Timing of Anterior Implant Placement Postextraction: Immediate Versus Early Placement

Type of Case: Implant placement in a postextraction site in the esthetic zone is a challenge for clinicians, since esthetic expectations of patients are high and potential esthetic complications can be devastating. The timing of implant placement is crucial, since it has an influence on esthetic treatment outcomes and the risk of complications. The topic of this paper is the timing of dental implant placement in the esthetic zone in relation to removal of the tooth to be replaced. Two opinions on the topic are presented. The first author (TGW) contends that under certain circumstances, immediate implant placement is appropriate in the esthetic zone. The second author (DB) favors early implant placement performed after 4 to 8 weeks of soft tissue healing. Both cite literature to substantiate their position and present their current therapeutic approach. Each author has been allowed to review the paper with the opposing view and comment. Clinical Approach #1 (TGW): By definition, an immediate implant is one that is put into position at the same surgery that the tooth to be replaced is removed. Sites that respond optimally to this approach in the esthetic zone are those with adequate bone for implant stability and an intact socket. Also important is the complete degranulation of the socket and in infected sites, the use of systemic antibiotics. The best implant position is normally to the palatal side of the extraction socket. This allows placement of hard and soft tissue grafts on the facial aspect, which increases the probability of esthetic outcomes. Clinical Approach #2 (DB): Following tooth extraction, early implant placement is performed after 4 to 8 weeks of soft tissue healing. This surgical approach allows implant insertion and simultaneous guided bone regeneration with an intact mucosa, which improves the predictability of contour augmentation. It is done with a resorbable collagen membrane, which is combined with autogenous bone grafts and a low-substitution, hydroxyapatite-based bone filler. In combination with a correct 3-dimensional implant position, successful contour augmentation provides a low risk for mucosal recession, and a convex contour of the alveolar process. Both are important prerequisites for successful esthetic outcomes.