Scientific Online Resource System

Scripta Scientifica Medicinae Dentalis

Immediate implant placement using customized healing abutments as a method of hard and soft tissue preservation. A review article

Ralitsa Yotsova, Stefan Peev, Rossen Kolarov


INTRODUCTION: Dental implant placement with its excellent and predictable results is becoming the treatment of choice after tooth removal. A key step in creating a proper environment and conditions for it is the process of tissue preservation after the extraction. Various ridge preservation procedures have been suggested and performed, one of which is the application of immediate implant protocol using customized healing abutments. 

AIM: This review observes immediate implants not only as a definitive treatment after tooth extraction but also as a method for ridge preservation, especially in conjunction with customized healing abutments. We compared and evaluated the reports on their application and summarized their features, advantages, and limitations. 

MATERIALS AND METHODS: The present article is based on 61 articles. A manual and electronic search using PubMed and Google Scholar databases was conducted until June 2022. 

RESULTS: The majority of studies support the concept of immediate implant placement with customized healing abutments as a successful and reliable strategy for tissue preservation. It has numerous advantages, some of which are reduced healing time and post-operative discomfort, and excellent aesthetic results without the need for additional surgical stages. 

CONCLUSION: Further investigation is still necessary to clarify the exact protocols and indications for this treatment, and to point out the conditions, which demand greater caution.


immediate implants, customized healing abutments, alveolar ridge preservation, sealing socket abutments, CAD/CAM

Full Text


Araújo MG, Silva CO, Misawa M, Sukekava F. Alveolar socket healing: what can we learn? Periodontol 2000. 2015;68(1):122-34. doi: 10.1111/prd.12082.

Pagni G, Pellegrini G, Giannobile WV, Rasperini G. Postextraction alveolar ridge preservation: biological basis and treatments. Int J Dent. 2012;2012:151030. doi: 10.1155/2012/151030.

Vieira AE, Repeke CE, Ferreira Junior Sde B, Colavite PM, Biguetti CC, Oliveira RC, Assis GF, Taga R, Trombone AP, Garlet GP. Intramembranous bone healing process subsequent to tooth extraction in mice: micro-computed tomography, histomorphometric and molecular characterization. PLoS One. 2015;10(5):e0128021. doi: 10.1371/journal.pone.0128021.

Amler MH. The time sequence of tissue regeneration in human extraction wounds. Oral Surg Oral Med Oral Pathol. 1969;27(3):309-18. doi: 10.1016/0030-4220(69)90357-0.

Farina R, Trombelli L. Wound healing of extraction sockets. Endodon Top. 2011;25(1):16-43. doi: 10.1111/etp.12016.

Kan JY, Rungcharassaeng K. Immediate placement and provisionalization of maxillary anterior single implants: A surgical and prosthodontic rationale. Pract Periodontics Aesthet Dent. 2000; 12(9):817-24; quiz 826.

Spear FM. Maintenance of the interdental papilla following anterior tooth removal. Pract Periodontics Aesthet Dent. 1999;11(1):21-8; quiz 30.

Kan JY, Rungcharassaeng K, Lozada J. Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study. Int J Oral Maxillofac Implants. 2003;18(1):31-9.

Lazzara RJ. Immediate implant placement into extraction sites: Surgical and restorative advantages. Int J Periodontics Restorative Dent. 1989;9(5):332-43.

Schropp L, Kostopoulos L, Wenzel A. Bone healing following immediate versus delayed placement of titanium implants into extraction sockets: A prospective clinical study. Int J Oral Maxillofac Implants. 2003;18(2):189-99.

Morton D, Jaffin R, Weber HP. Immediate restoration and loading of dental implants: Clinical considerations and protocols. Int J Oral Maxillofac Implants. 2004; 19 Suppl:103-8.

Rosenquist B, Grenthe B. Immediate placement of implants into extraction sockets: Implant survival. Int J Oral Maxillofac Implants. 1996;11(2):205-9.

Schwartz Arad D, Chaushu G. The ways and wherefores of immediate placement of implants into fresh extraction sites: A literature review. J Periodontol. 1997; 68(10):915-23. doi: 10.1902/jop.1997.68.10.915.

Schulte W, Heimke G. The Tubinger immediate implant. Quintessenz. 1976;27(6):17-23.

Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol. 2004;31(10):820-8. doi: 10.1111/j.1600-051X.2004.00565.x.

Araujo MG, Sukekava F, Wennstrom JL, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32(6):645-52. doi: 10.1111/j.1600-051X.2005.00726.x.

Araujo MG, Sukekava F, Wennstrom JL, Lindhe J. Tissue modeling following implant placement in fresh extraction sockets. Clin Oral Implants Res. 2006;17(6):615-24. doi: 10.1111/j.1600-0501.2006.01317.x.

Araujo MG, Wennstrom JL, Lindhe J. Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installation. Clin Oral Implants Res. 2006;17(6):606-14. doi: 10.1111/j.1600-0501.2006.01315.x.

Chen ST, Darby IB, Reynolds EC. A prospective clinical study of non-submerged immediate implants: clinical outcomes and esthetic results. Clin Oral Implants Res. 2007;18(5):552-62. doi: 10.1111/j.1600-0501.2007.01388.x.

Ferrus J, Cecchinato D, Pjetursson EB, Lang NP, Sanz M, Lindhe J. Factors influencing ridge alterations following immediate implant placement into extraction sockets. Clin Oral Implants Res. 2010;21(1):22-9. doi: 10.1111/j.1600-0501.2009.01825.x.

Matarasso S, Salvi GE, Iorio Siciliano V, Cafiero C, Blasi A, Lang NP. Dimensional ridge alterations following immediate implant placement in molar extraction sites: a six-month prospective cohort study with surgical re-entry. Clin Oral Implants Res. 2009;20(10):1092-8. doi: 10.1111/j.1600-0501.2009.01803.x.

Sanz M, Cecchinato D, Ferrus J, Pjetursson EB, Lang NP, Lindhe J. A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Clin Oral Implants Res. 2010;21(1):13-21. doi: 10.1111/j.1600-0501.2009.01824.x.

Fugazzotto PA. Implant placement at the time of maxillary molar extraction: treatment protocols and report of results. J Periodontol. 2008;79(2):216-23. doi: 10.1902/jop.2008.070338.

Fugazzotto PA. Implant placement at the time of mandibular molar extraction: description of technique and preliminary results of 341 cases. J Periodontol. 2008;79(4):737-47. doi: 10.1902/jop.2008.070293.

Degidi M, Piattelli A. Immediate functional and non-functional loading of dental implants: a 2- to 60-month follow-up study of 646 titanium implants. J Periodontol. 2003;74(2):225-41. doi: 10.1902/jop.2003.74.2.225.

Esposito M, Grusovin MG, Maghaireh H, Worthington HV. Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database Syst Rev. 2013;2013(3):CD003878. doi: 10.1002/14651858.CD003878.pub5.

Morton D, Chen ST, Martin WC, Levine RA, Buser D. Consensus statements and recommended clinical procedures regarding optimizing esthetic outcomes in implant dentistry. Int J Oral Maxillofac Implants. 2014;29 Suppl:216-20. doi: 10.11607/jomi.2013.g3.

Menchini-Fabris GB, Covani U, Toti P, Crespi G, Rubino L, Crespi R. Customized vs Conventional Abutments in Healing Fresh Extraction Dental Sockets on Maxillary Anterior Teeth. Int J Prosthodont Restor Dent. 2019;9(3):82–7. doi: 10.5005/jp-journals-10019-1239.

Buser D, Chappuis V, Belser UC, Chen S. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? Periodontol 2000. 2017;73(1):84-102. doi: 10.1111/prd.12170.

Saadoun AP, Sullivan DY, Krischek M, Le Gall M. Single tooth implant--management for success. Pract Periodontics Aesthet Dent. 1994 Apr;6(3):73-80; quiz 82.

Preston J, Daftary F, Bahat O. Is it a tooth or an implant? J Calif Dent Assoc 1992;20(5):53-6.

Kerstein RB, Castellucci F, Osorio J. Ideal gingival form with computergenerated permanent healing abutments. Compend Contin Educ Dent. 2000;21(10):793-7, 800-1; quiz 802.

Cobb GW, Reeves GW, Duncan JD. Guided tissue healing for single-tooth implants. Compend Contin Educ Dent. 1999 Jun;20(6):571-8, 580-1; quiz 582.

Akin R. A new concept in maintaining the emergence profile in immediate posterior implant placement: The anatomic harmony abutment. J Oral Maxillofac Surg. 2016;74(12):2385-92. doi: 10.1016/j.joms.2016.06.184.

Chu SJ, Hochman MN, Tan-Chu JH, Mieleszko AJ, Tarnow DP. A novel prosthetic device and method for guided tissue preservation of immediate postextraction socket implants. Int J Periodontics Restorative Dent. 2014;34 Suppl 3:s9-17. doi: 10.11607/prd.1749.

Juodzbalys G, Stumbras A, Goyushov S, Duruel O, Tözüm TF. Morphological classification of extraction sockets and clinical decision tree for socket preservation/augmentation after tooth extraction: a systematic review. J Oral Maxillofac Res. 2019;10(3):e3. doi: 10.5037/jomr.2019.10303.

Gamborena I, Sasaki Y, Blatz MB. Updated clinical and technical protocols for predictable immediate implant placement. J Cosmetic Dent. 2020;35(4):36-53.

Proussaefs P. Use of CAD/CAM healing abutment immediately after dental implant placement for the non-esthetic zone: a guided soft tissue healing technique. J Oral Implantol. 2016;42(2):189-93. doi: 10.1563/aaid-joi-D-14-00228.

Proussaefs P. Custom CAD-CAM healing abutment and impression coping milled from a poly (methyl methacrylate) block and bonded to a titanium insert. J Prosthet Dent. 2016;116(5):657-62. doi: 10.1016/j.prosdent.2016.03.026.

Ruales-Carrera E, Pauletto P, Apaza Bedoya K, Volpato CAM, Özcan M, Benfatti CAM. Periimplant tissue management after immediate implant placement using a customized healing abutment. J Esthet Restor Dent. 2019;31(6):533-41. doi: 10.1111/jerd.12512

Alshhrani WM, Al Amri MD. Customized CAD-CAM healing abutment for delayed loaded implants. J Prosthet Dent. 2016;116(2):176-9. doi: 10.1016/j.prosdent.2016.01.024.

Finelle G, Lee SJ. Guided immediate implant placement with wound closure by computer-aided design/computer-assisted manufacture sealing socket abutment: Case report. Int J Oral Maxillofac Implants. 2017;32(2):e63–e67. doi:10.11607/jomi.4770

Chu SJ, Salama MA, Salama H, Garber DA, Saito H, Sarnachiaro GO, et al. The dual-zone therapeutic concept of managing immediate implant placement and provisional restoration in anterior extraction sockets. Compend Contin Educ Dent. 2012;33(7):524-32, 534.

Su H, González-Martín O, Weisgold A, Lee E. Considerations of implant abutment and crown contour: critical contour and subcritical contour. Int J Periodontics Restorative Dent. 2010;30(4):335-43.

Menchini-Fabris GB, Crespi R, Toti P, Crespi G, Rubino L, Covani U. A 3-year retrospective study of fresh socket implants: CAD/CAM customized healing abutment vs cover screws. Int J Comput Dent. 2020;23(2):109-17.

Finelle G, Sanz-Martín I, Knafo B, Figué M, Popelut A. Digitalized CAD/CAM protocol for the fabrication of customized sealing socket healing abutments in immediate implants in molar sites. Int J Comput Dent. 2019;22(2):187-204.

Doliveux S, Jamjoom FZ, Finelle G, Hamilton A, Gallucci GO. Preservation of soft tissue contours using computer-aided design/computer-assisted manufacturing healing abutment with guided surgery in the esthetic area: case report. Int J Oral Maxillofac Implants. 2020;35(1):e15-e20. doi: 10.11607/jomi.7668.

Gowda VS, Anand D, Sundar MK, Reveredo AM, Shetty S. Custom anatomic healing abutments. J Indian Prosthodont Soc. 2016;16(4):386-9. doi: 10.4103/0972-4052.176518. .

Araújo MG, Linder E, Lindhe J. Bio-Oss collagen in the buccal gap at immediate implants: a 6-month study in the dog. Clin Oral Implants Res. 2011;22(1):1-8. doi: 10.1111/j.1600-0501.2010.01920.x.

Teślak M, Ziemlewski A, Foltyn I, Ordyniec-Kwaśnica I, Drogoszewska B. Development of custom anatomic healing abutment based on cone-beam computer tomography measurement on human teeth cross-section. Materials (Basel). 2021;14(16):4570. doi: 10.3390/ma14164570.

Alexopoulou MA. Effectiveness of sealing socket abutment (SSA) technique for immediate implant placement in molars – retrospective clinical trial. Clin Oral Implants Res. 2019;30(S19):300. doi:10.1111/clr.256_13509.

Mihali S, Freiman PC, Bratu EA. Maintaining tissue architecture in immediate implant placement following extraction of natural teeth using custom healing screw. Biomed J Sci Technol Res. 2018;7(5). doi: 10.26717/ BJSTR.2018.07.001554.

Joda T, Ferrari M, Braegger U. A digital approach for one-step formation of the supra-implant emergence profile with an individualized CAD/CAM healing abutment. J Prosthodont Res. 2016;60(3):220-3. doi: 10.1016/j.jpor.2016.01.005.

Alexopoulou M, Lambert F, Knafo B, Popelut A, Vandenberghe B, Finelle G. Immediate implant in the posterior region combined with alveolar ridge preservation and sealing socket abutment: A retrospective 3D radiographic analysis. Clin Implant Dent Relat Res. 2021;23(1):61-72. doi: 10.1111/cid.12974.

Valsan IM, Pauna MR, Petre AE, Oancea L. Biologic and esthetic outcome of cad/cam custom ceramic implant abutment: a clinical report. Maedica (Bucur). 2021;16(1):145-8. doi: 10.26574/maedica.2020.16.1.145.

Botticelli D, Persson LG, Lindhe J, Berglundh T. Bone tissue formation adjacent to implants placed in fresh extraction sockets: an experimental study in dogs. Clin Oral Implants Res. 2006;17(4):351-8. doi: 10.1111/j.1600-0501.2006.01270.x.

Lee CT, Chiu TS, Chuang SK, Tarnow D, Stoupel J. Alterations of the bone dimension following immediate implant placement into extraction socket: systematic review and meta-analysis. J Clin Periodontol. 2014;41(9):914-26. doi: 10.1111/jcpe.1227.

Avila-Ortiz G, Chambrone L, Vignoletti F. Effect of alveolar ridge preservation interventions following tooth extraction: a systematic review and meta-analysis. J Clin Periodontol. 2019;46(suppl 21):195- 223. doi: 10.1111/jcpe.13057.

Roccuzzo M, Gaudioso L, Bunino M, Dalmasso P. Long-term stability of soft tissues following alveolar ridge preservation: 10-year results of a prospective study around nonsubmerged implants. Int J Periodontics Restorative Dent. 2014;34(6):795-804. doi:10.11607/ prd.2133.

Botilde G, Colin PE, González-Martín O, Lecloux G, Rompen E, Lambert F. Hard and soft tissue analysis of alveolar ridge preservation in esthetic zone using deproteinized bovine bone mineral and a saddle connective tissue graft: a long-term prospective case series. Clin Implant Dent Relat Res. 2020;22(3):387-96. doi: 10. 1111/cid.12899.

Tonetti MS, Jung RE, Avila-Ortiz G, Blanco J, Cosyn J, Fickl S, et al. Management of the extraction socket and timing of implant placement: consensus report and clinical recommendations of group 3 of the XV European Workshop in Periodontology. J Clin Periodontol. 2019;46(suppl 21):183-94. doi: 10.1111/jcpe.13131.



Article Tools
Email this article (Login required)
About The Authors

Ralitsa Yotsova
Medical University of Varna

Department of Oral Surgery, Faculty of Dental Medicine

Stefan Peev
Medical University of Varna

Department of Periodontology and Dental Implantology, Faculty of Dental Medicine

Rossen Kolarov
Medical University of Varna

Department of Oral Surgery, Faculty of Dental Medicine

Font Size