The loss of bundle bone after tooth extraction results in alveolar ridge alterations during healing and thus, impacts the implant stability and the aesthetic results of the treatment. Various approaches have been introduced to minimize dimensional changes and maintain the integrity of the alveolar crest.
Thorough evaluation of biological and aesthetic aspects
The characteristics of the buccal bone determine the necessary procedure. This could be an immediate implantation with the insertion of implants at the time of tooth extraction. Early implantation is performed after minimally invasive tooth extraction and a healing time of 4–8 weeks, mostly following natural healing or socket seal technique. Delayed or late implantation in combination with socket preservation using bone substitute materials is a good option, particularly for thin buccal bone types. In cases of a non-intact buccal bone, ridge augmentation or preservation has to be carried out.
Immediate implant placement refers to a situation when a dental implant is placed immediately after the tooth is extracted. Prerequisite for this procedure is to obtain a sufficient primary stability of the placed implant. In addition, the presence of deficient bone walls, the periodontal phenotype and aesthetic demands are considered crucial for the decision of an immediate versus a delayed implantation.
After the natural healing of the extraction socket, an early implant placement procedure can be performed. According to the approach, the implant is placed after tooth extraction, before the bony regeneration of the socket has been completed. Typically, an early implantation is performed about 4–8 weeks after tooth extraction.
Socket/ Ridge Preservation
If a delayed/late implantation or restoration with a bridge is planned, the focus is on long-term bone preservation and the use of a bone substitute is recommended to preserve the alveolar bone. This may not prevent resorption of the bundle bone, but surely helps maintain the volume of the alveoli, thus enabling a later stable implant placement and improving the aesthetic outcome of the final prosthesis.