Implant Placement in Infected Sites-A Recipe for Failure: Yes or No??

Historically, various studies have shown that placing a n immediate implant in an infected site with either a periapical or a periodontal infection noted may be a recipe for failure.

Interestingly, a recent group of studies have found successful outcomes with this immediate implant placement. There are several clear advantages to the placement of an immediate implant. Some of these advantages include less treatment time, fewer procedures, and the ability to place the implant in the ideal axial position. The obvious disadvantage is whether or not the presence of infection compromises osseointergration or implant success.

A review of more than 12 human and animal studies carried on for one year or longer, demonstrated a high implant survival rate in sites with periodontal and periapical infection. In all of these studies a careful protocol was maintained which included a complete and thorough debridement of the socket and the aggressive use of systemic antibiotics.

The outcomes for immediate placement of implants in periodontally or periapically involved sites were comparable with those for implants that were delayed until the infection had cleared. The stringent protocol of complete debridement and systemic antibiotics used for all cases, perhaps contributed to the good clinical outcome.

Although these studies were seem to indicate that an immediate dental implant can be placed in an infected site with a high success rate, I feel that the protocol which must be followed; requiring a complete debridement of the site may be challenging to the implantologist because of dental root morphology or other anatomical considerations. Additionally, should the placement of the implant in an infected site result in a more serious infection; its resolution may be beyond the comfort zone of the implantologist.

At this time, I think the placement of a dental implant in an infected site must be determined on a case by case basis and if placed, must follow an absolute strict adherence to clinical protocol.

Gerald S. Fine, D.D.S.

Practice limited to oral & maxillofacial surgery‍