ABSTRACT Aim: To analyze the scientific literature on the etiology and pathogenic mechanisms underlying complications arising from dental implantation under immediate loading protocols and to outline promising approaches to their prevention and management. Materials and Methods: A review of the scientific literature addressing the complex mechanisms underlying potential complications of dental implantation under immediate loading protocols was conducted. Conclusions: The literature suggests that the primary causes of early dental implant failure include compromised mechanical stability during the critical phase of bone remodeling, inadequate seal control, and violation of the biological width. Soft tissue thickness deficiency (thin biotype) or the absence of keratinized mucosa triggers pathological bone destruction, which, in turn, facilitates infection and inflammation, further exacerbating destructive changes. These mechanisms are interrelated and mutually reinforce one another. The findings underscore the need to develop protocols for guided implant therapy in high-risk patients, to implement clear algorithms for objective monitoring of implant stability at all stages of treatment, and to identify the optimal sealing material. These measures have the potential to improve approaches to the fixation of prosthetic restorations.