Implant after tooth extraction: when it can be placed straight away and when it is better to wait a few weeks or months

How long after a tooth extraction can an implant be placed?

The consensus of the International Team for Implantology (ITI) distinguishes four timings for placing an implant after extraction. An immediate implant (type 1) is placed on the day the tooth is removed, an early one after the gum has healed (type 2, usually after 4 to 8 weeks) or after partial bone healing (type 3, usually after 12 to 16 weeks), and a late one (type 4) after full bone healing, that is, after more than 6 months.

The types describe the state of gum and bone healing, and the weeks given are typical ranges. Nor do they say when a tooth will appear on the implant, because that is a separate decision, described below. The whole course of implant treatment, from the CBCT scan to the crown, is covered in a separate article.

When can an implant be placed straight after extraction?

An implant straight after extraction needs conditions that the dentist assesses on the CBCT scan and during the procedure. The 2018 ITI consensus lists them for the most demanding version, an immediate implant with a temporary crown fitted straight away, and notes that this is a complex surgical and prosthetic procedure.

The older 2003 ITI consensus adds that when the bone wall on the lip side is damaged, an immediate implant is not recommended and a later timing is chosen. An implant is also not placed on the day of extraction if the shape of the bone does not allow it to be anchored stably in the correct position.

• Intact socket walls.
• A bone wall on the lip or cheek side at least 1 mm thick.
• Thick gum and mucosa at the implant site.
• No acute infection at the site of the procedure.
• Bone below the socket and on the palate or tongue side that allows the implant to be anchored stably.
• A bite that protects the temporary crown, and the patient’s cooperation during healing.

Immediate implant and immediate loading: how do they differ?

An immediate implant refers to when the implant is placed, and immediate loading to when a tooth is fitted on it; these are two separate decisions. According to the ITI definition, immediate loading means a crown within a week of placement, early loading from a week to 2 months, and conventional loading after more than 2 months.

The 2018 ITI consensus reports survival of 98% for immediate implants with immediate and early loading and 96% with conventional loading, and 96% for early implants with conventional loading. A Cochrane review found no convincing difference in implant failures between loading timings, and the 2023 ITI consensus considered an immediate implant with an immediate crown for a single upper front tooth to be predictable under favourable conditions.

Is an implant placed straight away more likely to fail?

The risk of losing an implant placed straight away is slightly higher in studies, but the difference is small. A review of 73 publications reports that 4.00% of implants placed in fresh sockets were lost, compared with 3.09% in healed sites, with the caveat that most of the studies were not randomised (Chrcanovic et al., 2015).

A more recent analysis of 163 publications confirmed the higher risk in fresh sockets, statistically significant in the upper jaw and not significant in the lower jaw. An earlier review prepared for the ITI reported survival above 95% in most studies and similar results for immediate and early implants (Chen and Buser, 2009).

What risk does an immediate implant carry in the front of the mouth?

The main risk of an immediate implant in the front of the mouth is the gum receding over the implant, which matters where it shows when you smile. A 2014 review reports that recession of the mucosa of more than 1 mm occurred at 9 to 41% of sites after immediate implant placement (median 26%) within 1 to 3 years, while after early placement it did not occur at all in two studies (Chen and Buser, 2014).

The same review describes two studies in which the bone wall on the lip side could not be seen on CT at 36% and 57% of sites after immediate placement, and these sites had more recession. Risk factors are a thin gum, an implant positioned too far towards the lip and a thin or damaged bone wall, which is why more recent studies apply strict patient selection criteria.

Socket preservation: when does it make sense if the implant will come later?

When the implant is to be placed later, socket preservation, that is, filling the socket with bone substitute material straight after extraction, can limit bone loss. Without it, the ridge loses 29 to 63% of its width and 11 to 22% of its height within 6 months, fastest in the first 3 to 6 months (Tan et al., 2012).

A 2021 Cochrane review (16 studies, 524 sockets) indicates that material of animal origin reduced the loss of width by 1.18 mm and of height by 1.35 mm at 6 months, but the certainty of this evidence is very low. No difference was shown in the need for later bone grafting or in implant loss. When bone is lacking in the back of the upper jaw, sinus floor elevation (a sinus lift) comes into play, described in a separate article.

What can you wear in place of the missing tooth until the crown is ready?

Until the final crown, the gap is filled by a temporary restoration, which restores appearance, helps with eating and keeps the space for the future crown. A 2017 review of temporary solutions divides them by when they are fitted, the material and how they are attached, and they matter aesthetically especially in the front of the upper jaw.

In the clinic’s price list, such solutions are a thermoplastic splint with an added tooth and an immediate denture, and with an immediate implant a 3D-printed temporary crown. Which to choose depends on the site, the timing of implant placement and whether the implant can take a crown straight away; the dentist decides in the treatment plan.

How much does an immediate implant cost?

The cost of an implant after tooth extraction is made up of the consultation and CBCT scan, the extraction itself, the implant, any socket preservation or bone grafting, a temporary restoration and the final crown. In the clinic’s price list, “Implantacja natychmiastowa z koroną tymczasową druk 3D” (immediate implant with a 3D-printed temporary crown) costs 5 000 zł, “Wszczepienie implantu” (implant placement) 3 500 zł, “Konsultacja implantologiczna” (implant consultation) 300 zł and “Tomografia komputerowa, szczęka lub żuchwa” (CBCT scan, upper or lower jaw) 300 zł.

“Zachowanie zębodołu” (socket preservation) is priced in the list “from 800 zł”, “Szyna termoplastyczna z dostawieniem zęba” (thermoplastic splint with an added tooth) costs 1 200 zł and “Proteza natychmiastowa” (immediate denture) 2 000 zł. The final crown is priced separately, and the full cost of treatment is discussed in the article on implant prices. The dentist sets the final scope and cost at the consultation, and prices may change.

How it works at DentalBlue

At DentalBlue in Białystok, implants are planned on a CBCT image from the clinic’s own radiology unit, which makes it possible to assess the socket walls and the amount of bone before the extraction. In selected situations the implant is placed straight after the tooth is removed, with a 3D-printed temporary crown. Extractions and implant procedures are performed under local anaesthesia or, for qualified patients, under general anaesthesia. A visit without pain includes a panoramic X-ray, a consultation, an examination and a written treatment plan. A consultation can be booked by phone.