[From an immediate implant placement in the post-extraction phase towards immediate loading application: current...

The fresh extraction socket site in the immediate post-extraction phase possesses unique characteristic wound healing cascade. Marked horizontal and vertical resorption of the edentulous ridge occurred shortly following tooth extraction. In periodontally involved teeth, when partial/full socket wall destruction is evident, the ingrowth of connective tissue into the extraction site is unavoidable leading to a deficient ridge. The use of bone substitute materials aiming to preserve the alveolar ridge by stabilizing the blood clot, thus maintaining the volume of the site and at the same time serves as an osteoconductive scaffold which facilitates continual bone formation. immediate Implant placement, is also a reliable, predictable, and successful procedure. Comparative studies regarding immediate implant placement vs. delayed placement (healed sites) reported similar high survival rate for both procedures. The addition of nonfunctional immediate provisionalization (clearance of all contacts in centric occlusion and during eccentric movements to avoid full functional loading of the implant during healing) achieving an instant aesthetic solution, has been shown to have predictable results. However, a meticulous surgical protocol should be followed. In recent years, an immediate functional loading of cross-arch splinted implants proved to be a reliable and successful approach. Moreover evidence-based data comparing immediate, early and delayed loading failed to show significant difference between those treatment modalities. Apparently, primary stability of implants is an important factor in achieving predictable success. It seems that the addition of controlled loading did not impair those results. A systematic review of the current literature related to this procedure showed a survival rate of over 95% in 34 prospective/retrospective studies. Since clinical parameters were proved to be equal whether implants were placed immediate post-extraction or delayed in a healed alveolar ridge, it appears that cross-arch immediate loading of implants placed in extraction and/or healed edentulous ridges is a predictable procedure with long term stability of the results.