For more than 3 decades, the criteria for successful replacement of teeth with restored dental implants followed a narrow construct of scientific and clinical protocols. Whether the goals of tooth replacement focused on a single site, a partially edentulous quadrant, or an edentulous arch, it was assumed that dental implants had to be located at sites where the alveolar bone was of sufficient quality, quantity, and morphology. Furthermore, the protective role of periimplant gingiva or detrimental effects of microorganisms in the gingival crevice surrounding the restored implant was seldom considered. These findings were among the original ideology proposed by Brånemark that assumed multiple root form dental implants should only be placed in healed edentulous sites, covered with alveolar mucosa for 3 to 6 months before second-stage abutment connection and restoration, and located mostly in the anterior region of the edentulous mandible. Single-tooth and partially edentulous treatment comprised less than 5% of their restorative cases, and dental implant placement distal to the mandibular foramen was considered experimental.

These principles were mandated to achieve a 1-year implant survival outcome of 88% in the anterior maxilla and 94% for the anterior mandible. For a series of dental implants penetrating the maxillary sinus, the result showed a 5- to 10-year functioning percentage between 70% and 72%. The scientific documentation of the Brånemark group and their protocol for osseointegration strongly influenced clinical applications of dental implant therapy until about the early 1990s.

To achieve osseointegration, which was considered to be intimate contact of bone to dental implant as assessed at the light microscopic level, this initial protocol required that the implant must be one inserted with a low trauma surgical technique, be placed with initial stability, and should not be functionally loaded until sufficient bone has been deposited in mineralized form.

This traditional clinical protocol for placing dental implants demanded a uniform intimate contact between the dental implant and surrounding walls of bone from the most coronal aspect of the implant to its most apical extent. This was achieved by employing a set of drills or burs that would successively increase in diameter. Bone to implant contact was further clinically enhanced by the use of an osteotomy that was narrower than the intended dental implant. Finally, the fixture was slowly turned or tapped into the osteotomy with copious and cool saline irrigation until the most apical extent engaged in osteotomy.

Subsequent to this initial protocol, it has been determined that it is not always possible to prepare an osteotomy without clinical voids or gaps surrounding the fixture. Subsequently, clinical guidelines were developed that led to employing principles of guided tissue regeneration to create mineralized tissue that supported frustrations or dehiscence at the time of implant placement. Seeing that the initial protocol for dental implant placement required a completely healed extraction site, the next logical phase of implant therapy focused on placing dental implants in extraction sockets immediately upon tooth removal and delivering a comfortable, aesthetic, semifunctional provisional restoration.

Many of the available studies concerning the placement of dental implants in extraction sites describe their use in the anterior and premolar regions, but careful applications of surgical principles resulted in predictable success of dental implants placed in extraction sites immediately following the removal of molars. This chapter will review principles associated with root form dental implants immediately placed in extraction sockets.