Aeklavya Panjali

Aeklavya Panjali

New York Implant Institute

Title: Immediate placement in infected sockets - myth or reality


Panjali is a graduate from New York University. He received his post graduate training in dental implants from Germany 1992. In 2004, he continued his training in Implant Dentistry at New York University and is currently pursuing a Master\'s Degree in Science (Oral Implantology). Dr Panjali is a Fellow of the Academy of General Dentistry, and Diplomat of the International Congress of Oral Implantologists. He is an active member of several dental organizations and has served on the Board of Advisors to Den-Mat. Dr. Panjali has been lecturing on Dental Implants nationally and internationally since 1996. He has trained over 700 dentists in the US and over a thousand dentists worldwide. He has evaluated and lectured on several different leading implant systems and presents a versatile approach in teaching treatment planning using non-invasive, conservative techniques. He has assisted in developing surgical instruments that have made surgical procedures easier for both dentists and assistants. Over the years, he has been developing surgical techniques which make immediate placement more predictably. He is currently working on clinical trials that could improve success rate with immediate placement. He is also developing a new, no drill osteotomy technique for surgical implant placement. He owns and operates an active private practice in Watertown, as well as in midtown Manhattan, with emphasis on Implant Dentistry.


Odontogenic infections occur as periapical inflammation, i.e. acute periapical periodontitis or a periapical abscess. Traditionally, before placing dental implants, the compromised teeth are removed and the extraction sockets are left to heal for several months. Early restoration of the masticatory function, phonetics and aesthetics are some of the current goals of immediate implant placement. However, placing implants in infected sites have always been questioned and debated for the longest time. Clinical experience has led most clinicians to avoid the immediate placement of endosseous dental implants at infected sites and to consider infection a contraindication for immediate implantation. A published systematic review emphasized the paucity of available literature discussing this subject. It also stressed the need for studies incorporating designs that eliminate confounding variables, including implant placement immediately compared with placement in intact ridges. Considering only the human case series, the protocol of most studies in literature includes socket debridement, curettage, the use of systemic antibiotics, and postsurgical chlorhexidine rinses varying from 1 to 8 weeks. Many performed GBR procedures. Some studies included peripheral intra socket ostectomy, PRGF coating of implant, combination of bone, xenograft and platelet-rich plasma, antibiotic solution irrigation of the socket, socket irrigation with chlorhexidine 0.12%, and the use of an erbium laser using photo acoustics to reduce the bacteria in osteotomy sites that were infected by apical pathology. These adjunct procedures often alter socket environment, destroy the periosteal cells present along the socket wall that are crucial for bone formation and regeneration. This presentation will rationalize, and describe step by step treatment protocol for immediate implant placement in six maxillary anterior teeth with infected sockets without the use of any adjunct procedures, to achieve good esthetics, form and function.