An immediate implant is a modern form of implant treatment in which a dental implant is placed immediately after tooth extraction. Immediate implants are considered a quick solution for immediately filling a tooth gap and aesthetically restoring the appearance following tooth loss. Compared to conventional implants, the treatment time is significantly shorter.
The tooth is extracted during the same appointment, and the implant is placed into the jawbone immediately. A prerequisite for successful immediate implantation is sufficient bone quality and the absence of inflammation. Many patients appreciate immediate restoration because a temporary prosthesis can often be placed. An experienced dentist determines on a case-by-case basis whether an immediate implant is possible.
Advantages and Possible Disadvantages of Immediate Implants—How Durable Is the Tooth?
The advantages of an immediate implant are
- fewer dental visits for the patient and
- less stress due to fewer surgical procedures on the jaw.
Among the advantages and disadvantages is that many patients benefit from a quick solution, since the implant is placed in the empty tooth socket immediately after extraction. The question of when an immediate implant is appropriate depends on stable bone structure, the absence of inflammation in the jaw area, and the individual situation; therefore, the advantages and disadvantages of immediate implants must be carefully weighed.
When comparing immediate implants to conventional dental implants, the “Teeth in a Day” concept allows the implant to be placed and, in many cases, a temporary crown to be attached during the same appointment, resulting in a fixed prosthesis. This immediate implantation is particularly aesthetically advantageous in the anterior region, as it covers the gums and closes the tooth gap while providing stabilization immediately after tooth extraction.
The procedure is usually performed under local anesthesia, with the implant being placed into the jawbone on the day of surgery. Healing begins after about 6–8 weeks, and after two to three months, the implant is usually fully integrated, making it capable of withstanding the forces of chewing over the long term and lasting a lifetime, provided no inflammation occurs in the area.
Requirements for the Use of Immediate Implants
An immediate implant is only advisable if ideal conditions are present. Otherwise, the immediate implant will not integrate properly. This could even necessitate further, sometimes complex, procedures. For example, it might become necessary to use a standard implant with bone grafting.
In cases of tooth loss or severe damage due to an accident, the jawbone is usually still intact. An intact jaw with sufficient solid bone mass is a prerequisite for an immediate implant.
If tooth decay is the reason for tooth extraction, there must be no inflammation present.
The following conditions must be met for an immediate implant:
- There must be no acute inflammation, such as in the area of the tooth root of the extracted tooth.
- The gum tissue must be firmly attached to the bone. Sometimes the gum tissue detaches when the tooth is extracted. To prevent this, experts use special instruments (periotomes). These are very thin and sharp, thus minimizing damage to the surrounding tissue. It is also possible to harvest and graft additional connective tissue, such as from the palate.
- There must be sufficient stable jawbone available.
The condition of the jawbone is a key factor in deciding whether to proceed with an immediate implant. An X-ray is only of limited help in assessing bone structure. Whether an immediate implant is possible can only be definitively determined after the tooth has been extracted.
The jawbone must be able to support the post of the immediate implant. Whether the bone density is sufficient for this becomes apparent only when the post is screwed in.
The dentist uses a device that works on the same principle as a torque wrench: as the post is screwed in, the device measures the force required in newton-centimeters (Ncm). For an immediate implant, the reading must be at least 30 Ncm. The higher the value, the better for the immediate implant.
If 30 Ncm is not reached, the dentist decides whether to adjust the treatment plan. For example, bone grafting may be necessary first.
When is an immediate implant appropriate, and how is it placed?
Techniques and Materials Used in Immediate Implantation
Structure of Immediate Implants
The basic structure of immediate implants is the same as that of a standard implant: The immediate implant is connected to the jawbone via a post. This is also called the implant body. It serves to anchor the dental prosthesis in the jaw.
In most cases, it is made of pure titanium or a titanium alloy. This material is widely used in prosthetic dentistry due to its stability. Patients generally tolerate it very well.
Alternatives include immediate implants made of zirconia ceramic. This material is increasingly being used and is also considered safe. However, long-term results regarding the durability of these immediate implants are not yet available. A crown is placed on top of the post. The crown is the actual visible dental prosthesis—in other words, the “new tooth.”
Structure of a dental implant: The post serves as the root, and the crown mimics the natural tooth and its function © ONYXprj | AdobeStock
Implant Placement
The size of the hole in the jaw is crucial for implanting the post. The space left by the extracted root does not exactly match the shape of the post.
If the hole needs to be enlarged, a compactor is used instead of a drill. As this device rotates, it pushes the bone material to the side so that it is not lost. The material remains available to provide a secure hold for the immediate implant.
Simultaneous augmentation—that is, filling the hole—is also possible. For immediate implants, the dentist uses a so-called bone substitute material. This material gradually resorbs over time. In this way, it ensures that the immediate implant integrates well.
Two Different Post Shapes
Two different post shapes can be used for an immediate implant. The apical post is relatively narrow but has a deep thread. As a result, when the immediate implant is placed, it literally cuts into the bone like a screw. The deep thread provides additional stability.
The alternative for an immediate implant is a coronal implant body. It is wider overall and has a shallower thread that gradually becomes tighter. In an immediate implant, the thread is tightest where the post is widest. When the immediate implant is screwed in, this causes slight compaction of the bone.
The forces exerted during chewing are absorbed by this compacted area. Thus, the immediate implant does not overload the bone.
With an immediate implant, soft tissue grafting may also be necessary under certain circumstances. This ensures a seamless finish.
The Material of the Permanent Crown
The crown should resemble the natural tooth as closely as possible. To achieve this, the dentist takes a plaster impression of the dentition before the tooth is extracted. This ensures that the artificial tooth fits perfectly into the gap. Only then can the immediate implant fully restore chewing function.
Solid cast gold crowns are no longer commonly used, even though they are well-tolerated and long-lasting. Gold crowns stand out too much in the dentition.
Ceramic Crowns
Nowadays, ceramic is the most popular material for crowns. Ceramic has very favorable properties; among other things, plaque does not accumulate on it as easily. Ceramic reflects light similarly to a natural tooth. As a result, the dental restoration is virtually indistinguishable from natural teeth.
Consequently, dentists usually recommend an all-ceramic crown for immediate implants. This crown contains no allergy-triggering components. It is therefore particularly well-suited for people who are prone to allergies.
Generally speaking, immediate implants with all-ceramic crowns are the most expensive option. However, prices vary widely. It may therefore be worthwhile for patients to obtain quotes from different dentists.
Statutory health insurance plans pay only a fixed subsidy for dental prosthetics. This subsidy depends, among other things, on the type of tooth being replaced—that is,
- a molar,
- incisor, or
- canine.
This also applies to immediate implants. The patient must cover the difference themselves or through supplemental dental insurance.
Alternatives to Ceramic Crowns
In recent years, a special type of ceramic called zirconia has gained popularity for immediate implants. It is considered particularly durable but behaves differently than standard ceramics when exposed to light. To ensure that the immediate implant looks like a natural tooth, it must therefore be veneered.
A ceramic-veneered crown can be a good alternative to an immediate implant. This option uses a more affordable metal framework. In a complex process, a plastic material is fired onto the framework layer by layer.
The immediate implant thus achieves the ceramic appearance that mimics natural teeth. However, this crown is less expensive than an all-ceramic crown.
It does have the disadvantage, however, that if the gums recede, a fine metal edge may become visible. This can be prevented using special techniques. For example, a so-called ceramic shoulder can cover this exact area.
The most affordable option for an immediate implant is a resin-veneered crown. As with ceramic veneering, a metal cap forms the foundation for the immediate implant. It is then covered with a biocompatible resin.
Color-matching the crown to the natural teeth
The dental restoration is fabricated in the dental laboratory. The crown is designed to meet aesthetic standards. For this reason, its color and shape are matched as closely as possible to the natural teeth.
Nowadays, dental technicians apply color in multiple layers, for example. This imitates a natural tooth even more effectively.
The finished crown can be refined later in terms of shape and color. Of course, this isn’t possible with gold crowns. They definitely stand out, and their color cannot be changed.
To determine the color of the dental prosthesis, the dentist compares various available shades with the natural color of the tooth © Aleksandr Rybalko | AdobeStock
Placement of the Crown
With an immediate implant, the supporting post is implanted immediately after the tooth is removed. However, the final crown may not be screwed on right away. The treating dentist decides whether the immediate implant can be loaded immediately.
Generally, there are two types of crowns: immediate restoration and immediate loading.
Immediate restoration: Use of a temporary crown
With immediate restoration, a temporary crown is placed on the immediate implant. It visually closes the gap in the same way as the final restoration will later, but it is slightly flatter. As a result, the temporary crown does not make contact with the opposing tooth. This means the teeth do not bite down on each other.
This protects the implant post and ensures proper healing. The patient should do their part by trying not to put pressure on that side of the jaw.
After about eight weeks, the dentist replaces the temporary crown with the permanent one. The immediate implant now fully takes over the function of the missing tooth.
Immediate Loading: Placement of the Permanent Crown
With immediate loading, the dentist places the permanent crown directly onto the implant. In this case, the jaw’s chewing force acts directly on the new post.
This method of immediate implant placement was viewed with skepticism for a long time. There were concerns that it would not ensure proper healing, which could result in the loss of the immediate implant.
However, there is another phenomenon to consider: The body uses its resources as efficiently as possible—if tissues or muscles are not needed, they atrophy. This also happens to the jawbone when a tooth is extracted: Since it no longer has to support a root at that site, it gradually resorbs over time.
Bone density and structure therefore deteriorate over time following tooth loss. This can only be counteracted by rapid replacement. Even with standard implants, patients should not wait too long; otherwise, there may not be enough bone material left for a dental implant.
Stress is always a signal for the body to strengthen bones and muscles. Immediate loading with an immediate implant takes advantage of these positive effects.
Various studies show that, in terms of the success rate of immediate implants, there are no significant differences between immediate loading and immediate restoration. However, this applies only if all the prerequisites for a positive outcome are met.
Factors that argue against immediate loading are not necessarily related to the condition of the jawbone. Diabetes or heavy smoking can also worsen the prognosis for an immediate implant.
Healing Times and Adhesive Bridges
It is not always possible to place a (temporary) crown immediately after implant placement. In some cases, the implant must first integrate with the bone. During this time, it must not be subjected to any load.
This is similar to the standard implant procedure, which also includes such a healing period. Nevertheless, the patient does not have to leave the dental office with a visible gap in their teeth.
One option here is an adhesive bridge (Maryland bridge). It is temporarily bonded to the adjacent teeth. The bridge ensures that the immediate implant is not subjected to any stress, while visually closing the gap.
This temporary restoration is securely fixed and is removed after about ten weeks. Only then does the dentist replace the immediate implant with the permanent crown.
FAQ
What is an immediate implant?
An immediate implant is a dental implant that is placed in the empty tooth socket immediately after tooth extraction, without waiting for a longer healing period.
When is an immediate implant possible?
An immediate implant is possible if there is no acute inflammation, there is sufficient jawbone, and good primary stability can be achieved.
What are the advantages of immediate implants?
Immediate implants offer a quick solution, a shorter treatment duration, fewer appointments, and often immediate aesthetic restoration of the tooth gap.
Are there any disadvantages to immediate implants?
Among the advantages and disadvantages of immediate implants is that they are not possible for every patient, and there is an increased risk if the healing process is disrupted.
How does immediate restoration work?
In immediate restoration, the implant is placed after tooth extraction, and a temporary prosthesis is usually attached, so that the tooth is immediately replaced both functionally and aesthetically.
