Question
I've been told I need to have a tooth extracted because of severe gum infection. I'd like to know whether it's possible to place an implant in that same spot right away, at the same time as the extraction.
Short Answer
A tooth extracted because of gum infection can sometimes be a candidate for a same-day implant, but this isn't possible in every case. Immediate placement (putting the implant into the socket right after extraction) requires enough remaining alveolar bone (the jawbone that surrounds the tooth root) for the implant to be held firmly in place without moving, and the risk that infection remains within the bone must also be weighed. If these conditions aren't sufficiently met, delayed placement is chosen instead: the socket is first allowed to heal or the bone is augmented, and the implant is placed later.
Why Is That?
What Makes Immediate Implant Placement Possible
Placing an implant directly into the socket right after extraction is done when the extraction socket (the hole left after the tooth is removed) retains enough alveolar bone for the implant to achieve initial stability. When conditions are met, this can reduce the number of surgeries and ease the patient's discomfort, and restoration can be carried out with the shape of the surrounding bone and gum taken into account.
However, for this approach to succeed, solid initial stability must be achieved from the moment the implant is placed. If initial stability is insufficient and the implant isn't held stably, direct bone-to-implant fusion (osseointegration) is disrupted, fibrous tissue can form in between, and the risk of failure increases.
Why a Tooth Extracted for Gum Infection Is Judged More Cautiously
When extracting a tooth that had infection, the risk that the infection hasn't fully resolved is considered one of the factors that make immediate placement more difficult. If the extraction socket is large, an additional soft-tissue (gum) graft may be needed to cover it. These conditions are what determine whether the implant is placed right after extraction or after a period of healing.
When Bone Volume Is Insufficient: A Delayed Plan That Restores the Socket First
If there isn't enough bone to achieve initial stability right away, one option is to first perform socket preservation (filling the extraction socket with bone graft material to protect its volume) and place the implant later. After extraction, the bone that surrounded the tooth remodels and its volume decreases. In particular, the thin bone toward the lips and cheek can change considerably, so how to maintain space for a future implant is planned for together. Socket preservation involves extracting the tooth with minimal trauma, then filling the socket with graft material such as allograft (graft material made from another person's bone), xenograft (animal-derived bone), or synthetic bone, and covering the opening with a collagen-based membrane or barrier membrane to help the bone hold its place.
When the bone has collapsed significantly to the side (buccal or lingual) and socket preservation alone isn't enough, guided bone regeneration (GBR) may be performed: opening the gum and using graft material together with a barrier membrane. If initial stability can be achieved from the remaining bone, GBR may also be performed at the same time as immediate placement, addressing bone defects in the surrounding area. The graft material and membrane serve to protect the space where new bone will grow, and this should be understood as separate from the initial stability needed at the moment the implant is placed.