John Thurmond D.D.S., M.S.
Dental implants may be immediately placed into extraction sites in the presence of periapical and periodontal infections following debridement and/or antibiotic usage.
Survival rates greater than 92 percent after a follow-up of more than one year were reported in eight human prospective studies, of which six were case series with few participants; no implant failures were reported in four animal studies.
Does the presence of infection compromise the osseointegration of dental implants immediately placed into an extraction site?
Two independent reviewers searched two electronic databases for publications dating from 1982 through November 2009. No hand searches were performed. Eligibility criteria included both animal and human studies and excluded any review articles, letters to the editor or articles not published in English. The intervention in the article had to be the placement of an implant into an infected site, and the main outcome was survival or success after a minimum of one year follow-up.
Eight human studies, of which only two were prospective clinical trials, met the inclusion criteria. These studies showed a greater than 92 percent success of implant survival, which is consistent with therapy in non-infected sites; but the evidence was limited to a small number of studies with a small number of patients (1-50) and implants (3-100) in each study.
Evidence suggests that dentists may successfully place implants into sites with periapical and periodontal infection after following a protocol that requires extraction sites to be thoroughly debrided and/or treated with antibiotics.
Source of Funding:
Importance and Context:
The immediate placement of a dental implant into a non-infected tooth socket is a highly successful procedure (1,2). A common clinical problem is a non-salvageable tooth in an infected site. The expedient approach would be to extract the tooth, thoroughly debride the site and immediately place an implant. Then, place the patient on postoperative antibiotics.
Strengths and Weaknesses of the Systematic Review:
The minimum requirements for an adequate systematic review were met because two electronic databases were searched. Because additional electronic databases, hand searches, any grey literature or foreign language publications were not included, the depth of available knowledge on this topic is unknown. The authors did not assess the quality of papers or the role of publication bias in the selected studies.
Strengths and Weaknesses of the Evidence:
The strength of the evidence is limited by the small number of low quality included studies, most of which were case series investigations or case reports. Other evidence was derived from animal studies, which typically are not considered in clinical systematic reviews. Also, the few prospective human studies included here are of dissimilar designs such that pooling of their data for a statistical meta-analysis was not feasible. Although the evidence is limited and the studies are generally of poor quality, they all appear to demonstrate a consistently high success rate comparable to the immediate insertion of an implant into a healthy, fresh socket. The protocol of all the studies included a thorough debridement of the infected extraction site and the use of systemic antibiotics.
Implications for Dental Practice:
There is extremely weak evidence that supports the immediate placement of dental implants into infected extraction sites. However, this review recommends a protocol that the extraction site be thoroughly debrided of infection before implant placement and systemic antibiotics be used postoperatively for an expectation of successful outcome. Additional randomized controlled human trials are needed to identify the criteria, indications and limitations for the immediate placement of dental implants into infected extraction sites. Provided the patient has been fully informed of the risks and benefits of this treatment protocol, it is reasonable to proceed cautiously in select cases.
1. Clin Oral Implants Res. 2012 Feb;23 Suppl 5:39-66. doi: 10.1111/j.1600-0501.2011.02372.x. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Lang NP, Pun L, Lau KY, Li KY, Wong MC.
2. Eur J Oral Implantol. 2010 Autumn;3(3):189-205. Timing of implant placement after tooth extraction: immediate, immediate-delayed or delayed implants? A Cochrane systematic review. Esposito M, Grusovin MG, Polyzos IP, Felice P, Worthington HV