Evaluating extraction sockets in the esthetic zone for immediate implant placement.

With the increasing demands of patients and the profession to maximize esthetic outcomes and minimize the number of procedures, clinicians must consider the use of immediate placement of implants into extraction sockets. Despite atraumatic extraction techniques, many cases present with a non-intact extraction socket, with bone deficiency in the coronal or apical aspect of the socket. In cases of immediate placement, an intact socket and guided bone regeneration procedures are often prerequisites to a successful esthetic outcome. In most cases, these grafting techniques can be performed at the time of immediate placement. Certain cases, however, have undergone such extensive bone and soft-tissue destruction that implants cannot be placed immediately and hard- and/or soft-tissue augmentation is required prior to implant placement. This article describes a classification system that considers both hard- and soft-tissue defects and the morphology of the extraction socket for immediate implant placement. Recommendations are made concerning the surgical technique required to treat the hard- and soft-tissue defects based on the socket morphology.