Survival and Esthetic Outcomes of Immediate Implant Placement in Infected Extraction Sites: A Scoping Review

Background: Immediate implant placement in extraction sockets with active infection remains a debated topic in implant dentistry. Traditionally, the presence of periapical or periodontal infection has been considered a contraindication due to concerns about residual contamination, impaired osseointegration, and compromised esthetic results. However, recent evidence suggests that with meticulous decontamination and appropriate case selection, successful outcomes are achievable even in infected sites. Objective: This scoping review aims to explore the available scientific literature reporting on the survival rates, esthetic outcomes, and complication profiles associated with immediate implant placement in infected extraction sites. The review also analyzes the decontamination protocols used to enable safe placement in these challenging scenarios. Methods: Following PRISMA-ScR guidelines (see Figure 1), a systematic search was conducted using PubMed to identify human clinical studies evaluating immediate implant placement into infected sites with at least 12 months of follow-up. Studies eligible for inclusion reported on at least one of the following outcomes: implant survival, esthetic results (such as Pink Esthetic Score [PES] or White Esthetic Score [WES]), or post-operative biological and/or technical complications. Only prospective or retrospective clinical studies, randomized controlled trials, and case series (n ≥ 10) were included. Relevant data were extracted using a standardized spreadsheet and synthesized thematically. Results: Thirteen studies were included, totaling 453 implants placed in infected sockets. The reported implant survival rates ranged from 90% to 100%. Esthetic outcomes, measured through PES/WES, showed mean scores between 13.9 and 15.2 (see Table 1). The majority of studies used systemic antibiotics and mechanical debridement, while some included laser decontamination and guided bone regeneration. Complication rates were low, and esthetic outcomes were generally favorable, particularly when guided bone regeneration and soft tissue grafting were employed. Conclusions: Immediate implants in infected sites demonstrate high survival and acceptable esthetic outcomes, particularly when laser decontamination and guided bone regeneration are utilized. Proper case selection and infection control remain essential. Further randomized controlled trials with long-term follow-up and consistent outcome reporting are needed.