How long after the extraction can an implant be placed?
This is a key question patients and referring colleagues want to know.
It’s also a question where differing dogmatic teaching protocols have resulted in very mixed messages - some advocating early placement and some delayed.
We are all aware of the volatile nature of alveolar bone but many will be surprised that 50% of the ridge width can be lost in the first 12 months. The advantages of immediate implant placement are very compelling but there are times when it is inappropriate, not possible or we may not yet have enough experience to make that treatment protocol predictable. In these circumstances we may have to wait.
The most helpful way to approach the question 'how long?’ is to understand what we are waiting for. If the barrier to immediate implant placement is an acute infection then we may reasonably wait for a few weeks for the infection to clear.
If we need to wait to grow viable keratinised mucoperiosteum then we will need to wait for a least eight weeks. If it is mature bone healing that we’re waiting for then we’re going to have to wait for 4-6 months!
The best time to make this judgement is after the extraction when thorough debridement and physical examination of the socket will give valuable insight.
A CBCT will also add diagnostic information to the mix- but be mindful that the best time for the CBCT is when we will get the most valid information from it (so, not now if we have already decided we’re going to wait!).
If we’re going to have to wait then we might consider limiting the volume loss with socket or ridge preservation. This usually involves the use of animal or synthetic bio-materials and therefore a comprehensive consent process.
So immediate, or early implant placement is possible and has benefits for volume stability - in the right circumstances!