Dental implants are a well-accepted treatment for the replacement of missing teeth. An estimated two million implants are placed annually, and it can be anticipated that an increasing number of implants will be placed and need to be maintained in the coming years. The intraoral environment and overall health of an individual patient influence patient selection/ implant candidacy and the outcome of implant therapy. Factors affecting the intraoral environment include the patient’s heath status, medication use, level of oral hygiene, and habits such as smoking and drinking. Oral hygiene is an important determinant of implant success, as it is with the health of the natural dentition. Brushing and flossing are also critical success factors, requiring considerable patient education and motivation, and adjunctive therapy may be considered. With careful patient selection and patient commitment to oral hygiene measures, the potential for long-term success and implant health is excellent.

Tooth extraction or tooth loss can often result in both alveolar ridge resorption and soft tissue collapse. Preservation of bone volume and soft tissue height at the time of tooth extraction is an important procedure that can facilitate implant placement and ensure that proper restorative goals are met. Proper management of extraction sites at the time of tooth extraction can reduce or eliminate the future need for advanced ridge augmentation procedures prior to implant placement. In addition, poor extraction site management may lead to esthetic and functional prosthetic complications.

Reflecting improvements in oral health as well as changes in treatment modalities and patient expectations and preferences, the majority of current baby boomers in the United States will retain their natural teeth for life. The impact of an extraction varies with location, and options may include saving the tooth through endodontic treatment or extracting the tooth and placing an implant. Both implant therapy and endodontic therapy have good success rates. With both endodontic and implant therapy, success factors and considerations include the patient’s systemic and oral health, choice of materials, and technique used. A patient’s general health status may dictate which treatment is appropriate, overriding other factors. Considerations include medication use, infection risk and more generally the patient’s ability to withstand the treatment. Oral health considerations include caries experience, periodontal health, alveolar bone, occlusal load and bruxism, parafunctional habits, health of the remaining dentition, and the presence of or need for fixed prostheses. Determination of the appropriate treatment requires careful consideration of these and potential outcomes, with the patient participating in the process.

Atraumatic dental extraction requires a complete preoperative assessment of the patient prior to surgery. The clinician must know the patient's medical status, and assess the level of difficulty of the extraction. During the extraction procedure, basic atraumatic surgical techniques must be followed and the clinician must be prepared to manage complications should they arise.

Success rates for endosseous dental implants are high. While historically implants were of standard lengths and diameters, implants increasingly became available that were shorter or longer and with wider or narrower diameters, as well as with varying macro-geometric designs. Anatomical considerations may exist that  require either adjunctive treatment prior to implant placement or, instead, the placement of short implants. Recent research has found that length, macro-geometric design and diameter influence the amount of bone that osseointegrates due to differences in surface area, as well as the distribution of forces and resulting stresses. With appropriate selection, high success rates can be enjoyed for both long and short implants where indicated.