Immediate loading of dental implants placed in periodontally infected and non-

infected sites: a 4-year follow-up clinical study.

Crespi R, Capparè P, Gherlone E.

J Periodontol. 2010 Aug;81(8):1140-6.

Department of Dentistry, Vita Salute University, San Raffaele Hospital, Milan, Italy.
robcresp@libero.it

Abstract

BACKGROUND: The aim of the present study is to compare the outcomes of immediate
loading of implants in replacing teeth with and without chronic periodontal lesions at 4 years
of follow-up.

METHODS: Thirty-seven patients were included in this study. A total of 275 implants were
placed and immediately loaded in extraction sockets, 197 in periodontally infected sites
(infected sites group [IG]), and 78 implants in non-infected sites (non-infected sites group
[NG]). Marginal bone levels and clinical parameters (plaque accumulation and bleeding
index) were evaluated at baseline and 12, 24, and 48 months after implant placement.
Comparisons between IG and NG values over time were performed by the Student two-tailed
t test.

RESULTS: At 48 months of follow-up, the IG presented a survival rate of 98.9% because two
implants were lost 1 month after placement; the NG reported a survival rate of 100%. The
marginal bone level was 0.79 +/- 0.38 mm for the IG and 0.78 +/- 0.38 mm for the NG,
plaque accumulation was 0.72 +/- 0.41 for the IG and 0.71 +/- 0.38 for the NG, and the
bleeding index was 0.78 +/- 0.23 for the IG and 0.75 +/- 0.39 for the NG. No statistically
significant differences were reported between the IG and NG over time and between time
points.

CONCLUSION: At 48 months of follow-up, dental implants that were placed and immediately
loaded in periodontally infected sockets showed no significant differences compared to
implants placed in uninfected sites.
Immediate placement of implants into infected sites: a systematic review of the
literature.

Waasdorp JA, Evian CI, Mandracchia M.

J Periodontol. 2010 Jun;81(6):801-8.

Abstract

BACKGROUND: 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?

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.
Radiographic changes around immediately restored dental implants in
periodontally susceptible patients: 1-year results.

Horwitz J, Zuabi O, Machtei E.

Int J Oral Maxillofac Implants. 2008 May-Jun;23(3):531-8.

Unit of Periodontology, Department of Oral and Dental Medicine, Rambam Health Care
Campus, Haifa, Israel. j_horwitz@rambam.health.gov.il

Abstract

PURPOSE: There is little information available about radiographic bone changes around
immediately restored implants in periodontally compromised patients. The aims of this study
were to evaluate the effect of immediate restoration on radiographic bone changes and to
compare radiographic changes between arches and between healed and extraction sites in
periodontally susceptible patients.

MATERIALS AND METHODS: Patients received periodontal treatment. "All in one" implant
surgery was then performed: Hopeless teeth were extracted, debridement around remaining
adjacent teeth was performed, implants were inserted guided by a surgical stent, and a
prefabricated screwed provisional restoration was immediately delivered on selected
implants. Periapical radiographs using a parallelism appliance were taken at implant surgery
and 6 and 12 months postsurgery. The distance between the alveolar crest and the implant
shoulder was measured at the mesial and distal aspect of each implant. Bone changes were
compared between immediately restored, submerged, and nonrestored implants; between
arches; and between healed and extraction sites.

RESULTS: Nineteen patients received 74 implants. Twelve implants in 4 patients failed

within the first 6 months. Mean bone changes (+/- SE) between baseline and 12 months
ranged between -1.19 +/- 0.19 mm and -1.88 +/- 0.3 mm. No difference was found between
restored versus nonrestored sites or between maxillary and mandibular sites. Bone loss was
slightly higher in healed sites.

CONCLUSIONS: First-year bone changes around immediately restored dental implants in

periodontally susceptible patients were slightly higher than most reports in the literature. This
indicates a potential influence of periodontal disease on the success rate of dental implants.