Title: Immediate implant placement in infected sites: Clinical outcomes, challenges, and protocol optimization
Abstract:
Background: Immediate implant placement in infected extraction sockets remains clinically challenging because residual microorganisms and inflamed tissues may compromise osseointegration. Nevertheless, current evidence suggests that infection alone is not an absolute contraindication when meticulous surgical and regenerative protocols are followed.
Objective: To review the clinical outcomes of immediate implant placement in infected sites and identify the key measures associated with predictable treatment.
Materials & Methods: A focused review of clinical studies evaluating immediate implant placement in sockets affected by periodontal or endodontic infection was conducted. Implant survival, marginal bone changes, soft-tissue healing, postoperative infection, and protocol-related factors were assessed. Particular attention was given to patient selection, complete debridement, socket irrigation, primary stability, grafting, antibiotic use, and loading strategy.
Results: Published evidence indicates that immediate implants placed in carefully treated infected sockets can achieve survival rates comparable to those placed in non-infected sites. Favorable outcomes are associated with thorough removal of granulation tissue, copious irrigation, adequate apical or palatal bone for primary stability, and appropriate management of the peri-implant gap. Residual infection, inadequate stability, uncontrolled systemic disease, smoking, and poor plaque control may increase the risk of early failure and postoperative complications. Evidence supporting routine systemic antibiotics remains inconsistent.
Conclusion: Immediate implant placement in infected sites can be a predictable treatment option in selected patients. Success depends primarily on rigorous decontamination, stable three-dimensional implant positioning, appropriate regenerative measures, and careful follow-up. Well-designed prospective studies with standardized protocols and longer observation periods are still required.
