Implants in Sockets: Healed vs Fresh?

Following tooth extraction, there is an inevitable remodeling process that can influence subsequent implant therapy. Several studies indicate that implants placed at the time of extraction have high success rates. But, are the success rates higher for fresh sockets or for those inserted in healed sockets? A recent study1, tackled this question, by measuring implant stability quotient (ISQ) values at three different time points after surgical procedures.

The conclusion:

The stabilities of the implants placed in the fresh sockets and in healed sites exhibited similar evolutions in ISQ values and thus osseointegration; however, the implants in the healed alveolar sites exhibited superior values at all time points.

In your practical experience do you think that implants placed into fresh sockets are more at risk for failure than implants placed in more mature bone? Has your treatment philosophy altered over time, based on the evidence? What do you feel now is the optimum treatment plan?

1.Stability of implants placed in fresh sockets versus healed alveolar sites: Early findings., Clin Oral Implants Res. 2016 May;27(5):577-82. Gehrke SA, et al.

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17 thoughts on “Implants in Sockets: Healed vs Fresh?

  1. Without question, there is a higher success rate in healed sockets than in fresh sockets. But sometimes, particularly with unsalvagable anterior teeth, we must perform immediate implants. If you can, waiting a month or so following extraction, when the site is “clean” and osteoblastic activity is intense, is a great time for implant placement.

      1. I will generally graft maxillary molar sites following extraction if the patient intends to have an implant placed. Elsewhere, if there is not a significant buccal wall defect and the space has a tooth to the mesial and distal of it, I generally find little need for grafting.

  2. As long as there is thorough debridement, the success rate is similar. Smokers and sites with failed endo can fail or develop peri-implantitis. Additionally, larger diameter implants should not be used. immediately. The large displacement can inhibit angiogenesis, osteogenesis and subsequent remodeling.

    1. This seems to be contrary to what Dr Tarnow is proposing these days. Especially with Max type 7-8mm wide implants. Have you heard him lecture about this recently?

      1. The literature actually states that it is best to place average size diameter implants rather (4-4.5) than large Diamter implants. Remember it is simple more blood healthier bone.
        Mikey (Calderon Institute.com)

  3. I’ve found no difference in short or long tern success rates for immediate implants compared to implants placed in healed extraction sites. However I will rarely place immediate implants into maxillary molar sites and will normally only place into mandibular molar sites when I’m able to insert the implant into one socket or the other, not down the middle. I am also careful with case selection for all immediate implants.

    1. Now we’re starting a whole new discussion, re: immediate implant placement in mandibular molar sites.
      Placement of the implant into “one socket or the other” can lead to periodontal or prosthetic disaster. The mesial or distal angulation of the crown will generally yield a food impaction situation; very uncomfortable for the patient, even if the implant survives.
      If you good inter-radicular bone following extraction of the mandibular molar and are far enough away from the inferior alveolar nerve, carefully reduce the height of the inter-radicular bone with a surgical #8 round bur, leaving about 3-4 mms of bone from the base of the socket. At that point, start your osteotomy preparation as usual. You will then be able to place a stable implant. You will certainly have to graft the empty space surrounding the implant, but this technique works well under the proper conditions.

  4. We are all prone to opinions but at the same time we were all taught a scientific approach to everything we do. There had never been a greater need for scientific guideline than now because of implants. So far we read opinions about procedures that start with ” I do…”. Are we professionals or craftsman?

    1. Exactly!
      Statistics dictate immediate implants have a greater failure rate. With that said it is imperative that practitioners make independent clinical decisions every time they have a surgical case.
      Many criteria affect the ultimate decision. Bone mass, cause of infection, patient immune profile, level of training of the surgeon. The list is too long to answer simply with a yes or no.

      1. Comparison of Immediate and Delayed Implants in the Maxillary Molar Region:
        A Retrospective Study of 123 Implants
        David Peñarrocha-Oltra, DDS1/Carla Leandro Demarchi, DDS, PhD2/Laura Maestre-Ferrín, DDS3/ Miguel Peñarrocha-Diago, MD, DDS, PhD4/María Peñarrocha-Diago, MD, DDS, PhD5

    2. Actually, a little bit of both. What would you have called Dr. Leonard Linkow? A craftsman? A professional? A visionary? Yes to all. But if you are going to consider yourself a surgeon, as well, thinking outside of the box is a must. As for the procedure that “I do” and am advocating, I have had great success with it over the years. There are certain procedures that are better performed by others and I include myself in that mix. But while following “scientific guidelines” we must all keep our minds open to methods that enhance our own practices and improve the lives of our patients.

  5. Rarely will I place an immediate molar implant. The success rate for these is still high but the relative degree of success, or excellence of result in terms of bone level on the implant or implant positioning etc are variable, so not acceptable. The situation I was referring to in using “one socket or the other” arises when a lower bridge from a second molar to second premolar fails at the molar. The bridge is sectioned at the distal of the premolar retainer, the molar extracted and an immediate implant placed in primarily the mesial or distal root socket along with another implant in the previous pontic site. Again case selection is key here as it is in any immediate implant placement.

  6. I think that if you have skills and logic you can select the case and by this increase your success rate.
    There is no clear yes and no indications
    I personally think that fresh socket is advantage

  7. If there is no infection [periodontitis[ inthe socket apically or coronolly implantation can be done but why extract the tooth then in some rare cases implantation becomes a must.At that point periodontal membrane sould be curetted and a proper size implant that will fill the socket must be chosen ofcourse this is impossible .The distance between the implant and the socket wall if 2 mm or less new bone formation may fill the gap or filling this space be an unresorbable implant material can be done but coronal resorption of bone sould be taken in to consideration.But in my opinion itis best to wait for the socket to be healed naturally before implantation.

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