The surgical technique is based on the pre-treatment evaluation and on the type of implant to be utilized.
The following also should be considered (Iacono V.J. 2000)
a) Aseptic technique
b) Appropriate surgical protocol
c) Surgical template utilization
d) Appropriate postoperative instructions.
The surgical steps consist of the following
1. Extraction of the tooth
2. Placement of the implant with adequate primary stability
3. Management of the socket
4. Need for any adjunctive soft tissue procedures
5. Possibility of immediate loading and temporisation and follow up.
Tooth extraction and implant placement procedures (Stman PS 2008)
The tooth extraction procedures for immediate implant placement should follow the cardinal principle and that is “maintain the socket integrity”.
Various surgical flap procedures can be used to gain access for tooth extraction.
Teeth to be removed and implants placed immediately after extraction can be accessed using either open flap surgery or a minimally invasive surgical technique.
A flapless technique starting with an intrasulcular circumferential incision or release of the attached cervical periodontal ligament fibers is preferred.
Careful atraumatic tooth extraction is a key factor in minimizing further bone loss or widening of the socket dimensions. To avoid damaging the buccal plate, care must be exercised not to luxate the tooth bucco–lingually.