2014 and 2022, written in the English language, peer-reviewed, and were randomised trials or comparative studies. The quality of the evidence was assessed using the Cochrane Risk of Bias 2.0 and Risk of Bias in Non-randomised Studies-of Interventions appraisal tools and implant survival, and the primary outcome was meta-analysed using RevMan v.5.3. RESULTS: A total of 10 studies were eligible for inclusion, including six randomised controlled trials and four non-randomised comparative studies. Five of the six randomised trials observed a low risk of bias, while the comparative studies had a moderate-to-serious risk of bias. The search strategy resulted in 341 implants placed immediately into fresh extraction sites (332 survived, 97.4%) and 359 implants inserted into delayed sites (350 survived, 97.5%). CONCLUSION: The meta-analysis demonstrated that there was no significant difference in the implant survival rates between immediately placed implants and implants placed using a delayed timing protocol (risk ratio 0.99; 95% CI 0.96, 1.02, Z = 0.75, p = 0.45). However, the detailed analysis showed that slightly more implant failures happened in the immediate dental implant placement group, with survival rates in some studies ranging between 90 and 95%, while the delayed placement group had survival rates of more than 95%.

Abstract

The placement of immediate dental implants in the esthetic zone is a highly successful procedure, however it requires careful case selection. Depending on the structural integrity of the alveolar socket and the gingival level, either an implant can be placed immediately and provisionalized or its insertion may need to be delayed. If the extraction site is compromised, implant placement should be deferred to allow bone or soft-tissue grafting or a combination of both to facilitate esthetic implant placement. In addition, two other treatment factors need to be considered with regard to immediate placement: (1) if the implant has low primary stability (ie, low insertion torque value), a custom healing abutment should be fabricated to maintain tissue contour and retain bone placed into the buccal gap; (2) if there is high primary stability (ie, high insertion torque value), fabrication of an immediate fixed provisional will preserve tissue contour, hold a buccal gap bone graft in place, and provide an esthetic result. At sites where the implant will be placed, factors favoring immediate placement include the following: coronal position of the gingiva compared to adjacent teeth, a type I socket classification, and class I or II sagittal root position. The purpose of this article is to present clinical guidelines that can aid in the decision-making process for delayed versus immediate implant placement.