The placement of dental implants in extraction sites has steadily increased in the past 15 years. In the 1980s, dental implants were only inserted in healed sites. This approach—often called late implant placement—offered high success rates, but also had significant clinical disadvantages. Most importantly, local bone atrophy was often observed at extraction sites within 6 to 12 months of healing, resulting in contraindications for implant therapy. In addition, the time from extraction to implant restoration lasted often between 12 to 18 months. To eliminate these disadvantages, alternative procedures were developed, such as immediate implant placement on the day of extraction or early implant placement 4 to 8 weeks following extraction and an initial soft tissue healing period. Whereas immediate implant placement has received a lot of attention at implant conferences, early implant placement has been overlooked for many years.
This lecture will present the rationale and clinical procedures for early implant placement in the esthetic zone. Details of extraction technique, socket handling, flap design, correct three-dimensional implant positioning, simultaneous bone augmentation with guided bone regeneration, and a tension-free primary wound closure technique will be demonstrated. In addition, the results of two clinical studies, a retrospective study on 45 patients, and a prospective study on 20 patients will be presented. Both studies clearly demonstrate that this approach offers good clinical outcomes with high predictability and a low risk for esthetic complications. Therefore, this approach can be recommended for daily practice.