The placement of dental implants in postextraction sites has steadily increased in the past 15 years. In the 1980s, dental implants were only placed in healed sites. This approach, often called late implant placement, offered high success rates but had significant clinical disadvantages. 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 was long and lasted between 12 and 18 months. In the past 15 years, alternative procedures have been developed; these include immediate implant placement on the day of extraction, early implant placement with soft tissue healing, 4 to 8 weeks following extraction, and early implant placement with partial bone healing, 12 to 16 weeks following extraction. All of these treatment options, including late implant placement, have their indications based on clear clinical parameters. In esthetic sites, early implant placement following 4 to 8 weeks of soft tissue healing is clearly preferred, because it offers successful treatment outcomes with high predictability and a low risk for esthetic complications. In addition, this approach is well documented with clinical studies. The four placement options will be discussed, with their advantages and disadvantages, and documented with typical case reports.
Daniel Buser, DDS, Dr med dent, is professor and chairman of the Department of Oral Surgery and Stomatology and executive chairman of the School of Dental Medicine at the University of Bern in Switzerland. He has conducted research at Harvard School of Dental Medicine and Baylor College of Dentistry and spent a sabbatical year at the University of Melbourne in Australia. Dr Buser has served as president of various academic associations and foundations, including the European Association for Osseointegration, the Swiss Society of Oral Implantology, the Swiss Implant Foundation, and the International Team for Implantology. He has received several scientific awards, such as the André Schroeder Prize from the International Team for Implantology, the Osseointegration Foundation Research Award from the Academy of Osseointegration, and the Daniel M. Laskin Award from the American Association of Oral and Maxillofacial Surgeons. Author of roughly 250 publications, his main research interests are bone regeneration around endosseous implants, surface technology, and guided bone regeneration.