Traditional vs Immediate Dental Implantation: What's the Difference

Modern dental implantation offers two main approaches to tooth restoration – traditional two-stage methodology and immediate implantation (also known as tooth implantation immediately after extraction or “implantation in one day”). Both methods aim to install an artificial root (implant) and crown in place of a lost tooth, but differ in the timing of stages and treatment tactics. To help you understand the difference and make an informed choice, let’s examine each approach in detail – its stages, advantages, disadvantages, indications and success rates according to leading Swiss and American medical sources.

What is traditional (two-stage) implantation?

Traditional dental implantation is a classic approach where implant installation occurs not immediately after tooth extraction, but after a certain time (usually several months) after socket healing. This methodology is also called two-stage or delayed implantation. Treatment proceeds in several stages with pauses for tissue healing:

• Stage 1: Tooth extraction and healing. First, the damaged or diseased tooth is removed. After this, the area is given time to heal and regenerate bone tissue (usually 2–4 months or more, if needed). Often bone grafting (bone augmentation) is performed simultaneously to restore bone volume if necessary. During this period, natural osseointegration occurs – formation of new bone at the tooth extraction site.
• Stage 2: Implant installation. After successful healing, the surgeon installs a titanium implant into the jawbone. The operation is performed under anesthesia: the gum is incised, the bone is prepared by drilling, and the implant is screwed into the root’s place. Sometimes during the healing period, the patient receives a temporary removable prosthesis or plastic crown for aesthetics, which does not load the implant.
• Stage 3: Healing period (waiting for osseointegration). After implantation comes a waiting phase while the bone densely fuses with the implant surface. This healing process lasts approximately 3–6 months, depending on the patient’s health condition and bone quality. During this time, the implant may be completely covered by gums (so-called two-stage technique) or have a healing abutment installed.
• Stage 4: Installation of abutment and prosthetics. After the implant has integrated, a second small operation is performed (if the implant was closed by gum) – it is opened and an abutment (special connector) is fixed. Soft tissues heal around the abutment, forming the gingival contour. Then impressions are taken or the dental row is scanned to manufacture a permanent crown. After several weeks, the manufactured crown is attached to the abutment – and the patient receives a new tooth.

Thus, traditional implantation is extended over time: from the moment of tooth extraction to installation of a permanent crown, six months to a year may pass, and in complex cases – even up to two years. A significant part of this time is spent waiting for bone healing and implant integration. Although the process is lengthy, the step-by-step approach allows maximum preparation of the bone bed for the implant and ensures high predictability of results. The classic two-stage implantation protocol is historically considered the gold standard, especially in cases where infection must first be eliminated or bone restored before implant installation.

What is immediate implantation (implantation in one day)?

Immediate implantation is a modern methodology when a dental implant is installed immediately after tooth extraction, within one surgical intervention. This approach is also called single-stage or immediate implantation. If the situation allows, the doctor removes the destroyed tooth and immediately implants an artificial root into the same socket. Moreover, immediate loading of the implant is possible – installation of a temporary crown within 24 hours, thanks to which the patient leaves the clinic with a new “tooth” the same day.

The main idea of immediate implantation is to minimize the time gap between tooth loss and its replacement. There’s no need to wait several months for bone healing: the implant integrates into a fresh socket of the extracted tooth. According to research data, such immediate tactics help preserve bone tissue and gums from volume reduction, which usually occurs after tooth extraction. The patient also benefits aesthetically – immediately having a temporary crown that maintains the smile and psychological comfort.

Single-stage implantation is performed using special techniques and implants. Usually, implants with aggressive threading and special design are used, which provide reliable primary stability even in a freshly extracted socket. It’s very important that the implant is rigidly fixed in the bone immediately after installation – then the chance of successful osseointegration is high, even if it immediately receives chewing load from a temporary crown. Leading manufacturers such as Straumann have developed separate implant lines optimized for immediate protocols. For example, the Straumann® BLX system has a conical shape, deep threading, and special SLActive® coating to accelerate healing, allowing reliable implant installation immediately after tooth extraction.

It’s important to understand that immediate implantation is not suitable in all clinical cases. The doctor chooses this method only when favorable conditions exist: sufficient bone volume, absence of acute inflammation or pus, thick gum type. According to implantologists’ recommendations, immediate implant installation is indicated if at least 50% of the socket’s bone walls are undamaged, gums are thick, and tooth extraction was atraumatic. With bone defects or thin gum biotype, plastic surgery is often performed simultaneously – bone material or membranes are added to close the socket. If there’s significant infection in the extraction zone, bone is severely atrophied, or the patient has serious contraindications (for example, uncontrolled diabetes, blood clotting problems), then it’s better to turn to the step-by-step approach.

How does the immediate implantation procedure work? First, the patient has a 3D X-ray (CT) and implantation is planned on a computer. On the day of surgery, under anesthesia, the tooth is carefully removed, maximally preserving surrounding tissues. An implant selected by size is installed into the same socket at the required angle. If the implant achieved good primary fixation, an abutment is immediately screwed onto it and a temporary crown is placed. Such a crown is manufactured in advance or directly on the day of surgery and is lightweight – it restores aesthetics, but the patient should chew carefully, avoiding excessive load on the implant during the healing period. The final permanent crown from strong ceramics is usually manufactured after several months when the implant has fully integrated. (In separate cases described in literature, a permanent crown may be fixed after 1–2 weeks, but more often the standard osseointegration period is still awaited to guarantee success).

The single-stage approach has the advantage that the implant is installed transgingivally, i.e., through the gum, and a second surgery stage (opening the implant) is not needed. Actually, the entire implantation happens in one operation, and subsequent visits are only needed for control and prosthetics. For the patient, this means fewer surgical manipulations and faster results.

Traditional vs immediate dental implantation: what’s the difference

Advantages and disadvantages of traditional implantation

Advantages of two-stage (traditional) implantation:

• High predictability and success rate. The traditional method is verified by decades of practice and gives consistently high implant integration rates (success reaches ~97–99% of cases). Since the implant is installed in fully formed bone, the risk of failure is somewhat lower in complex cases. Research shows that with delayed implantation, the percentage of long-term implant survival may be several points higher than with immediate implantation (in separate samples ~95+% vs 90–95% respectively). Thus, result predictability with the standard approach is very high.
• Possibility to prepare the bone bed. In the pause between tooth extraction and implant installation, the doctor has time to eliminate all problems: cure infection, build up bone, form gums. This is especially important if there was a cyst, granuloma, or significant bone atrophy. The two-stage protocol allows first creating optimal conditions, and only then implanting – which increases the chances of implantation success.
• Less load on the implant during healing. Since in the classic scheme the implant is screwed into unloaded bone and sutured under the gums, no chewing forces act on it until complete integration. This minimizes the risk of implant micromovements in the bone and promotes reliable fusion. Meanwhile, the patient can use a removable prosthesis or temporary construction that doesn’t press on the implant zone.
• Flexibility in prosthetics. When using classic two-stage systems (with separate abutment), the dentist has more possibilities to correct the position and angle of the crown during the prosthetic stage. If necessary, individual abutments can be used or the gingival contour shape can be changed before installing the permanent crown. This is important for aesthetics in the frontal zone.

Disadvantages of traditional implantation:

• Long treatment time. The main minus is the overall process duration. From tooth extraction to receiving a permanent crown, several months or even up to a year pass. According to Mayo Clinic data, a complete implantation course with all stages can last many months, since significant time is allocated for bone healing. For the patient, this means more clinic visits and a longer period when the tooth is absent (or they need to use a removable temporary prosthesis).
• Two surgical operations. The traditional protocol involves at least two surgical interventions: implant installation, and then – after several months – its opening and abutment installation. Each operation is stress for the patient, as well as risk of discomfort, swelling, pain after intervention. Immediate methodologies allow avoiding this by performing all manipulations at once.
• Bone and gum resorption. Inevitable waiting after tooth extraction leads to bone tissue in this area gradually decreasing (resorbing) due to lack of load. Research indicates that with delayed implantation, more alveolar bone is lost, especially if delaying more than 4–6 months. This may worsen initial conditions for the implant or require more extensive bone grafting. Additionally, gums without tooth support may also partially lose volume, complicating achievement of ideal gingival contour aesthetics.
• Temporary inconveniences. In the interval between tooth extraction and implant installation, the patient may experience discomfort due to tooth absence. If it’s the frontal zone, temporary removable prostheses or caps with artificial tooth must be used for aesthetics. This is not always convenient and may affect quality of life, especially when it concerns front teeth.

Advantages and disadvantages of immediate implantation

Advantages of immediate implantation:

• Shortened treatment terms. The most obvious plus is significantly shorter duration of the entire implantation process. In many cases, the patient receives a new “turnkey” tooth literally in one day, without months of waiting. According to Straumann data, the immediate protocol allows reducing the delay between extraction and implant loading to zero – a temporary crown is fixed on the day of surgery. The final restoration is manufactured individually, but overall treatment time is still significantly less compared to the traditional approach. This is especially valuable for busy people or when quick restoration is needed (for example, loss of a front tooth).
• Minimum surgical interventions. Single-stage methodology simplifies the surgical protocol – actually the entire implantation is performed in one operation. The patient doesn’t need to undergo repeated surgical intervention to open the implant, as with the two-stage scheme. Fewer operations mean less stress, discomfort, and risk of complications. Clinicians’ experience shows that patients evaluate this factor very positively.
• Immediate aesthetic result. For front teeth, immediate implantation is a real salvation, as it allows avoiding a “gap” situation in the smile. The patient leaves the clinic with a temporary crown that looks quite natural. This solves both aesthetic and psychological problems of tooth loss – the person doesn’t feel incomplete even at the early treatment stage. Gum formation around the temporary crown happens immediately, promoting good gingival contour aesthetics.
• Preservation of bone and gums. By installing an implant immediately after extraction, we prevent bone atrophy. The implant fills the tooth socket and transmits functional load to the bone, stimulating its preservation. Gum architecture is also preserved – the interdental papilla doesn’t sink, gum contours remain more stable. As a result, the final work has better aesthetic appearance, especially in the smile zone.
• Lower overall time and cost expenses. Although immediate implantation requires high doctor qualification and careful planning, overall the protocol saves resources. The patient doesn’t need to come multiple times for surgical stages, take several days off for operations. According to experts, reducing the number of procedures may also decrease the total treatment cost for the patient – since the need for additional operations, temporary prostheses, etc. disappears. Additionally, modern digital technologies (CAD/CAM, surgical templates) make the implantation process faster and more predictable for the doctor, which also increases efficiency.

Disadvantages of immediate implantation:

• Demanding indications (application limitations). Immediate implantation is only possible in carefully selected cases. If conditions are far from ideal – there’s acute infection, insufficient bone, very thin gums, or anatomically complex position – the doctor is forced to refuse the immediate approach. That is, this method is not universal: a significant portion of patients still needs preparation first (treatment, bone regeneration) and only then implantation at delayed terms. Immediate installation is also not recommended for young people under 18 while jaw bone growth hasn’t completed.
• Somewhat higher risk of implant failure. Statistically, immediate implantation success is very high, almost the same as with traditional protocols. However, some studies note a slightly higher percentage of complications with implantation immediately after extraction. Specifically, in separate samples, implant survival after 1–3 years was 90–95% for the immediate method vs >95% for delayed. The reason is that not all implants manage to integrate under early loading. Chewing immediately after installation may cause implant micro-displacement, preventing bone from fusing with it. Therefore, immediate tactics are more sensitive to errors: it’s critical to follow the protocol and not overload the implant in the first weeks. If immediate implantation fails (implant doesn’t integrate), the situation becomes complicated, since the patient loses not only the tooth but also additional bone tissue, and repeated implantation will require even more reconstruction.
• Technical complexity and experience requirements for the surgeon. Performing implantation in one stage requires very careful planning and high doctor skill. It’s necessary to precisely determine implant position, angle, depth to compensate for removed bone and ensure crown aesthetics. Surgical navigation templates, intraoperative 3D diagnostics are often used. Additionally, the implantologist must predict the need for simultaneous bone or gum plastic surgery during implant installation. All these factors make immediate implantation technologically more complex – accordingly, not every clinic or doctor is ready to perform it qualitatively. Sufficient experience and certified skills are needed.
• Limited prosthetic flexibility. With the immediate method, monolithic implants or constructions with fixed angle are often used, which doesn’t always allow correcting implant inclination during crown installation. If the implant was installed imperfectly (due to the need to achieve stability, it might have been slightly shifted), correcting the position can be difficult. In the traditional protocol, there’s more maneuvering space between surgery and prosthetics (using angled abutments, etc.). Thus, immediate implantation requires maximum precise work “on the edge” from the surgeon, since possibilities to fix something later are limited.

Indications for each type of implantation

Both implantation methods – traditional and immediate – have clear indications when their application will be most appropriate and successful. The choice is made individually after examination and diagnostics, but general recommendations can be outlined:
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When to choose traditional two-stage implantation:

• Presence of inflammatory processes or infections in the tooth extraction zone (cysts, granulomas, periodontitis). First, infection needs to be cured and bone given time to heal, and only then install an implant.
• Significant bone tissue deficit. If after tooth extraction bone volume is insufficient for stable implant, bone grafting and time for its integration (3–6 months) are needed. The traditional scheme allows doing this step by step.
• Traumatic tooth extraction. If during extraction the socket walls were damaged or bone fracture occurred, immediately placing an implant is inadvisable – it’s better to wait until everything heals and anatomy is restored.
• Thin periodontium (gums) or high smile line, where there’s risk of gum recession. In such cases, delayed implantation with preliminary soft tissue preparation may give a better aesthetic result.
• Patients with certain systemic diseases (uncontrolled diabetes, osteoporosis, immunodeficiency) or harmful habits (smoking). In them, healing is slower, so it’s better not to risk and implant under optimal conditions, not immediately after extraction.
• Cases when the patient is not in a hurry and it’s not critical for them to wear a temporary prosthesis for a certain time. Some people are ready to go through a longer path for maximum predictability.

When to choose immediate implantation (implantation in one day):

• Healthy condition of tooth socket. The ideal candidate is a patient whose tooth is extracted atraumatically, without major inflammation and bone destruction. For example, a fractured tooth root without infection or very recent trauma.
• Sufficient bone volume and density. If the jawbone is quite massive and dense, it’s capable of immediately holding an implant. For example, in the anterior lower jaw the bone is dense, so immediate implantation there is more successful than, say, in the upper lateral area with soft bone.
• Thick gum biotype. When gums are thick, fibrous, they better adapt around the implant and there’s less risk of recession. Thin and delicate gums are a relative contraindication for immediate protocol, as they may sink.
• High aesthetic requirements of the patient. If a person doesn’t want to go without a tooth for a day – immediate implantation with temporary crown is the optimal choice (provided there are no other contraindications). This often concerns front teeth, smile zone.
• Desire to reduce number of operations. Patients who psychologically or physically have difficulty tolerating surgical interventions prefer to do everything at once. Immediate methodology wins here, as it allows avoiding repeated surgery.
• Absence of serious comorbidities. For immediate implantation, the patient should be relatively healthy (or their diseases should be controlled by medications). If immunity is severely weakened, it’s better not to rush with implantation.

Of course, the final decision about the implantation method is made by the dental implantologist after detailed analysis of the clinical situation, CT images, and discussion with the patient of their priorities. Both traditional and immediate methodologies in skilled hands give excellent results – the question is only which path is optimal in your particular case.

Which implant systems are suitable for each method?

In the modern dental implant market, there are systems developed specifically for different treatment protocols. Generally, most leading implant systems are universal, meaning the same implant can be used for both two-stage and immediate implantation – the decision depends more on the doctor’s tactics. However, some implant models have proven themselves better in certain situations.

For traditional implantation, classic two-component implants (consisting of an intraosseous screw and separate abutment) are usually used. For example, popular Bone Level implants from Swiss manufacturer Straumann or analogs from other brands. They are installed at bone level and if necessary are covered by gums for the osseointegration period. Such implants provide excellent long-term stability and give flexibility in prosthetics. Installing them according to two-stage protocol is verified standard practice with high success percentage. In Straumann systems, the classic representative is the Straumann® Bone Level (BL) line, as well as Tissue Level (TL) implants with protruding shoulder, which are often installed simultaneously with healing abutment (actually implementing single-stage healing). Manufacturer Straumann notes that their implants are universal and can be effectively used both in standard step-by-step implantation and in immediate protocols.

For immediate implantation, implant design that ensures maximum stability immediately after installation is important. Here, conical implants with aggressive threading and modern surfaces for accelerated healing come to the forefront. Straumann company specially developed the Straumann® BLX line for implantation with immediate loading. These implants have conical shape with progressive threading that “cuts into” bone and compacts it, ensuring high stability even in soft bone tissue. Additionally, BLX are made from unique Roxolid® alloy (titanium with zirconium), whose strength allows using smaller diameter implants without losing reliability. And the innovative hydrophilic SLActive® surface accelerates osseointegration, shortening the critical healing period and increasing success chances even with early loading.

Another example is the Straumann® TLX system, which combines tissue level (smooth collar for single-stage gum healing) with aggressive BLX-type threading. These implants are optimized for immediate implantation in complex cases, particularly in posterior jaw sections where bone is softer. Due to transgingival healing with TLX, often one operation is sufficient – the implant doesn’t need to be opened later, as it’s immediately installed at gum level.

It’s worth noting that not only Straumann, but other leading manufacturers (Nobel Biocare, Zimmer Biomet, Dentsply Sirona, etc.) offer implants and components for different protocols – from immediate loading to classic delayed. Key importance lies in the implantologist’s experience and correct system selection for the specific patient. For example, in thin bone situations, the doctor may choose a smaller diameter implant with special threading and perform immediate implantation, but simultaneously use bone material to fill gaps. Or when planning two-stage implantation in the aesthetic zone – prefer an implant with platform that will provide better gum and papilla support. Modern implant systems are extremely reliable – integration success in leading brands exceeds 97–98%. Therefore, the key to success is not so much the system name, but its correct application according to protocol and patient indications.

Conclusion and recommendations

Traditional vs immediate dental implantation is not a confrontation of “what’s generally better,” but choosing the optimal path for a specific patient. Traditional two-stage methodology ensures maximally predictable results and is used when it’s necessary to first create a healthy foundation (healed bone, absence of infection) for the implant. Immediate implantation allows getting a new tooth significantly faster, avoiding unnecessary operations and preserving natural tissues, but requires ideal conditions and high doctor skill. From a long-term success perspective, both approaches demonstrate comparable effectiveness – studies with observation up to 10 years don’t reveal significant differences in implant integration or bone level between immediate and delayed implantation. That is, a correctly selected case of immediate implantation can be as successful as the classic scheme.

How to understand which method suits you? The decision should be made jointly with an implantologist after comprehensive diagnostics. YAREMA DENTAL clinic specialists have experience implementing both approaches – traditional and immediate – and use certified Swiss Straumann implant systems to achieve the best results. During consultation, the doctor will assess your oral cavity condition, bone quality, consider your preferences regarding timing and cost, then propose an optimal treatment plan. Schedule an appointment with an implantologist at Yarema Dental today – and take a step toward restoring a healthy smile for years to come! 😊