Immediate implant is relatively technique sensitive, but with practice it becomes much easier and safer than delayed implant. In fact there is no absolute contraindication to it. It can be done in the socket with infection (1), bony and soft tissue defects, next to pathology, and systemic diseases.
The biggest advantage of immediate implant is that patients accept treatment plan easier. When they feel that the teeth are non salvageable, they want to get rid of them and build a new world at the same time. The most surprising is that immediate implant does not add up discomfort associated with surgery. In contrast, it decreases the chance of dry socket and pain.
There are three keys to successful immediate implant: primary stability, control of infection and design. Can an implant be placed next to an infected tooth?
The biggest challenge for immediate implants is how to close sockets. The sockets of the premolars and molars are large and irregular. Raising flap is associated with pain, delayed healing and esthetic issue. Placement of a large healing abutment or a provisional is a solution. In fact the provisional is a must sometimes (1 2 3). The latter can reduce chance of shifting of the neighboring teeth.
Common complications, which are rare, include implant loosening, fallout and malpositioning. Advantages and disadvantages of immediate implant is summarized by CT follow-up study
When an implant fails, it can be removed and a new larger implant placed immediately or in a delayed manner.
Sometimes immediate implant could be difficult due to pain, and hemorrhage. Sometimes in these situation, socket preservation (1) is preferable. Immediate implant is indicated in Type II and III extraction sockets.
Xin Wei, DDS, PhD, MS 1st edition 12/28/2013, last revision 05/14/2017