Under what circumstances can implant be placed at the same time as an extraction?

Implant: When there is good supporting bone. You would need atleast 3 mm of support below the previous tooth. The chances of complications with immediate implants are 5% higher than graft and wait, then do implant after 4-6 months.

Many: If the extraction site is not badly infected and can be thoroughly debrided, and there is sufficient bone for primary stability, you can usually place it @ same time. We look for a couple of things:1.Is implant diameter bigger than extraction site -- if so, we are in new, solid bone, 2. Can the implant be placed well beyond the socket depth where the root was. Must be clean and well anchored.

NO INFECTION: An implant should never be placed into an extraction site as the result of chronic or acute infection. Thus the only time we should practice immediate implant placement is when there is a traumatic fracture (fighting, fell on hard surface). In the case of infection, the extraction site should be drained, flushed, and allow to heal. Then we would come back six week later to graft and implant.

Few Variables: There are a few variables involved in an immediate implant placed at the time of extraction. The most important are presence of preexisting infection and amount of bone available to obtain primary stability of the implant. If the extraction site, if compromised by infection, or bone loss, may need to be augmented before the placement of an implant (possible bone or soft tissue graft). Best of luck.

For success?: That decision is highly dependent upon the surgeon and his philosophies. Some feel it is almost always an option, while others, as myself, prefer to have good, healthy, and sufficient existing mature bone present before placing an implant. Infection is one reason to not place an immediate implant. Under certain conditions, especially for esthetic reasons, immediate implants can be very successful.

Good bone no infect!: Implants placed at the time of an extraction should have a pt. In ideal health, a surg. Site absent of infection and plenty of properly located supporting bone for implant fixation. A pre-assess by 3d cbct x-ray can be critical. Also, expect a bone graft since an implant mimics a single, conically shaped root. Bone fills in the extra sockets of multi-rooted teeth & gaps left by ovoid roots.