The question of when to place an implant relative to extraction is one of the most consequential decisions in implant dentistry. The answer depends on the condition of the socket, the available bone, the patient's tissue biotype, and your surgical experience level.
The ITI Classification
Type 1 — Immediate Placement (Day of extraction)
Indications: Intact socket walls, no acute infection, thick tissue biotype, adequate apical bone for primary stability (minimum 3–4mm beyond apex), experienced surgeon.
Advantage: Single surgical visit, preserved ridge volume, reduced treatment time.
Risk: Highest technical difficulty. Jumping distance between implant and buccal wall must be managed with bone graft. Thin biotype carries 1–2mm buccal recession risk.
Type 2 — Early Placement (4–8 weeks post-extraction)
Indications: Infected socket that required healing, inadequate primary stability at extraction, soft tissue deficiency requiring healing first.
Advantage: Soft tissue closure over socket, reduced infection risk, still preserves most ridge width.
Best for: Beginners. The healed soft tissue gives you a proper flap to work with.
Type 3 — Delayed Placement (12–16 weeks)
Indications: Significant bone deficiency, large periapical lesion, compromised host, need for ridge augmentation first.
Advantage: Most predictable osseointegration, partial ridge fill from natural healing.
Disadvantage: Ridge resorption occurs — 25% of width is lost in the first 3 months.
Decision Rule for New Implantologists
If you are placing your first 20–30 implants: default to Type 2 or Type 3. The increased predictability is worth the extra waiting period. Add immediate placement to your protocol only after you are consistently achieving primary stability and understand socket morphology intuitively.
