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Authors: Dr. P. Venkat Ratna Nag


Immediate implants are the ones which can be placed in fresh sockets just after tooth extraction. They are considered to be an attractive option to patients as well as the dentists. The intention ofimmediate implantation is to preserve tissue contour, dimension, and also to decrease the time of the treatment. These have become widely accepted despite controversial beginning. This case describesthe immediate placement of a dental implant in the extraction socket using the TTPHIL technique.


Endosseous implant therapy is becoming the prosthetic standard of care for many clinical applications, but despite the high success rate, it is yet to achieve wide public acceptance and utilization. The concept of osseointegration was introduced by Branemark in 1964. He also described the guidelines for obtaining a direct connection between bone and titanium in 1977.1 Generally, a stress-free healing period is recommended to achieve osseointegration.1 The traditional guidelines recommend a six- to twelve-month healing period for the alveolar bone following the extraction of the tooth.2

The definition for an immediate endosseous implant is the extraction of a natural tooth followed by immediate placement of an endosseous dental implant. Also the extraction socket which acts as a guide, determines the appropriate parallelism and alignment relative to the adjacent and opposing residual dentition.3

Immediate implantation can be performed on extracting teeth with poor prognosis, with chronic apical lesions which are not likely to improve with endodontic treatment and apical surgery.4 The requirement for the procedure includes extraction with the least trauma possible, preserving the extraction socket walls and thorough alveolar curettage to eliminate all pathological material.


A 38 year old man was considered for implant treatment for his failing right lateral incisor (fig. 1). The patient had no relevant past medical history. He had undergone a traumatic injury involving this tooth. Past dental history revealed that he underwent root canal treatment 10 years back.

Clinical examination showed that the residual tooth has no tenderness on percussion. Apparently there were no signs of occlusal trauma or of periodontal inflammation. No alveolar height loss was detected.

Important parameters, such asquality and quantity of soft and hard tissues were evaluated by the surgical team and the patient was informed that he was an ideal candidate for immediate placement and loading of dental implants.

Treatment options given to the patient were 1) immediate implants and loading 2) Delayed implantation. Patient optioned for the first one. Extraction of the residual tooth and the immediate insertion of a dental implant with immediate provisional restoration and functional loading planned.

Atraumatic extraction done with periotomes and forceps. Available bone height to the nasal floor was 17 mm in intraoral periapical radiograph. The 15 mm dental implant guaranteed the primary stability,extending the preparation 4 mm further from the apex level of the extracted tooth (fig.2). Subcrestal implant placement done using TTPHIL technique (fig.3). Implant level impression made with single step technique using polysiloxane puttylight body. Provisionalisation was done with the composite material on the cast and shade matching was done on the same day and was sent to lab for the final prosthesis.

Immediately on the second day zirconia crown was fabricated in the laboratory using CADCAM exocad software. Immediate loading of the implant done with zirconia crown was on the next day (fig.4). No papillary recession observed after 6 months of follow up (fig.5).

Figure 1: Failing right lateral incisor
Figure 2: Marking drill
Figure 3:Implant placement done using TTPHIL technique
Figure 4: Final restoration
Figure 5: 6 months follow-up
Figure 6: OPG after 6 months


Tooth loss can be emotionally difficult, especially when it is in the esthetic zone. Immediate implantation and loading achieve better and faster functional results with a predictable treatment strategy and a very high rate of success. With this technique we were able to deliver the zirconia prosthesis in just 2 days.

The reduced number of surgical appointments, reduction of time of edentulism, prevention of bone loss and preservation of soft tissue architecture are considered to be the major advantages of immediate implant.5-7 Therefore, this method has become the procedure of choice.

Implant placement in the fresh alveolus results in a gap between the occlusal part of an implant and bone walls. Bone substitutes, membranes, or a combination of these can be used to achieve bone formation in such defects.8,9

Dental implants that are immediately placed and loaded into carefully selected extraction socket have survival rates when compared to the implants placed in healed site.

Tall: 18 mm implant from Noris Medical 3.75 x 18 was used to engage the basal nasal floor cortical bone.

Tilted: Buccal to palatal 25 degree angulation was given to engage the native bone.

PinHole: No incision and flap was given and raised to prevent bone loss and preserve the interdental papilla.


Implant therapy must fulfill both functional and esthetic requirements to be considered as a primary treatment modality. This case series concludes that it is possible to achieve good efficiency in the efforts to render the patient with sound, timely and economical treatment. Aiming to reduce the process of alveolar bone resorption and treatment time, the immediate placement of endosseous implants into extraction sockets achieved high success rate.

  1. Branemark PI, Hansson BO, Adell R, et al. Osseointegrated implants in the treatment of the edentulous jaw. experience from a 10- year period. Scand J PlastReconstr 1977; 16: 1-132.
  2. Branemark P-I. Introduction to osseointegration. In: Branemark P-I, Zarb G, Albrektsson T, eds. Tissue-integrated prostheses. Osseointegration in clinical dentistry. Chicago, Berlin: Quintessence Publishing Co., 1985:11–76.
  3. Abu-Hussein M, Azzaldeen A, Aspasia SA, Nikos K Implants into fresh extraction site: A literature review, case immediate placement report. J Dent Implant2013, 3: 160-164.
  4. Abu-Hussein M., Abdulgani A., Watted N .Zahalka M. ; Congenitally Missing Lateral Incisor with Orthodontics, Bone Grafting and Single-Tooth Implant: A Case Report. Journal of Dental and Medical Sciences2015 , 14(4),124-130
  5. Barzilay I, Graser GN, Iranpour B, Natiella JR, Proskin HM (1996) Immediate implantation of pure titanium implants into extraction sockets of Macacafascicularis. Part II: Histologic observations. Int J Oral Maxillofac Implants 11: 489-497.
  6. Schropp L, Isidor F (2008) Timing of implant placement relative to tooth extraction. J Oral Rehabil 35: 33-43.
  7. Polizzi G, Grunder U, Goené R, Hatano N, Henry P et al. (2000) Immediate and delayed implant placement into extraction sockets: A 5-year report. Clin Implant Dent Relat Res 2: 93-99.
  8. Covani U, Cornelini R, Barone A (2003) Bucco-lingual bone remodeling around implants placed into immediate extraction sockets: A case series. J Periodontol 74: 268-273.
  9. Parel SM, Triplett RG (1990) Immediate fixture placement: a treatment planning alternative. Int J Oral Maxillofac Implants 5: 337-345.

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