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Dr. Khalid AletaibiConservative Dentistry · Dubai

One appointment, or two stages

Immediate implants: placing at the extraction, and when not to

There is a moment, right after a tooth is removed, when the socket is the exact shape of the root that was in it. Placing an implant then rather than months later saves a surgery and a wait, and it is the reason the approach exists. It is also a narrower window than it sounds, because the socket has to be intact, the bone around it has to hold the implant still, and the tissue has to be healthy enough to close over the result.

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Quick answer

An immediate implant is placed into the socket at the same appointment the tooth is removed, rather than after the site has healed for several months. A 2024 systematic review and meta-analysis of 16 studies compared immediate placement with immediate provisionalisation against delayed placement in the front of the mouth and found no difference in crestal bone levels, comparable implant success and survival, and around 1 mm less facial gum recession than in sites that were grafted and left to heal. It also found more implant-related complications in the immediate group.[^1] Dr. Khalid Aletaibi plans the case with the implant surgeon and does the restoration; whether the socket qualifies is decided at the extraction itself, not promised in advance.

What it is

The implant placed at the extraction appointment

Against delayed placement

Comparable survival, more complications

Aesthetic difference

About 1 mm less facial recession

Decided when

At the extraction, with the socket in view

How Dr. Khalid helps

The decision is made twice: once on the images beforehand, and once with the tooth out and the socket visible, because the wall of bone on the outer side is thin and its condition is the thing that most often changes the plan. Dr. Khalid Aletaibi plans the case with the implant surgeon from the restoration backwards, so the implant position is chosen for where the crown has to emerge rather than for where the socket happens to lead. He makes and fits the provisional and the definitive restoration. If the socket does not qualify on the day, the honest move is to graft and wait, and that possibility is part of the consent rather than a surprise.

What immediate placement is actually buying

Two things, and they are worth separating. The first is time and surgery: one procedure instead of two, and months removed from the sequence. The second is tissue. A socket left empty changes shape as it heals, and the soft tissue follows the bone underneath it. Placing an implant and a provisional crown immediately gives that tissue something to hold its shape against while it heals, which is why the aesthetic findings in the evidence favour it.

What it does not buy is a shortcut past the biology. The implant still has to integrate with bone, and that takes the same months it always did. The provisional crown fitted on the day is out of the bite while that happens. Same-day teeth and same-day function are different claims, and only the first one is being made.

The outer wall of bone decides most of it

On the front of an upper tooth, the plate of bone between the root and the lip is often less than a millimetre thick, and sometimes it is not there at all before the tooth is removed. If it is intact, an implant can sit behind it with the tissue supported. If it is fractured or missing, placing into that socket puts the implant where the bone cannot protect it, and the gum above it recedes to find the new bone level. This is why the second decision is made with the tooth out and the socket in view.

Where grafting first is the better sequence

Where the socket cannot hold an implant still, or the outer wall has gone, or infection has taken bone with it, the sequence changes: the site is grafted, given months to consolidate, and the implant placed into rebuilt bone at a later visit. This is not a lesser version of the treatment. It is the version that produces a stable result when the immediate one would not, and building the bone first is often what makes the implant possible at all.

Immediate, or graft and wait

Immediate, or graft and wait
What happensWhen it is the right sequence
Immediate placementThe implant goes into the socket at the extraction, usually with a provisional crown out of the bite while it integrates.The socket is intact, the outer wall of bone is present, the implant is stable at placement, and there is no active infection.
Graft first, implant laterThe site is grafted and closed, given months to consolidate, and the implant placed into rebuilt bone at a later appointment.The wall is fractured or absent, the socket cannot hold an implant still, or infection has taken bone. This is a normal outcome, not a failure.

What to expect

In practice

  • The plan drawn from where the crown has to emerge, not from where the socket leads
  • A second decision at the extraction itself, once the socket can actually be seen
  • Grafting and waiting offered as a real outcome, not treated as a failure
  • The higher complication rate of immediate placement stated before you consent
  • The provisional and the definitive restoration made and fitted by Dr. Khalid Aletaibi

You always get an honest opinion and a written plan before any treatment begins, with no pressure.

Common questions

Frequently asked questions

Is an immediate implant less reliable than waiting?
On survival, the review found them comparable to delayed placement, with no difference in crestal bone levels in the anterior maxilla and similar success and survival rates. What it did find was more implant-related complications in the immediate group.[^1] Those are two different things: the implant is about as likely to be there in five years, and the road there has more events on it. Whether that trade is worth making depends on the socket in front of you rather than on a preference.
Will the gum look right afterwards?
This is where immediate placement has its clearest advantage. The same review reported roughly 1 mm less facial gingival recession where the implant was placed immediately and provisionalised than where the socket was grafted instead, and no difference in papilla loss compared with delayed placement. A flapless approach preserved the papillae better than raising a full-thickness flap.[^1] A millimetre sounds small; on a front tooth it is the difference between a result you stop noticing and one you do not.
Does the gap around the implant need filling with bone?
A socket is wider than the implant that goes into it, so a gap exists by definition. Among the studies that filled that gap with graft material, the review found no significant difference in bone level changes.[^1] That is a narrower finding than it sounds and it does not mean grafting the gap is pointless, only that the evidence in these studies did not separate the two. The decision is made at the site, on how wide the gap is and how thin the outer wall is.
What happens if the socket turns out not to be suitable?
The site is grafted, closed, and left to heal, and the implant is placed at a later visit. That is a normal outcome rather than a complication, and it is the reason it is discussed before the extraction rather than after. What makes it a problem is only being told about it once it has happened. Ridge preservation at that point is worth doing on its own terms: no graft material fully prevents the ridge from shrinking, but the reduction is measurably smaller than leaving the socket empty.[^2]

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