Survival Outcomes of Immediate Dental Implant Placement in Infected Versus Non-Infected Extraction Sockets: An Umbrella Review

Abstract

Background: Immediate implant placement (IIP) in infected extraction sockets remains controversial because residual infection and biofilm may compromise osseointegration. Existing systematic reviews have reported inconsistent findings, highlighting the need for higher-level evidence synthesis.

Objectives: To evaluate implant survival, success, marginal bone loss (MBL), peri-implant outcomes, and complications following IIP in infected compared with non-infected extraction sockets.

Methods: This umbrella review was conducted according to PRISMA 2020 guidelines (PROSPERO: CRD420251110840). Ten databases were searched through August 2025. Eligible studies were systematic reviews and meta-analyses of human clinical studies comparing infected and non-infected sockets. Methodological quality was assessed using AMSTAR-2 and QATSDD, overlap by the corrected covered area (CCA), and certainty of evidence using GRADE.

Results: Fifteen reviews involving several thousand implants were included. Implant survival rates ranged from 94% to 100%, with most meta-analyses showing no significant difference between infected and non-infected sites. MBL remained consistently below 1 mm and was comparable between groups. Soft-tissue outcomes and complication rates were generally similar, although a slight reduction in keratinized mucosa was reported in some infected cohorts. Evidence certainty was moderate for survival outcomes and low for complications.

Conclusions: When thorough debridement, appropriate antimicrobial measures, and adequate primary stability are achieved, IIP in infected sockets demonstrates clinical outcomes comparable to those in non-infected sites. However, heterogeneity among studies and the limited number of randomized trials reduce confidence in the overall evidence.