Immediate Implants — Same-Day Tooth Replacement After Extraction

Immediate placement is suitable when the socket walls are intact, infection is absent, and sufficient bone remains to anchor the implant. Most teeth in the front and premolar regions can be assessed for immediate placement once these conditions are confirmed.

The clinical criteria your clinician will assess include:

• Whether the socket walls (especially the facial/buccal wall) remain intact after the tooth is removed
• Whether sufficient bone exists beyond the socket apex (typically 3 millimetres or more) to give the implant primary anchorage
• Whether the gum thickness will support a stable soft tissue contour around the crown
• Whether the site is free of acute infection at the time of extraction
• The position of nearby anatomical structures (the sinus floor in the upper jaw, the nerve canal in the lower jaw)

Chronic periapical lesions are not always a barrier. Recent systematic reviews report comparable outcomes when sockets with chronic apical pathology are properly debrided before placement. Acute infection, by contrast, remains a contraindication. A CBCT scan (a 3D dental scan) is used to confirm the available bone before any decision is made.

Many patients enquiring about immediate placement are not just asking what it is. They want to know whether it fits their specific tooth, their general health, and the timeline they have available. That assessment is the central purpose of the implant consultation.

Same-day placement carries the standard implant risks plus a few specific to the immediate protocol. The procedure is well documented in the implant literature, with implant survival typically reported in the high nineties for appropriately selected cases.

General implant risks include implant failure (lack of integration), infection, nerve disturbance in the lower jaw, and sinus involvement in the upper jaw. Specific to immediate placement: the buccal bone wall continues to remodel after extraction regardless of how the site is managed, and a small amount of recession is common at the gum margin even in well-handled cases. Patient selection and surgical technique reduce these risks rather than eliminate them.

Certain patients carry higher risk. Smokers have lower success rates than non-smokers. Patients with uncontrolled diabetes (HbA1c above approximately 7.5 percent) need glycaemic control reviewed before treatment. Patients on anti-resorptive medication (oral bisphosphonates such as alendronate, intravenous treatments such as zoledronate, or denosumab injections) need a careful risk discussion before any surgical procedure that affects bone. The Scottish Dental Clinical Effectiveness Programme estimates the risk of medication-related osteonecrosis of the jaw in osteoporosis patients on these drugs at between 1 in 1,000 and 1 in 10,000, with intravenous treatments carrying substantially higher risk than oral. Recent head or neck radiotherapy is a further reason to delay or reconsider implant treatment.

In clinical practice, complications with immediate implants tend to surface in the early healing weeks. They are most commonly related to surgical technique, site assessment, or patient factors such as smoking, rather than the immediate-placement decision itself. Most are manageable when identified early at follow-up review.

If your tooth is in a position where immediate placement is not advisable, the alternative is usually the standard single tooth implant pathway with delayed placement. Implant outcome should not be compromised to keep treatment short.