Immediate Implant Placement in Infected Sockets: A Consecutive Cohort Study

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study

BACKGROUND

Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets.

METHODS

We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann-Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05.

RESULTS

All implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26-1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39-1.47 mm in groups I and N, respectively.

CONCLUSION

Within the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession.

TRIAL REGISTRATION

The protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

Five- and 18-Year Outcome of Two Cases with Full-Arch Rehabilitations Ad modum All-on-4 in the Presence of Challenging Conditions

Placing implants in fresh postextraction sites is a borderline rehabilitation procedure. The purpose of this report is to describe the pre-, per-, and postoperative procedures for maintaining long-term stability of two full-arch rehabilitations through the All-on-4 protocol, performed in the presence of challenging conditions. Two patients were referred for full-arch rehabilitation with immediate function, with both patients presenting infection in the jaws: patient 1 with an implant (position #45) inserted in a cystic cavity; patient 2 with one implant (position #24) inserted transsinus after the removal of a cyst on the base of the maxillary sinus and another implant (position #15) inserted with a dehiscence. Both patients received a preoperative dental hygiene appointment, a regenerative surgical protocol, and were enrolled in a postoperative maintenance protocol. After surgery a provisional prosthesis was provided ensuring immediate function, and 6 months after surgery, the final prosthesis was delivered. During the follow-up appointments (final follow-up at 5 and 18 years), the implants were stable, and no infection was observed for both patients. The present case report describes two full-arch rehabilitations in immediate function, supported by dental implants inserted in the presence of challenging conditions that do not represent the norm, rather are highly demanding for the clinical team, warranting caution in the interpretation of the results.

Placement of immediate dental implants in extraction sockets exhibiting the apical pathosis. A meta-analysis

Objectives

It is commonly accepted that immediate implantation is the best option for patients since it shortens the time patients must wait for ultimate restoration and provides a predictable functional and aesthetic result. However, this approach is still controversial in patients with apical pathosis. The goal of this systematic review and meta-analysis was to determine the efficacy of immediate implant insertion in patients with apical pathosis.

Material and methods

Between 2000 and 2023, PRISMA-compliant keywords were used to search PubMed, MEDLINE, CENTRAL, and the Cochrane Library. All English-language clinical studies that met PICOS criteria were included in a manual search. The included studies' demographic profile and event data for immediate dental implantation success in patients with or without apical pathosis were meta-analyzed using RevMan. The implant survival rate was assessed using risk ratio of plaque index and bleeding index. Begg's test using MedCalc and RevMan risk of bias assessment assessed publication bias.

Results

A meta-analysis of 10 trials with 849 dental implantation patients found a substantial difference in initial implant placement success rates in infected sites. The pooled risk ratio for plaque index is 0.59 (95% CI: 0.36-0.96) with heterogeneity of Tau2 = 0.62, chi2 = 109.69, df = 11, I2 = 90%, z = 2.12, and p < 0.05. While, the pooled risk ratio for bleeding index is 0.77 (95% CI: 0.60 to 0.98) with Tau2 = 0.16, chi2 = 103.67, df = 11, I2 = 89%, z = 2.12, and p < 0.05. The pooled odds ratio of implant survival rate is 2.08 (95% CI: 1.56 to 1.79) with Tau2 0.16; chi2 52.43; df 9; I2 83%; z 4.93 and p < 0.05. As evidenced by the funnel plot and statistically insignificant Begg's test p values of 0.45.

Conclusion

The placement of immediate implants in locations affected by apical pathosis is a clinically beneficial surgery, resulting in favorable aesthetic and functional outcomes for patients.

Immediate implant placement for chronic peri-apical periodontitis in the molar region: a randomised controlled trial

The aim of this study was to evaluate the feasibility of immediate implantation for chronic peri-apical periodontitis in the molar region. Seventy-four molars were selected and allocated randomly to two groups. The experimental group (n = 38) received immediate implantation by flap surgery and the control group (n = 36) received delayed implantation. CBCT was performed immediately after surgery (T1) and 12 months after the permanent repair (T3). The implant survival rate at T3 was 100% in both groups. There was no significant difference in buccal or lingual vertical marginal bone loss between the groups (P = 0.515, P = 0.736). However, the buccal horizontal margin bone loss was significantly greater in the experimental group: 0.98 ± 0.34 mm vs 0.77 ± 0.27 mm in the control group (P = 0.003). In the experimental group, the highest point of buccal and lingual implant-bone contact increased at T3. The buccal and lingual jump gap widths were 3.21 ± 1.10 mm and 2.92 ± 1.01 mm at T1, and CBCT showed no jump gap around the implants at T3. The clinical outcomes showed immediate implantation to be feasible for chronic peri-apical periodontitis in the molar region.

A clinical protocol for immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser

BACKGROUND

Placement of dental implants into fresh extraction sockets offers some advantages, such as reduced treatment times and enhanced patient comfort. The Er,Cr:YSGG (Erbium, Chromium-doped: Yttrium, Scandium, Gallium, and Garnet) laser can significantly reduce bacterial concentration after the extraction of a compromised tooth. The aim of this article is to provide a clinical protocol for the management of implants placed in infected extraction sites decontaminated with Er,Cr:YSGG laser.

METHODS

A compromised tooth, which was an abutment for a fixed bridge, with clinical and radiological signs of infection was extracted. The infected site was treated and decontaminated with an Er,Cr:YSGG laser device (Biolase iPlus®) and two implants (Straumann®) were placed in the same surgery, in order to rehabilitate the edentulous area. The intervention was completed by tissue regeneration with biomaterials.

RESULTS

Prosthetic rehabilitation after the surgical phase allowed us to provide correct function and satisfactory esthetics. In the follow-up visit, clinicians found good tissue healing and did not observe any complications, such as implant loss or peri-implantitis. The technique used in our study is repeatable and predictable, but patient selection is very important for this type of protocol as the presence of contraindications can lead to failure. The photoacoustic effect exerted by this type of laser has been proven to be effective against many pathogens. Several authors have previously demonstrated the effectiveness of this technique.

CONCLUSIONS

Immediate implantation in infected sites decontaminated with Er,Cr:YSGG laser does not seem to contribute to an increased risk of failure; however, it is necessary to follow a certain set of protocols and procedures to prevent peri-implantitis and other complications.

Case report and literature review: autonomous robotic system assisted palatal implantation at an anterior teeth site compromised by periapical cyst

Background

Immediate implant placement (IIP), which preserves gingival height and papilla shape while simultaneously accelerating the implant treatment period, has become a popular method due to its commendable clinical outcomes. Nonetheless, deploying immediate implants demands specific preconditions concerning the remaining alveolar bone. This poses a challenge to the accuracy of implant surgery.

Case presentation

In this report, we present the case of a 60-year-old woman with a left upper anterior tooth crown dislodged for over a month. Cone beam computed tomography (CBCT) revealed the absence of a labial bone wall on tooth 22, a remaining 1 mm bone wall on the labial side of the root apex, and a 17.2 mm*8.9 mm*4.7 mm shadow in the periapical region of the root apices of teeth 21 and 22, with the narrowest width on the sagittal plane being approximately 5 mm. After the surgeon removed the cyst, they completed the subsequent implantation surgery using an autonomous robot in a challenging aesthetic area. This method circumvented the potential exposure of the screw thread on the labial implant surface, assured initial implant stability.

Conclusion

Five months after the operation, the dental crown was restored. The implant remained stable, with yielding notable clinical results. To the best of our knowledge, this clinical case is the first to report the feasibility and precision of immediate implantation in anterior teeth site with periapical cyst removal, performed by an autonomous robotic surgical system. Autonomous robots exhibit exceptional accuracy by accurately controlling axial and angular errors. It can improve the accuracy of implant surgery, which may become a key technology for changing implant surgery. However, further clinical trials are still needed to provide a basis for the rapid development of robotic surgery field.

High-Power Laser Application for Immediate Implant Placement in Infected Sites: A Systematic Review

Objective: The purpose of this study was to review the literatures regarding the treatment outcomes of applying laser to the infected sites in immediate implant placement. The review tended to primarily target a question: does applying high-power laser have any positive effect on infected sites in immediate implant placement? Background: Although immediate placement of dental implants has been referred to as a predictable and successful procedure, it is prone to the presence of infection that interferes with the healing process, and triggers the failure of implants. Materials and methods: A thorough electronic database search was conducted on PubMed/Medline, Embase, Web of Science, Google Scholar, and the Cochrane library in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two writers worked separately on screening the eligible studies, assessing whether there was a risk of bias, and extracting the required data. Results: Five out of the 60 studies nominated by the database search matched the inclusion criteria. The studies were carried out on a total of 192 patients with 296 implants in all. Ultimately, the study focused on 245 implants whose infected bed had been already decontaminated and prepared with the help of the high-intensity laser, used either alone or in combination with other approaches before implantation. With only nine failures, the implants inserted in infected and irradiated areas had a 96.3% overall survival rate. Conclusions: Taking the limitations of the review into account, the authors arrived at the conclusion that high-power laser irradiation can be beneficial for immediate implant placement in infected sites.

Comparison of Prophylactic Effects between Localized Biomimetic Minocycline and Systematic Amoxicillin on Implants Placed Immediately in Infected Sockets

This study evaluated the prophylactic effect of localized biomimetic minocycline and systemic amoxicillin on immediate implant placement at infected extraction sites. Twelve mongrels with six implants each were randomly assigned to five groups: uninfected negative control (Group N); infected with oral complex bacteria (Group P); infected and treated with amoxicillin one hour before implant placement (Group A); infected and treated with minocycline during implant placement (Group B); and infected and treated with amoxicillin one hour before implant placement and with minocycline during implant placement (Group C). Radiographic bone level, gingival index (GI), probing depth (PD), papillary bleeding index (PBI), and removal torque (RT) were recorded. There was no significant difference between Groups A, B, and C for bone loss. Group A showed the highest RT, the lowest PBI, and significantly lower GI and PD values than Group P. Group B exhibited significantly higher RT value than Group N and significantly smaller PD value than Group P at 6 w postoperatively. Localized minocycline could improve implant success by reducing bone loss and increasing RT and systemic amoxicillin could maintain the stability of the peri-implant soft tissue. However, combined use of these two antibiotics did not augment the prophylactic effect.

Five-year outcomes of immediate implant placement for mandibular molars with and without chronic apical periodontitis: A retrospective study

BACKGROUND

Most physicians consider molars with chronic apical periodontitis (CAP) lesions as contraindications for immediate implant placement. At the patient’s request, we perform immediate implant placement of the mandibular molars with CAP in clinical practice.

AIM

To retrospectively analyze and compare the 5-year outcomes of immediate implant placement of the mandibular molars with CAP and those without obvious inflammation.

METHODS

The clinical data of patients with immediate implant placement of the mandibular molars in the Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, from June 2015 to June 2017 were collected. The patients were divided into CAP (n = 52) and no-CAP (n = 45) groups. Changes in bone mineral density and bone mass around implants were analyzed 5 years after implant restoration.

RESULTS

At 5 years after implantation, the peri-implant bone mineral density was 528.2 ± 78.8 Hounsfield unit (HU) in the CAP group and 562.6 ± 82.9 HU in the no-CAP group (P = 0.126). Marginal bone resorption around implants did not differ significantly between the two groups, including buccal (P = 0.268) or lingual (P = 0.526) resorption in the vertical direction or buccal (P = 0.428) or lingual (P = 0.560) resorption in the horizontal direction. Changes in the peri-implant jump space did not differ significantly between the two groups, including the buccal (P = 0.247) or lingual (P = 0.604) space in the vertical direction or buccal (P = 0.527) or lingual (P = 0.707) space in the horizontal direction. The gray value of cone-beam computed tomography measured using Image J software can reflect the bone mineral density. In the CAP area, the gray values of the bone tissue immediately and 5 years after implant placement differed significantly from those of the surrounding bone tissue (P < 0.01).

CONCLUSION

The results of this study suggest that immediate implant placement of the mandibular molars with CAP can achieve satisfactory 5-year clinical results, without significant differences in the complications, survival rate, or bone tissue condition from the no-CAP mandibular molars.

Five-year outcomes of immediate implant placement for mandibular molars with and without chronic apical periodontitis: A retrospective study

BACKGROUND

Most physicians consider molars with chronic apical periodontitis (CAP) lesions as contraindications for immediate implant placement. At the patient's request, we perform immediate implant placement of the mandibular molars with CAP in clinical practice.

AIM

To retrospectively analyze and compare the 5-year outcomes of immediate implant placement of the mandibular molars with CAP and those without obvious inflammation.

METHODS

The clinical data of patients with immediate implant placement of the mandibular molars in the Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, from June 2015 to June 2017 were collected. The patients were divided into CAP (n = 52) and no-CAP (n = 45) groups. Changes in bone mineral density and bone mass around implants were analyzed 5 years after implant restoration.

RESULTS

At 5 years after implantation, the peri-implant bone mineral density was 528.2 ± 78.8 Hounsfield unit (HU) in the CAP group and 562.6 ± 82.9 HU in the no-CAP group (P = 0.126). Marginal bone resorption around implants did not differ significantly between the two groups, including buccal (P = 0.268) or lingual (P = 0.526) resorption in the vertical direction or buccal (P = 0.428) or lingual (P = 0.560) resorption in the horizontal direction. Changes in the peri-implant jump space did not differ significantly between the two groups, including the buccal (P = 0.247) or lingual (P = 0.604) space in the vertical direction or buccal (P = 0.527) or lingual (P = 0.707) space in the horizontal direction. The gray value of cone-beam computed tomography measured using Image J software can reflect the bone mineral density. In the CAP area, the gray values of the bone tissue immediately and 5 years after implant placement differed significantly from those of the surrounding bone tissue (P < 0.01).

CONCLUSION

The results of this study suggest that immediate implant placement of the mandibular molars with CAP can achieve satisfactory 5-year clinical results, without significant differences in the complications, survival rate, or bone tissue condition from the no-CAP mandibular molars.

Initial Development of an Immediate Implantation Model in Rats and Assessing the Prognostic Impact of Periodontitis on Immediate Implantation

BACKGROUND

To establish an immediate implantation rat model and to evaluate the effects of pre-existing periodontitis and two different socket rinse solutions on immediate implantation prognosis.

METHODS

Sprague-Dawley (SD) rats were randomly divided into three groups before immediate implantation, including the control group, the group with experimentally induced periodontitis (EP), in which rats have been experimentally induced periodontitis before implantation, and the group with induced periodontitis and with extraction sockets rinsed with three percent H2O2 (EP-H2O2), in which rats have been induced periodontitis before implantation, and extraction sockets were rinsed with three percent H2O2. Periodontitis was induced by ligating the thread around the molars for four weeks. Six weeks after titanium alloy implants were self-tapped and left to heal transmucosally, maxillae were dissected after the clinical examination to perform micro-CT and histological analysis.

RESULTS

An immediate implantation model was successfully built in rats. There was no significant difference in implant survival rates between the EP and control groups. However, the clinical examination results, micro-CT analysis, and histological analysis in EP and EP-H2O2 groups showed a significantly worse prognosis than in the control group. Three percent H2O2 showed a similar effect with saline.

CONCLUSION

This study presented a protocol for establishing a rat immediate implantation model and showed that periodontitis history might negatively affect the prognosis of immediate implantation. These findings urge caution and alternative strategies for patients with periodontal disease history, enhancing the long-term success of immediate implantation in dental practice. Additionally, the comparable outcomes between 3% H2O2 and saline suggest the use of saline as a cost-effective and safer alternative for implant site preparation in dental practice.

Retrospective analysis of dental implants immediately placed in extraction sockets with periapical pathology: immediate implant placement in infected areas

BACKGROUND

The aim of this study is to examine the survival rates of immediate implants placed in extraction sockets with chronic periapical pathology.

METHODS

69 patients and 124 immediate implants were included in the study. The patients included in the study were examined in 3 groups. Group 1: Patients who underwent tooth extraction with periapical pathology and immediate implant placement. Group 2: patients who underwent tooth extraction with periapical pathology, immediate implant placement and guided bone regeneration. Group 3: Patients who underwent tooth extraction with periapical pathology, sinus lift procedure and immediate implant placement. In statistical analysis, t-test and Anova analysis were used in the evaluation of quantitative data, cross-tables and chi-square (χ2) test were used in the evaluation of classified qualitative data. Statistical significance was determined as p < 0.05.

RESULTS

It was observed that 116 (95.55%) of 124 implants were successful and 8 (4.45%) failed. The success rate was 97.2% in Group 1, 93.5% in Group 2 and 81.8% in Group 3. A significant correlation was found between the study groups and implant success in terms of χ2 test (p = 0.037). A significant relationship was found between smoking and success in terms of the χ2 test (p = 0.015).

CONCLUSIONS

High survival rates are observed for immediate implant placement in sockets with periapical pathology. The success rates observed in guided bone regenerations simultaneously with immediate implant placement are at satisfactory levels. In cases where simultaneous sinus lifting procedures are required, the success rates were observed to be significantly lower. In case of adequate curettage and debridement in sockets with periapical pathology, high implant survival rates are observed. As the complexity of the surgical procedure increases, treatment protocols may progress in safer ways.

Immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser: a retrospective cohort study

Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.

Incidental finding of paradental cyst in the maxillary anterior teeth during immediate implant placement

Paradental cyst is classified as an inflammatory cyst, and its occurrence in the anterior maxillary region is very rare. Several hypotheses have been put forward on the etiopathogenesis among which the formation of cyst secondary to inflammatory destruction of the periodontium and alveolar bone can be attributed to the present case. A 26-year-old male patient reported with loosened maxillary anterior teeth. After clinical and radiological examination, extraction of teeth #12, #11, #21, and #22 followed with immediate implant placement was planned. During extraction of #21, incidentally, a cyst was noted to be attached to the apices of #21 tooth. Implants were placed at #12, #11, and #22 sites, and socket of #21 was debrided thoroughly, followed by the placement of graft. A histopathological study of the cyst revealed it to be a paradental cyst. The patient was followed up for 6 months, and no recurrence of cystic lesion was noted. When immediate implant placement is being planned, considerations to the periodontal and periapical disease status of the teeth being extracted are crucial to achieve better treatment outcomes.

Management of Postsurgical Complication in Multiple Implant-Infected Postextraction Sites in the Lower Arch

Currently, dental implants are a very frequent therapeutic alternative for replacing missing teeth. However, they are not exempt from developing complications of infectious origin. Therefore, this case report describes a 67-year-old female patient presenting infectious complications caused by suture rupture. Surgery combined with therapeutic management with antibiotics was performed, allowing preservation of the osseointegration of the implants in the lower arch. Within the limitations of this study, it was shown that more research is needed to determine the success and survival of implants presenting complications due to infections during the osseointegration process.