Many people think that after a tooth is removed, you always have to wait several months before an implant can be placed. That isn't always true.

In some cases, the tooth can be removed and the implant placed in the same procedure. This is called immediate implant placement.

It isn't always the best option, though.

Whether an implant can be placed straight away depends on many things, including why the tooth is being removed, whether there is infection, how much bone there is around the root, the condition of the gums and where in the mouth the tooth is.

What does immediate implant placement mean?

When a tooth is removed, a space is left in the bone where the root used to be. In some cases, an implant can be placed in that space right away, at the same visit as the extraction.

This doesn't always mean the patient gets a final tooth on the same day.

It's important to separate three steps:

• removing the tooth
• placing the implant
• fitting a crown or temporary tooth on the implant

Often all of this can be done on the same day. Sometimes the tooth can be removed and the implant placed straight away, but the crown is fitted later. Sometimes it's safer to remove the tooth first, let the area heal and place the implant later.

Why can it be an advantage to place the implant straight away?

When conditions are good, it can be an advantage to combine the extraction and the implant placement into one procedure. That means fewer visits, and the total treatment time can be shorter.

In some cases, immediate placement can also help preserve the shape of the gums and bone, especially when the treatment is well planned and carried out correctly. This can matter a lot in the front of the mouth, where the appearance of the gums and smile line is especially important.

For the patient, this can be convenient: one procedure instead of two, and often a shorter path to the final result.

When can an implant be placed at the same time a tooth is removed?

It's mainly possible when conditions are favourable.

There needs to be enough bone for the implant to be stable from the start. The dentist must be able to place the implant in the right position: not just in the socket where the root was, but in the position that best suits the future tooth.

The gums also need to be in good condition, and any infection must be under control. If the tooth is being removed because of a fracture, a root crack or decay that can't be treated, conditions for immediate placement can sometimes be very good, as long as the surrounding bone walls are sufficiently intact.

In short, we need to assess:

• whether there is enough bone
• whether the implant can achieve good initial stability
• whether there is infection
• whether the gums are healthy
• whether the implant can be positioned correctly for the future crown
• whether the aesthetic risk is low or high
• whether the patient can keep the area clean
• whether general health and medication could affect healing

When is it better to wait?

It isn't always sensible to place an implant straight away. This can apply if there is significant infection, if a lot of bone has been lost, if the gums are unstable or if the implant can't be placed in the right position.

It can also be better to wait if the front tooth area is very sensitive aesthetically. There, a small change in the gums or bone can have a big effect on the final appearance. In such cases it can be safer to remove the tooth, rebuild bone or gum tissue if needed, and place the implant later.

Waiting isn't necessarily worse. Sometimes it's the best way to get a safer and better-looking long-term result.

Can an implant be placed if there is infection around the tooth?

This needs to be assessed case by case.

In the past, infection was often seen as a clear reason to wait before placing an implant. Newer research shows that in selected cases it may be possible to place an implant straight away, even if there was inflammation or infection around the root, as long as the area is cleaned very thoroughly and there is enough healthy bone.

That doesn't mean it's always possible. Acute infection, pus, major bone loss or uncertainty about how well the area can be cleaned can all be reasons to wait.

The goal isn't to make the treatment as fast as possible, but to give the implant the best possible chance of lasting long term.

Do you get a tooth on the same day?

Sometimes, but not always.

In some cases a temporary tooth can be fitted on the implant the same day, especially in the front of the mouth where it's important that the patient doesn't have a visible gap. This tooth is usually made so that it takes little or no pressure when biting while the implant heals.

In other cases it's better to let the implant heal under the gum or with a small healing cap and fit the crown later. This is especially common when conditions aren't ideal or when there's a risk of too much load on a newly placed implant.

Getting a "tooth on the same day" sounds simple, but it has to be the right case.

Why is a bone graft sometimes needed?

When a tooth is removed, there's a space in the bone around the implant. The implant rarely fills the whole space left by the root. That's why bone grafting material is often placed in the gap between the implant and the bone wall.

This supports the surrounding bone and gums and reduces the chance of the area collapsing during healing. It can be particularly important in the front of the mouth, where the gums are clearly visible.

Sometimes a connective tissue graft or other soft tissue treatment is also needed if the gums are thin or the aesthetic risk is high.

Why is an X-ray or 3D scan needed?

It isn't possible to make a good decision just by looking at the tooth in the mouth. X-rays show the roots, bone, infection and nearby important structures, such as the sinus in the upper jaw or the nerve in the lower jaw.

In some cases a standard X-ray is enough. In most cases a 3D scan is needed to assess the amount and thickness of the bone and the best position for the implant.

A thorough diagnosis before the procedure is one of the most important factors in deciding whether to place the implant straight away or wait.

Is immediate placement better than waiting?

Not always.

Immediate placement can be a very good treatment in carefully selected cases. It can shorten treatment time, reduce the number of procedures and sometimes help preserve the appearance of the gums and bone.

But it isn't automatically better than waiting. It's more technically demanding and requires the right conditions. If an implant is placed in unfavourable conditions, it can increase the risk of problems, such as poor implant position, gum recession, bone loss or a less attractive result.

Sometimes the safest and best treatment is to remove the tooth first, let the area heal and place the implant later.

How is the decision made?

The decision is based on an examination, X-rays and an assessment of the risks.

Among other things, the dentist assesses:

• why the tooth needs to be removed
• whether there is infection or inflammation
• how much bone there is around the tooth
• whether the implant can achieve enough stability
• whether the implant can be positioned correctly for the future crown
• whether bone grafting is needed
• whether soft tissue treatment is needed
• whether a temporary tooth can be fitted
• how the bite works
• the patient's general health, smoking and medication

This is an individual assessment. The same solution doesn't suit everyone.

Conclusion

Yes, sometimes an implant can be placed at the same time a tooth is removed.

It can be a very good solution when there is enough bone, infection is under control, the gums are healthy and the implant can be placed in the right position. In such cases the treatment can be simpler for the patient and the total treatment time shorter.

But it's not always best to rush.

In many cases it's better to remove the tooth first, let the area heal or rebuild bone, and place the implant later. The goal isn't just to place an implant as soon as possible, but to choose the treatment that gives the best chance of a good, safe and attractive long-term result.

So an implant isn't placed straight away just because it can be. It's placed straight away when the conditions are right.

References

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