Immediate placement of implants into infected sites: a systematic review of the literature

Immediate implant placement of dental implants into fresh extraction sockets was shown to be a predictable and successful procedure when proper protocols were followed. Placement into infected sites has been considered a relative contraindication. However, data from animal research, human case reports and case series, and prospective studies showed similar success rates for implants placed into infected sites compared to implants placed in non-infected or pristine sites. The focus questions addressed in this review are: Does the presence of infection compromise the osseointegration of immediate placement of implants? Does the presence of infection compromise immediately placed implant success? What protocols have been used to address the infection prior to immediate implant placement?

A systematic search of MEDLINE/PubMed articles published from 1982 up to and including November 2009 was independently performed by two investigators (JAW and CIE). The search strategy used combinations of the following terms: dental implants, immediate, immediately, extraction, infection, infected, and pathology. The search included data from animal and human studies. The selection criteria excluded animal studies that did not include a pristine control group and human case reports and case series with <1 year of follow-up. All prospective human studies were included. Studies were limited to those published in the English language, and review article data were excluded.

The search strategy initially yielded 417 references. After screening the abstracts for those related to the focus questions, 12 publications qualified for inclusion. The majority of studies examined sites with chronic periapical infection; however, the classification of infection was often vague and not categorized to be related to the outcome. The data from animal studies demonstrated high levels of implant survival, although conflicting data showed that the bone-to-implant contact may be impaired. Human studies showed high levels of implant survival consistent with therapy in non-infected sites, but evidence was limited to a small number of studies and patients. Thorough debridement and the use of systemic antibiotics were employed in all studies.

Evidence suggests implants can be placed into sites with periapical and periodontal infections. The sites must be thoroughly debrided prior to placement. Guided bone regeneration is usually performed to fill the bone-implant gap and/or socket deficiencies. Although controversial, systemic antibiotics should be used until further controlled trials prove otherwise.