Timing of dental implant placement

Soon implantation
Early implantation can be recommended, if, due to acute inflammatory processes or anatomical compromise immediate implant placement may not be indicated. The aim of early implant placement is to shorten the treatment time of late implant placement and to bypass at the same time disadvantages of immediate implant placement. One of the most important advantages is the completed soft tissue healing.
Early implantations showed a very good implant survival rate of 91-100%. However, comparative prospective studies at other implantation time points are only available in very limited numbers. A recent systematic review showed no significant difference in implant survival depending on the time of implantation. Long-term stable peri-implant conditions can be achieved by augmentative measures during early implantation.

Immediate implantation
showed a reduced survival rate compared to soon or late implantation. Immediate implant placement is a complex surgical procedure and requires appropriate clinical expertise. Since its success depends on a variety of patient-sided systemic and local factors, the indication for each case should be made individually after careful consideration.

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Patients under medication with bone antiresorptive drugs or with radiatio in the head and neck region show a reduced rate of bone remodeling and bone new bone formation rate. Therefore, the indication for immediate implant placement and soon implantation should not be made.

Regardless of the time of implant placement, the untreated periodontally infected residual dentition is a risk to the success of the implant and should therefore be addressed prior to implant placement.

Taking a three-dimensional radiograph provides accurate bone dimension and possible local pathologies information and can be helpful for the decision-making process for immediate implant placement.

In patients with a thick gingival type, thick and intact vestibular bone lamella (> 1mm) and a small horizontal gap between the implant and the vestibular bone lamella (<2mm), simultaneous augmentation during immediate implant placement can be omitted.
In case of thin gingival type or thin vestibular bone lamella and vertical tissue deficit in the esthetic zone, simultaneous soft tissue and/or hard tissue augmentation/optimization should be performed during immediate implant placement.

Immediate implant placement can be performed with careful consideration of the indications in a chronically infected alveola without acute clinical symptoms.

Summary

Treatment planning for implant therapy should begin as soon as the indication for a tooth extraction with subsequent implantological treatment. The possible implantation schedules are differentiated with different clinical difficulties and treatment risks. The selection of the time of implantation is determined by the individual patient’s systemic and local factors. With regard to the systemic risk factors, it should be noted that a variety of diseases or therapies result in a compromised bone remodeling and new bone formation rate. This disturbed bone physiology should be taken into account by the clinician when determining the time of implantation. The timing of the implantation may have a negative impact on the survival and success if the specific requirements are not or only partially fulfilled. Furthermore, the decision is influenced by a multitude of local factors and is directly dependent on the respective soft and hard tissue properties of the alveola in the process of healing. and hard tissue properties of the healing alveolus.The predictability of implant success is largely determined by these local factors, although the initial local situation can be modified by augmentative measures. Implant placement is a technique-sensitive surgical intervention that varies in complexity depending on the time of implant placement, thus requires different prerequisites on the clinical expertise of the practitioner. Finally, the advantages and disadvantages of the various implant placement protocols must be analyzed on a patient-specific basis and carefully weighed for each case.