Immediate placement of dental implants into infected versus noninfected sites in the esthetic zone: A systematic review and meta-analysis

Statement of problem. Immediate implantation has been established to shorten waiting time before definitive restoration, offering the ability to deliver a predictable esthetic and functional outcome for patients. However, this approach remains controversial for a tooth with a periodontal or periapical lesion. Purpose. The purpose of this systematic review was to analyze the treatment outcomes of immediate implant placement into extraction sockets with or without infection of periodontal or periapical origin in the esthetic zone and to provide treatment protocols based on current studies. Material and methods. An electronic search was performed in PubMed, ISI Web of Knowledge, and the Cochrane Library between January 2009 and October 2017. A subsequent manual search included all clinical studies published in the English language and excluded any reviews or animal studies. An article quality assessment scale, Newcastle-Ottawa Scale (NOS), was used to evaluate the quality of studies enrolled. The implant survival rate was expressed as risk ratio, whereas bone level changes and gingiva level changes were expressed as mean differences in millimeters with 95% confidence intervals. The meta-analysis was conducted by using commercial software. Results. The search initially found 1171 references. The manual search of the reference lists of identified articles yielded additional papers. Altogether, 9 studies were identified within the selection criteria, with NOS scores between 5 and 8. Compared with the healthy sites, immediate implant placement in infected sites in the esthetic zone showed similar survival rates (97.6% vs. 98.4%, respectively; risk ratio [RR], 0.99; 95% confidence interval [CI], 0.97 to 1.00; P=.138). No statistically significant differences were found in bone level changes (mean difference [MD], 0.03; 95% CI, -0.09 to 0.14; P=.667) or in gingiva level changes (MD, -0.06; 95% CI, -0.13 to 0.01; P=.070) between the 2 groups. Conclusions. Meta-analysis showed that immediate implant placement into infected sites and noninfected sites in esthetic zone had similar survival rates, bone level changes, and gingiva level changes.