Tooth Extraction and Immediate Implant Placement

In 1989, Lazzara defined the immediate implantation protocol following tooth extraction. The researcher argued that graft material and/or membrane should be used for this. The implant should be as long as the bone allows to achieve good primary stability. Today, the placement of wide-diameter implants after tooth extraction is recommended for immediate implantation. Wide-diameter implants will better fill the alveolar space. Increasing the implant diameter also increases the primary stability of the implant and reduces the need for biomaterial placement.


Extraction of any teeth without a source of infection
Traumatic tooth avulsion with preserved bone
Endodontic complications requiring extraction
Root cracks and fractures
Permanent tooth agenesis and resorption of deciduous tooth roots
Internal or external root resorption
Root resorption following orthodontic treatment

Minimal alveolar bone resorption after tooth extraction
Shorter treatment time
Fewer surgical procedures
Use of the tooth axis
Good physiological adaptation of the patient


Difficulty in covering the implant area with the gum after extraction

Sometimes insufficient primary stability of the implant


Severe bone loss before or after tooth extraction

Inadequate amount of bone to provide stabilization of the implant at the apex of the tooth

Anatomical formations (nerve, sinus)

Severe infection requiring tooth extraction

Esthetic and primary closure of the implant area should be taken into account when opening the flap during the procedure. Atraumatic tooth extraction helps preserve the integrity of the alveolar bone. The alveolar space should be cleared of all granulation tissue remnants. Immediate or delayed implantation is decided based on morphology and bone volume. Even if the existing bone wall is insufficient, the implant can be placed while paying attention to the implant’s primary stability.

In some cases, the exposed implant surface can be covered using bone grafts and/or membranes. In such cases, the flap should completely cover the implant area.

It is crucial to determine the location where the implant will be placed in the anterior region precisely. Excessive buccal placement of the implant causes poor aesthetics. On the other hand, excessive lingual placement of the implant can be corrected by increasing the contour of the prosthetic restoration. The increase in contour towards buccal in the prosthetic restoration makes hygiene and maintenance of peri-implant tissues difficult.

During the osseointegration period, temporary restorations should not apply pressure on the implant. Micro-movements of the soft tissues covering the implant during this process can lead to implant loss.