Devorah Schwartz-Arad* and Gabriel Chaushu7

A waiting period of 12 months or longer to allow total socket healing used to be

accepted protocol for placing dental implants. More than 15 years of research and clinical practice were needed for the -concept of
immediate endosseous implantation

into fresh extraction sites to be accepted. Today the dilemma is no longer when, but which, protocol to follow. The diverse
recommendations found in the literature leave the practitioner confused as to the methodology of choice. The conclusions drawn after

reviewing the'relevant literature on immediate dental implantation are: 1) im

plants placed into fresh extraction sockets have a high rate of survival, ranging between 93.9% to 100%; 2) implants must be placed
3 to 5 mm beyond the apex in order to gain a maximal degree of stability; 3) implants should be placed as close as possible to the

alveolar crest level (0 to 3 mm); 4) there is no consensus regarding

the need for gap filling and the best grafting material; 5) the use of membrane does not imply better results-on the contrary, membrane
exposure may carry complications

in its wake; and 6) the absolute need for primary closure remains to be established. / Periodontol 1997;68:915-923.

Key Words: Bone rsorption; dental implantation, autogenous; wound healing.

Much of the experimental and clinical data published by the

Brnemark group'-3 have provided the dental profession with safe methods and predictable outcomes of implant dentistry. Their

traditional protocol recommends a 12-month

healing period between tooth extraction and placement of

implant.1
Bone loss after tooth extraction remains an important is

sue in dentistry.4 Woelfel et al.5 listed 65 factors conducive to bone rsorption associated with removable dentures, which were grouped
under 5 major headings: anatomic, physiologic, metabolic, behavorial, and miscellaneous. A

combination of any of these factors might be regarded as etiologic in the individual patient. Today, over 20 years later, little is still known

about major elements or mediators that influence bone rsorption. Anatomically, bone rsorption oc

curs both buccolingually and apicocoronally,6 and the first 6 months postextraction are critical, carrying the highest rate

of bone rsorption in either direction.7-9

*Department of Oral and Maxillofacial Surgery, The Maurice and Ga-briela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel.
'Department of Oral and Maxillofacial Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.