Upper and lower alginate impressions are taken in addition to the registration of the relationships of the jaws in maximum intercuspation. Face bow recordings are recommended, when appropriate, to transfer information relating to the position of the condyles, as well as condylar and tooth guidance.
Restorative requirements, interarch space and jaw relationships, location of edentulous areas, and the quantity and quality of available bone should be evaluated before implants are selected as a treatment option.
Surgical considerations for patients requiring implant placement should include evaluation of: anatomy and location of vital structures, bone quality, quantity and contour, and soft tissues.
Kois in 2001 proposed five diagnostic keys for predictable single peri implant aesthetics when an immediate extraction and implant insertion are contemplated, which include:
1) Relative tooth position
2) Form of the periodontium
3) Biotype of the periodontium
4) Tooth shape
5) Position of the osseous crest before extraction
There should be no acute pathology present in either the periodontal tissues or in the periapical region. There should be no signs or symptoms, no clinically visible exudation or pus, and no pain where implant is to be placed.
However teeth/roots with chronic periapical infections/lesions can undergo immediate implant after thorough removal of lesion. Vertical root fractures of teeth that have been restored by means of post crowns should be assessed carefully to ensure that the labial plate of bone has not been compromised.
The contours of the soft tissues around the tooth to be extracted should be such that they will appear acceptable around the intended restoration. Teeth with thick gingival biotype are preferable for immediate post extraction implant placement as compared to teeth with thinner gingival biotypes. It has been observed that immediate post extraction placement in sites with thinner biotypes has resulted in soft tissue deficiency over time, though; at the time of implant placement the soft tissue margins were stable.
An alveolar intact socket with intact buccal and palatal walls is a prerequisite for immediate post extraction implant placement. The intactness of the buccal wall is of utmost importance. Apart from the level of the bone on the mesial and distal sides of the tooth being replaced, it is also important to determine the level of and the position of the interproximal papilla. It is also preferred to have a socket that is wider at the top so that the desired implant, when placed, does not come in contact with the buccal wall of the extraction socket. In case there is a deficiency of the buccal wall, loss of bone and exposure of the buccal aspect of the implant may be observed. Preoperatively this can be checked by means of probing of the socket walls with a periodontal probe. Loss of bone around the tooth to be replaced may result in the bone healing to a level that is not predictable. The level of bone that exists in contact with the adjacent teeth is critical because it will be responsible for the maintenance of the papillary height.
For successful placement of a dental implant immediately post extraction into the socket depends upon the ability to have proper / adequate primary stability. A minimum of 3mm of bone beyond the apex of the socket is necessary to provide adequate primary stability to these implants.