Article

Feature Article
Sep 24, 2025 // 9 min read
The Effect of the Type of Gap-Grafting Materials in Post-extraction Immediate Placement
Anina N. Zuercher
Marc Balmer
Ronald E. Jung
Daniel S. Thoma
DOI: 10.63580/ITI.FI.45766
immediate implant placement graft materials peri-implant gap soft tissue augmentation bone substitute materials
Abstract

Background: Immediate implant placement (IIP) is a widely adopted clinical approach aiming to reduce treatment time and increase patient satisfaction. However, dimensional changes following tooth extraction – particularly buccal bone resorption and soft tissue recession – remain a biological challenge that may compromise esthetic and biological outcomes. Grafting the peri-implant gap has emerged as a key intervention to support ridge stability. The type of grafting material – whether for bone or soft tissue augmentation – may substantially influence wound healing dynamics and long-term success.

Objectives: This article examines the role of graft materials in managing the peri-implant gap in conjunction with immediate implant placement. It summarizes current biological insights and clinical data on autogenous, allogeneic, xenogeneic, and alloplastic grafts, focusing on their regenerative potential, clinical indications, and impact on esthetic and volumetric outcomes.

Conclusion: Peri-implant gap-grafting enhances volume stability, particularly in cases with thin buccal bone or in patients with the highest esthetic demands. Slowly resorbing xenografts demonstrate predictable contour preservation, while faster-resorbing materials may result in faster remodeling. Soft tissue phenotype, defect morphology, and implant position determine clinical decision-making. Although current evidence supports grafting in selected scenarios, further standardized, long-term studies are needed to define optimal materials and protocols.

Introduction

Immediate implant placement (IIP) following tooth extraction offers several advantages, including reduced treatment time, fewer surgical interventions, and preservation of soft and hard tissue contours (Chen & Buser 2014). This approach has gained increasing popularity among clinicians due to its efficiency along with high patient satisfaction. However, IIP presents distinct biological and clinical challenges, particularly related to the buccal contour and management of the peri-implant gap – a horizontal defect often observed between the implant and the buccal bone wall (Fig. 1).

The gap arises because implant diameters rarely match natural root dimensions, especially in the anterior maxilla, where roots are ovoid and the facial bone is thin (Araújo et al. 2005). If the gap is left unfilled, there is a risk of soft tissue ingrowth, impaired osseointegration, and a partial loss of the alveolar ridge – most notably at the buccal aspect (Botticelli et al. 2004). Numerous studies (Araújo et al. 2006; Cosyn et al. 2013; Hämmerle et al. 2012) highlight that buccal bone resorption can lead to mucosal recession and esthetic impairments or even implant or esthetic failures (Cosyn et al. 2012). This article explores the biological and clinical principles of peri-implant gap healing in immediate implant placement. It critically assesses the available evidence on autogenous, allogeneic, xenogeneic, and alloplastic grafts, with special attention to their role in dimensional stability, soft tissue management, esthetic outcomes, and clinical decision-making.

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Fig. 1: Schematic cross-sectional illustration of the clinical situation showing “filling the gap”. The cross-section demonstrates soft tissue, alveolar bone, an implant positioned within the alveolar socket, a peri-implant gap filled with bone graft material and covered with a resorbable membrane. Such illustrations emphasize the principle that gap grafting supports clot stability, reduces buccal collapse, and improves dimensional outcomes compared with ungrafted sites