Immediate Dental Implants: Can You Get a Tooth Extracted and Implant Placed the Same Day?
Wondering if you can get a tooth extraction and dental implant on the same day? Dr. Daniel Choi, board certified periodontist since 2011 and Dr. Sungjoon T. Koo reveal the truth about immediate implants, success factors, and what patients need to know.
Understanding Your Options After Tooth Extraction
When facing a tooth extraction, patients typically have three main replacement options:
- Dental bridge – Requires shaving down adjacent teeth (7–10 year average lifespan when done well)
- Dental implant – A permanent tooth replacement solution
- Immediate dental implant – Extraction and implant placement in one appointment
This article focuses on immediate dental implants and whether this “same-day” solution is right for you.
What Is an Immediate Dental Implant?
An immediate dental implant is a procedure where your dentist extracts a damaged tooth and places the implant during the same appointment. This approach eliminates the traditional 4–6 month waiting period between extraction and implant placement.
The alternative approach:
- Extract the tooth
- Perform socket preservation (bone grafting)
- Wait 4–6 months for healing
- Schedule a second surgery for implant placement
Can Everyone Get an Immediate Dental Implant?
The short answer: No. Immediate implant candidacy varies significantly based on several critical factors.
Location in Your Mouth Matters
Front Upper Teeth (Anterior Maxilla)
- Immediate implants often possible with adequate bone thickness
- Requires expert placement due to aesthetic concerns
- Visible when you smile, so precision is critical
Premolars (Smaller Back Teeth)
- Generally good candidates for immediate implants
- Success depends on bone quality and nerve proximity
Upper Molars
- More complex due to sinus cavity location
- Sinus height determines candidacy
- Risk of insufficient bone support if sinus hangs too low
Lower Front Teeth
- Often suitable for immediate implants
- Bone is frequently very thin, requiring careful grafting
Lower Molars and Premolars
- Major consideration: Inferior alveolar nerve proximity
- Requires 3D scan to assess nerve location
- High nerve risk may necessitate delayed implant approach
7 Critical Factors That Determine Immediate Implant Success
1. Septal Bone Preservation
Septal bone is the bone between tooth roots. For immediate implant placement, this bone must be:
- Intact and preserved during extraction
- Sufficient density to anchor the implant
- Present to provide initial stability
Without adequate septal bone, immediate implant placement becomes extremely difficult or impossible.
2. Root Formation Pattern
Teeth with divergent roots (roots spreading apart) typically have:
- More septal bone available
- Better implant stability potential
- Easier immediate implant placement
Teeth with fused or converging roots present challenges for immediate implant procedures.
3. Nerve Proximity
The inferior alveolar nerve runs through your lower jaw, and its location varies by individual. A 3D CBCT scan reveals:
- Exact nerve position
- Safe drilling depth
- Risk assessment for nerve damage (paresthesia)
Nerve damage can cause permanent numbness or altered sensation in your lip and chin.
4. Infection Status — The Most Critical Factor
Heavily infected root canal sites show significantly higher implant failure rates, even when not placed immediately. Clinical experience over 17 years demonstrates strong correlation between failed implants and previously infected root canal sites.
If your tooth has a periapical lesion (infection around root tips):
- Complete infection removal may be impossible due to complex root patterns
- Bone quality is compromised
- Waiting 6–7 months after extraction is recommended (versus standard 4 months)
5. Bone Density and Quality
Dense bone provides:
- Better initial implant stability
- Improved long-term success rates
- Easier surgical procedure
Soft or compromised bone may require delayed placement for optimal results.
6. Tooth Condition at Extraction
Root canal treated teeth:
- More brittle and prone to fracturing during extraction
- Often break into pieces, complicating removal
- May require bone removal to extract fragments
- Lost bone reduces immediate implant viability
Severely decayed teeth:
- Similar challenges to root canal teeth
- “Like pulling a rusty pole from concrete”
- Higher risk of root fracture
The earlier you address a failing tooth, the better your immediate implant options.
7. Implant Positioning Requirements
Immediate implants must be placed in available bone, which may not align with the ideal prosthetic position. This can complicate:
- Crown placement later
- Aesthetic outcomes
- Long-term function
Delayed placement allows precise positioning in healed, stable bone.
The Honest Truth: When Immediate Implants Aren't Worth the Risk
Even experienced periodontists often choose the delayed approach for their own mouths when:
- Nerve proximity is concerning
- Significant infection is present
- Root canal teeth are involved
- Bone quality is questionable
- Precise positioning is critical
The philosophy: Keep it simple for predictability.
What to Expect: Setting Realistic Expectations
Before agreeing to an immediate implant attempt, understand that:
- Final decision happens during surgery – Your dentist cannot fully assess candidacy until extraction begins
- Plans may change mid-procedure – Unexpected root fracture or bone loss may necessitate delayed placement
- Bone grafting is still required – Immediate implants need additional bone grafting around the implant
- Success requires initial stability – The implant cannot move during the 4-month healing period
The Socket Preservation Alternative
When immediate implants aren't ideal, socket preservation offers excellent results:
The process:
- Careful tooth extraction
- Bone grafting at extraction site
- 4–6 month healing period (6–7 months for infected sites)
- Second surgery for implant placement
- Additional 3–4 month healing before crown
Advantages:
- Optimal bone quality for implant
- Precise implant positioning
- Reduced surgical complications
- Higher long-term success rates
Questions to Ask Your Periodontist
Before scheduling an immediate implant:
- What does my 3D scan show about nerve location?
- How much septal bone do I have?
- Is there infection present around the tooth?
- What's your success rate with immediate implants in this location?
- What happens if you can't place the implant immediately?
- How will this affect the final crown position?
The Bottom Line
Immediate dental implants can save time and eliminate an additional surgery when conditions are ideal. However, rushing the process can compromise long-term success.
The best approach prioritizes predictability over convenience. An experienced periodontist will:
- Thoroughly assess your candidacy
- Set realistic expectations
- Make the final decision during surgery based on actual conditions
- Prioritize long-term success over short-term convenience
When in doubt, the delayed approach with socket preservation offers the most predictable, successful outcomes.
About the Authors
This article is based on insights from Dr. Choi, board certified periodontist and Dr. Koo, have decades of combined experience placing dental implants. Their clinical expertise provides patients with honest, evidence-based guidance for tooth replacement decisions.
