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Treatment Algorithm · Module
When to place: extraction-site timing
Choosing between immediate, early, and delayed placement after extraction. Based on the ITI consensus classification (Types 1–4), weighing esthetic risk, socket-wall integrity, and the ability to achieve primary stability.
Use: Treatment-planning reference
Framework: ITI Type 1–4
Key driver: Socket walls + stability
01 — Classification
The four placement timings
The ITI classification defines timing by the state of socket healing at placement. Success rates are broadly comparable across types when case selection is correct — the choice is driven by esthetic risk and the ability to obtain primary stability and tissue support.
Type 1
Immediate
- Same day as extraction
- Needs intact socket walls + thick biotype
- No acute infection at site
- Apical/palatal bone for primary stability
Type 2
Early — soft tissue
- ~4–8 weeks post-extraction
- Soft-tissue healing, no significant bone fill
- Allows resolution of infection
- More keratinized tissue for flap
Type 3
Early — partial bone
- ~12–16 weeks post-extraction
- Significant radiographic bone fill
- Good stability, some ridge resorption
- Useful in larger/compromised sockets
Type 4
Delayed / late
- > 6 months — fully healed ridge
- Greatest ridge resorption
- Often needs augmentation
- Most predictable primary stability
02 — Decision Pathway
Interactive timing selector
Assess the socket the moment the tooth is out. The combination of buccal-wall integrity, infection, biotype, and achievable stability points to a timing.
Tap the scenario that best matches your extraction site.
Step 1 — Evaluate the socket immediately after extraction
SCENARIO A
Intact buccal wall, thick biotype, no infection
Can engage apical/palatal bone for stability.
SCENARIO B
Thin/damaged wall or active infection, esthetic zone
Soft tissue intact but bone not yet healed.
SCENARIO C
Large socket, compromised walls, stability doubtful
Needs time for partial bone fill.
SCENARIO D
Severe bone loss / healed ridge / high risk
Significant deficiency or medical/esthetic risk.
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03 — Immediate Provisionalization
Can I load it the same day?
Immediate placement and immediate provisionalization are separate decisions. Even with a Type 1 placement, restore out of occlusion unless stability criteria are clearly met (see the Loading Protocol module).
| Factor | Favors immediate provisional | Defer loading |
|---|
| Insertion torque | ≥ 35 Ncm | < 25 Ncm |
| ISQ | ≥ 70 | < 60 |
| Occlusion | Can keep out of function | Parafunction / bruxism |
| Arch / bone | Anterior, dense bone | Posterior maxilla, soft bone |
| Gap to buccal plate | Small, graftable jumping gap | Large defect, exposed threads |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. Verify protocols and device instructions against current manufacturer guidance and local guidelines.
- Hämmerle CHF, Chen ST, Wilson TG. Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets. Int J Oral Maxillofac Implants. 2004;19(Suppl):26–28.
- Gallucci GO, et al. Implant placement and loading protocols in partially edentulous patients — ITI Consensus. Clin Oral Implants Res. 2018;29(Suppl 16):106–134.
- Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla — a systematic review. Int J Oral Maxillofac Implants. 2014;29(Suppl):186–215.
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0