Immediate Implant Placement: Primary Stability, ISQ and Implant Choice

For dental professionals. Immediate implant placement means placing the implant into a fresh extraction socket at the same visit as the extraction. Done in the right case, it saves the patient a surgery and months of healing time. Done in the wrong case, it risks buccal recession and early failure. This guide covers case selection, how to get and measure primary stability, and how implant design changes the odds.

Immediate placement vs. immediate loading

The two terms are often confused:

Term	What it means
Immediate placement	The implant goes into the socket on the day of extraction
Early placement	The implant goes in after soft-tissue healing, usually 4 to 8 weeks
Immediate loading	A provisional restoration in occlusion is attached within about a week of placement
Immediate restoration (non-functional)	A provisional is attached but kept out of occlusion
Conventional loading	The implant is left to integrate, typically 2 months or more, before loading

You can place immediately and still load conventionally. Whether you also load immediately depends mainly on primary stability.

Case selection

Immediate placement works best when:

• the socket walls are intact, especially a buccal plate of about 1 mm or more;
• there is no acute infection with pus at the site;
• there is enough bone beyond the apex or in the septum to anchor the implant (often 3 to 5 mm);
• the patient has a thick gingival phenotype, which lowers the risk of recession in aesthetic zones;
• the patient's general health allows normal healing.

A thin or missing buccal plate, active infection or a thin phenotype in the aesthetic zone are common reasons to switch to early placement.

Primary stability: the key to immediate placement

Primary stability is the mechanical stability of the implant at the moment of placement, before any bone has grown onto it. In a fresh socket, much of the implant sits in an empty space, so stability has to come from the apical bone and the socket walls. Two numbers are used to measure it.

Insertion torque is read from the surgical motor or a torque ratchet as the implant seats. Many immediate-loading protocols look for roughly 30 to 35 Ncm or more before loading. Torque should not exceed the manufacturer's limit: the maximum insertion torque for Surcam implants is 50 Ncm, per the implant instructions for use. Excess torque compresses bone and can cause necrosis.

ISQ (implant stability quotient) is measured by resonance frequency analysis with a handheld device and a small transducer screwed into the implant. It runs from 1 to 100. Values in the high 60s and up are commonly treated as high stability and favor immediate loading, while values in the 50s and below usually favor a delayed protocol. ISQ is also useful later, because a rising value over the following weeks shows integration is on track.

Torque and ISQ measure different things (resistance while seating vs. stiffness after seating), so many clinicians record both.

How to improve primary stability in a socket

• Engage native bone beyond the apex, or in the interradicular septum for molars.
• Under-prepare in soft bone. Stopping the drill sequence one step early, or skipping the final drill, raises insertion torque. See How to Choose Implant Drills.
• Choose the implant design for the site (below). Implant diameter and length matter too; see our dental implant size chart.
• Place the implant palatally in the socket to protect the buccal plate, and fill the gap with graft material per your protocol.

Implant design for immediate placement

Thread and body shape decide how well an implant grips a socket:

Design feature	Why it helps in a socket	Surcam example
Deep, sharp, coarse thread	Bites into the limited native bone at the apex and walls	SC-Type Cortical, designed for extraction sites and immediate loading. See the cortical implants collection
Aggressive bone-condensing thread	Compresses soft bone instead of removing it	U-Type, for D1 to D4 bone
Self-drilling, tapered apex	Can be guided into the apical bone with less preparation	A-Type
One-piece body	No microgap, abutment is part of the implant; a provisional can go on at once	Compressive one-piece implant, bendable neck up to 30°
Collar at tissue level	One-stage protocol, no second surgery	C-Type Tissue Level

Surcam implants ship gamma-sterilized, and every internal hex line uses the same 2.43 mm prosthetics, so the temporary abutment and healing caps work across those lines.

Provisional and loading decisions

• High stability (good torque and ISQ): an immediate provisional on a temporary abutment is an option, kept out of heavy contact.
• Moderate stability: a healing cap shaped to support the soft tissue, with loading after integration.
• Low stability: a cover screw and submerged healing.

For full-arch immediate loading, see All-on-4 Dental Implants and the multi-unit abutments used to splint implants.

FAQ

Can every extraction site take an immediate implant?
No. Infection, a damaged buccal plate or too little apical bone are common reasons to wait and use early or delayed placement instead.

What insertion torque is needed for immediate loading?
Many protocols use roughly 30 to 35 Ncm or more. Never exceed the implant manufacturer's maximum, which is 50 Ncm for Surcam implants.

What is a good ISQ value?
ISQ values in the high 60s and above are generally seen as high stability. Lower values usually call for a delayed loading protocol.

Is immediate placement the same as immediate loading?
No. Immediate placement is about timing of the implant. Immediate loading is about timing of the restoration.

Which implant is best for immediate placement?
An implant with an aggressive or deep thread that can anchor in apical bone usually gives the best primary stability. The right choice depends on the site, bone density and the clinician's protocol.