Scientifically supported evidence for immediate implant placement and provisionalization has gained more support in literature. Although data varies between practitioners and clinical settings, there is a consensus among doctors that there is a fairly high success and stability for immediate or delayed implant placement.
Keep in mind, good patient anatomy, favorable hard/soft tissue factors, and idealized techniques for the situation still are in play. A clinician’s familiarity and experience will be a factor if it is safe for them to do immediate placement. Additionally, any ideal patient may still result in implant failures if there is a failure to recognize red flags in a delayed implant placement case. Each patient case requires a customized treatment plan which requires different degrees of expertise. However, if one was able to get an immediate placement, a surgical visit can be saved.
The traditional protocol for delayed treatment allows greater bone interface with the implant. On top of that, surgical guides planned with cone beam computed tomography, the surgery can be performed though the gingiva and periosteum. With a healing cap often placed on top afterwards, we can avoid any suturing. Two-stage models also still have a place for scenarios requiring fixed or removable prosthodontics. A downside to note would be the possible need for a removable denture if you were in full arch scenarios that would expose it to lateral forces during chewing/biting. Those forces can lead to early implant failure.
Implants that qualify for immediate placement can help preserve bone and tissue structures as sometimes a delay can lead to changes in the anatomical site. Obviously immediate placement allows you to reduce surgical intervention and trauma to the site if possible. Immediate placement is aided by the fact that the modern implants have osteophilic properties that promote bone growth and osseointegration.
Some practitioners fairly argue that immediate placements still come with other risks. There is risk of higher difficulty in the implant placement and position. Gaining primary stability is also much harder. Finally, the prosthodontic restoration may be more difficult to place if the implant placement is not ideal. The immediate placement has greater demands when there are needs such as hard and soft tissue augmentation, provisionalization, extraction, and debridement. The more difficult cases have sites that make immediate placement very risky and unpredictable.
Brian Y. Kuo DDS FAGD
🦷 Q-Implant certified dentist