Immediate Dental Implants in Ukraine

Immediate implant placement means placing an implant in the socket of a tooth straight after it has been extracted, under the same anaesthetic and at the same visit. In the international classification this is type 1: the implant goes into a fresh socket. The other options are early placement after 4–8 weeks, once the gum has healed; after 12–16 weeks, once the bone has partly healed; and delayed placement after six months or more.

The appeal of the protocol is obvious: one operation instead of two, an overall treatment time roughly 3–4 months shorter, and the gum contour and the papillae between the teeth keep their natural shape, because the gum is not opened a second time. But it is not a simpler version of implant treatment; it is a more demanding one: a mistake in implant position costs more here than in a healed socket.

The protocol is considered when a tooth cannot be saved: a vertical root fracture, breakdown below the gum line, a perforated canal, failed root canal retreatment. Other conditions: the socket walls are intact, there is no acute purulent inflammation, enough bone remains beyond the root tip or on the palatal side for the implant to hold straight away, and the gums and neighbouring teeth are in a satisfactory condition.

The protocol is not suitable where there is an acute purulent infection with a fistula or abscess, a destroyed buccal socket wall, or too little bone for primary stability. General health factors also count against it: uncontrolled diabetes, treatment with bisphosphonates or denosumab, radiotherapy to the jaws, untreated periodontitis, jaw growth not yet complete in teenagers, heavy smoking. A thin gum biotype in the smile zone is not an absolute bar, but it is a reason to discuss the delayed option.

MediUkraine is a service that finds and coordinates treatment; it is not a clinic. We choose the clinic and a surgeon with the right specialism, arrange the date and support patients, including those travelling from abroad. The surgeon decides on the method and timing after an in-person examination and review of the CT scan.

Implant placement after extraction is classified into four types by timing, and the difference between them is not convenience but the biology of healing. Type 1 is an implant in a fresh socket on the same day. Type 2 is after 4–8 weeks, when the gum has closed over the socket but the bone has not yet formed; this is a compromise often chosen in the smile zone. Type 3 is after 12–16 weeks, when the socket has partly filled with bone. Type 4 is delayed placement after six months or more, in a fully formed ridge.

Everything starts with atraumatic extraction. The tooth is removed without levering the instrument against the buccal wall: periotomes and luxators are used to sever the ligament all the way round, and multi-rooted teeth are sectioned into fragments with each root removed separately. In the front of the upper jaw the buccal plate is often only 0.5–1 mm thick, and one careless levering movement turns an immediate protocol into bone grafting with a wait of several months.

Then comes the key decision point. The socket is cleaned of granulation tissue and rinsed, and a probe is used to check that all the walls are intact and that there are no perforations. This is the first time the surgeon sees what no scan can show: whether a wall cracked during extraction, whether the inflammatory process has spread to the bone. If a wall is missing or destroyed, the correct decision is socket preservation: the socket is filled with bone material and covered with a membrane, and the implant is placed 3–4 months later.

When conditions allow, the implant is placed not in the centre of the socket but towards the palatal or lingual wall, roughly 3–4 mm below the future gum margin. It is anchored not in the socket walls but in the bone beyond the root tip and in the palatal plate; this requires at least 3–4 mm of dense bone further towards the apex. A gap is left between the implant and the buccal wall, known in the literature as the jumping distance, and it is filled rather than left to heal on its own.

Primary stability is a number, not a feeling. The surgical motor shows the insertion torque: 25–35 N·cm and above is considered an adequate level for the immediate protocol, and stability is also measured with a resonance frequency analysis device. If the implant spins freely or the torque falls short of 15–20 N·cm, it is not left in the socket "as is": either the size and depth are changed, or the immediate option is abandoned in favour of socket preservation.

The gap between the implant and the wall is filled with slowly resorbing granules, most often deproteinised bovine bone mineral, which maintains volume for a long time. A collagen membrane is placed on top if needed. With a thin gum biotype the surgeon adds a connective tissue graft from the palate: this thickens the gum over the implant and reduces the risk that a year later the gum margin will recede and expose the metal neck.

Next, the surgeon decides how to close over the implant. There are three options: burying it under the gum, a healing abutment, or a temporary crown the same day. In the smile zone a temporary crown is fitted when torque is 35 N·cm or more and is kept out of the bite so that it takes no chewing load: it works not as a tooth but to shape the gum contour. Where stability is insufficient, immediate loading is abandoned and you wear a removable temporary denture.

Back teeth are a different case. A molar socket is wider than any implant, so support is sought in the bone between the roots or in the bone below the socket, and the gaps are larger and need more material. For this reason, early placement after 4–8 weeks is chosen more often at the back of the mouth: the gum has already closed over the socket and the bone has not yet had time to shrink. At the front, by contrast, preserving the gum contour is the priority, and that is where the immediate option is used most, provided all the conditions are strictly met.

The partner clinic in Lviv works with Neodent implants from the Straumann group: the Grand Morse conical connection, the hydrophilic Acqua surface, and the Helix design with an aggressive thread that helps achieve torque in soft bone. The choice of system matters not only surgically: it determines whether your dentist will be able to find compatible abutments and components in five or ten years' time. Check this before the operation, especially if your implant will be maintained in another country.

To be honest about the limits: an implant in a fresh socket does not stop bone resorption. The bundle bone that nourished the tooth's ligament disappears together with the tooth, whether or not there is an implant in the socket, and the buccal wall still loses some of its volume. That is why the gap is filled with material and the gum in the smile zone is thickened, not "just in case" but to compensate for a predictable loss. Implant survival in carefully selected cases is comparable to the delayed protocol, but aesthetic complications are statistically more frequent here, and you should know this before the operation.

The first two days set the course for healing. Apply cold in short sessions, sleep with your head raised, and on the day of the operation do not rinse your mouth or touch the area with your tongue. Swelling increases until the second or third day and then subsides; this is an expected reaction, not a complication. Hot drinks, saunas, sport and flights are best avoided in the first days.

Take painkillers on the schedule the surgeon gives you, and an antibiotic only if one has been prescribed; from the second day, add chlorhexidine rinses or antiseptic mouth baths. Brush your teeth from the first day, working around the surgical site with a soft brush. Smoking in the first two weeks sharply increases the risk that the implant will not take, and it is one of the few factors entirely under your control.

Sutures are removed on day 7–10, and at the same time the surgeon checks the gums and, if a temporary crown is in place, checks that it has not come into the bite. Until then, do not chew on that side, and keep to soft food that is not hot.

Osseointegration, the fusion of the implant with the bone, takes roughly 3–4 months in the lower jaw and 4–6 months in the upper. If bone material was added in large volume, it may take longer. The permanent crown is made after a check X-ray and a stability test, not by the calendar.

The gum contour stabilises more slowly than the bone: the final shape of the margin and the papillae is assessed 6–12 months after the operation. Slight recession of the gum margin during this period is possible, especially with a thin biotype, which is why photos are taken from the same angles each time. Only a surgeon, after an examination that takes into account wall thickness, gum biotype and bite, can predict the outcome in your case.

Contact the clinic immediately if pain gets worse after the third to fifth day, there is a discharge of pus or an unpleasant taste, you develop a temperature, numbness of the lip or chin lasts more than a day, or the temporary crown or the implant has become mobile. Acting quickly often saves the situation; waiting for it to "pass by itself" does not.