Implant placement in fresh extraction sockets

Recent systematic reviews have shown that the survival rate of immediate implant placement is similar to those with a delayed approach. However, preclinical models and human studies have shown that immediate implant placement per se does not preserve the anatomy of the alveolus, mainly at the buccal bone crest, leading to bony dehiscences and subsequently to soft-tissue recession, with a great impact on esthetic outcomes. On the other hand, preclinical and human studies have identified factors that may prevent bone resorption after immediate implant placement, such as anatomical/biological (alveolus, gingival biotype, periapical/periodontal pathology) and surgical/restorative ones (implant diameter and positioning, flap/flapless, bone and connective tissue grafts, immediate loading/provisionalization, antibiotics). Taking these factors together and with a critical treatment plan made by an expert professional, the immediate treatment approach could be possible and beneficial for the patient.