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24 November 2022

Microbial flora in immediate and delayed implants: a comparative study

Lara Figini

Many factors determine the long-term success or failure of dental implants, and one of them is bacterial contamination. Little is known about the importance of supra and subgingival microbial flora around implants, and the differences in the peri-implant microflora between immediate — placed immediately after tooth extraction — and delayed implants — placed after bone healing following a dental extraction.

Materials and methods  

In a study published in the Journal of Dental Implants in July 2020, the authors analyzed microbial flora in the oral cavity before implant placement and during the various stages of implant treatment for both immediate and delayed implants.
A supragingival plaque was registered and removed with sterile cotton pellets. Paper points soaked with supragingival plaque picked up were placed in sterile transport vials filled with 1 ml anaerobic medium and were sent to the laboratory. Bacterial culture media used in the study include blood agar, Kanamycin blood agar, and Kanamycin‑vancomycin blood agar.  

The schedules for the collection of sample during the study were:

1) preoperative (before antibiotic regimen) (S1)

2) 1-day postoperative 1st stage surgery (S2),

3) suture removal (7–10 days postoperative) (S3)

4) 2 weeks (S4)

5) 2nd stage surgery (S5)

6) 2 days after abutment connection (S6)

7) on the day of prosthesis placement (S7)

8) 2 days after prosthesis placement (S8)

9) 1‑month recall (follow‑up) (S9), and

10) 2‑month recall (S10).

The collected samples were tested to estimate the growth of the following microorganisms: Streptococcus, Aggregatibacter actinomycetemcomitans, Porphyromonasgingivalis, Prevotella intermedia and Fusobacteriumnucleatum


Streptococci, which are normal commensals of the oral cavity, were consistently observed at higher titers (36% in delayed implants and 35% in immediate ones compared to the rest of the bacterial flora), while other organisms such as P. gingivalis (21% in delayed implants, 22% in immediate implants), Fusobacterium, P (25% vs 24%). intermedia and A. actinomycetemcomitans showed comparatively lower titers, both in cases of immediate and late implantations.  

The presence of organisms such as Porphyromonas gingivalis and Fusobacterium, which have pathogenic potential, is of importance.


Delayed or immediate implant placement does not alter the flora of the oral cavity. Organisms present preoperatively remained the same in all phases of the treatment. To prevent the disease, one must continuously monitor the implant. With increasing age changes, the microflora is continually changing in the oral cavity. Periodontal health should be assessed before the placement of the implant, with follow-up appointments after a set period for a better prognosis. Clinical and radiographic monitoring could help in recognizing the potential for peri-implantitis and in the prevention of the same for better prognosis.

Hiremath, Keerthi G, Viraj N Patil, Zarir Ruttonji, Preethi Kusugal, K M Sushma, Preeti Astagi. “Comparative Evaluation of Changes in Microflora in Delayed and Immediate Implant Placement: An In vivo Study.” Journal of Dental Implants. July 2020 Volume 10, Issue 1; P. 16-22.

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