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Lollobrigida M, Pingitore G, Lamazza L, Mazzucchi G, Serafini G, De Biase A. Antibiotics to Prevent Surgical Site Infection (SSI) in Oral Surgery: Survey among Italian Dentists. Antibiotics (Basel) 2021; 10:949. [PMID: 34438999 PMCID: PMC8388912 DOI: 10.3390/antibiotics10080949] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
The benefit of an antibiotic prophylaxis for most oral surgical procedures is controversial. The aim of this study was to collect information on the prescribing habits of a sample of Italian dentists with respect to the role of antibiotic prophylaxis in preventing surgical site infections (SSI). An anonymous questionnaire was prepared and made accessible online by sharing a Google Forms link. General anagraphic data and educational background information were collected to obtain a profile of the participants. Different clinical scenarios were then proposed, with the participants asked to choose whether they would prescribe an antibiotic prophylaxis and with which dosage regimens. In total, 169 dentists participated in the questionnaire and the obtained data were assessed through a percentage report. The results showed a substantial agreement in antibiotics prescription, but only in a limited number of clinical scenarios, such as deciduous teeth extraction or simple extractions in healthy adult patients. Discordant responses were found for several clinical cases, particularly for cases of comorbidities, surgical or multiple extractions, implant placement and abscess drainage. The answers obtained from the survey sample were notably heterogeneous, indicating that the choice to prescribe an antibiotic prophylaxis to prevent SSIs is often discretionary. Moreover, the dosage regimen of prophylaxis is also controversial. The results of this study demonstrate the need for specific guidelines on antibiotics in dentistry and, specifically, on antibiotic prophylaxis in oral surgery. Such guidelines would help to avoid unnecessary prescriptions.
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Affiliation(s)
- Marco Lollobrigida
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (G.P.); (L.L.); (G.M.); (G.S.); (A.D.B.)
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Bernabeu-Mira JC, Peñarrocha-Diago M, Peñarrocha-Oltra D. Prescription of Antibiotic Prophylaxis for Dental Implant Surgery in Healthy Patients: A Systematic Review of Survey-Based Studies. Front Pharmacol 2021; 11:588333. [PMID: 33643035 PMCID: PMC7902906 DOI: 10.3389/fphar.2020.588333] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Systemic antibiotic prophylaxis is frequently prescribed by dentists performing dental implant surgery to avoid premature implant failure and postoperative infections. The scientific literature suggests that a single preoperative dose suffices to reduce the risk of early dental implant failure in healthy patients. Material and Methods: A systematic review was made based on an electronic literature search in the PubMed-Medline, Embase, Web of Science, Scopus and Open Gray databases. The review addressed the question: "which antibiotic prophylaxis regimens are being used in dental implant surgery in healthy patients according to survey-based studies?" The identification, screening, eligibility and inclusion phases were conducted according to the PRISMA statement by two independent reviewers. The following data were collected: country, number of surveyed dentists, number of dentists who responded (n), response rate, routine prescription of antibiotic prophylactic treatment (yes, no, or conditioned prescription), prescription regimen (preoperative, perioperative or postoperative) and antibiotic choice (first and second choice). Cohen's kappa coefficient (k) evaluated the level of agreement between the two reviewers. The analysis of risk of bias was performed follow the Joanna Briggs Institute checklist for observational studies. A descriptive statistical analysis was performed to calculate total target sample, sample size and total mean. Results: A total of 159 articles were identified, of which 12 were included in the analysis. Two thousand and seventy-seven dentists from nine different countries on three continents were surveyed. The median response rate was low and disparate between studies. About three-quarters of the surveyed dentists claimed to routinely prescribe systemic antibiotic prophylaxis for dental implant surgery. The prescription regimen was perioperative, postoperative and preoperative, in decreasing order of frequency. The most frequent first choice drug was amoxicillin, with amoxicillin-clavulanic acid as second choice. Conclusions: A majority of dentists from different countries do not prescribe systemic antibiotic prophylaxis for dental implant surgery following the available scientific evidence and could be overprescribing. Efforts are needed by dental educators and professionals to reduce the gap between the use of antibiotic prophylaxis for dental implant surgery as supported by the scientific evidence and what is being done by clinicians in actual practice.
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Affiliation(s)
- Juan Carlos Bernabeu-Mira
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Miguel Peñarrocha-Diago
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - David Peñarrocha-Oltra
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Patel R, Clarkson E. Implant Surgery Update for the General Practitioner: Dealing with Common Postimplant Surgery Complications. Dent Clin North Am 2020; 65:125-134. [PMID: 33213706 DOI: 10.1016/j.cden.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is essential for practitioners who place dental implants to be able to diagnose and treat common complications or know when to refer to a specialist. Common complications can include nerve injuries, infections, sinus membrane perforations, and edema. This article discusses these complications, incidence rates, tips to avoid common complications, and management options when a patient returns with a complication.
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Affiliation(s)
- Rinil Patel
- NYC Health + Hospitals/Woodhull, 760 Broadway, Room 2C-320, Brooklyn, NY 11206, USA.
| | - Earl Clarkson
- NYC Health + Hospitals/Woodhull, 760 Broadway, Room 2C-320, Brooklyn, NY 11206, USA
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Kashani H, Hilon J, Rasoul MH, Friberg B. Influence of a single preoperative dose of antibiotics on the early implant failure rate. A randomized clinical trial. Clin Implant Dent Relat Res 2019; 21:278-283. [DOI: 10.1111/cid.12724] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Hossein Kashani
- Faculty of Odontology, Department of Oral & Maxillofacial SurgeryUniversity of Göteborg Gothenburg Sweden
| | - Jack Hilon
- Faculty of Odontology, Department of Oral & Maxillofacial SurgeryUniversity of Göteborg Gothenburg Sweden
| | - Mahdi Hasan Rasoul
- Faculty of Odontology, Department of Oral & Maxillofacial SurgeryUniversity of Göteborg Gothenburg Sweden
| | - Bertil Friberg
- The Brånemark Clinic, Public Dental Health Service Västra Götaland Sweden
- Department of Biomaterials, Institute for Surgical SciencesUniversity of Göteborg Gothenburg Sweden
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Al-Kattan R, Al-Shibani N. Current trends in antibiotic prescription behavior among Saudi dentists performing implant surgery: A cross-sectional observational study. ACTA ACUST UNITED AC 2018; 10:e12383. [PMID: 30556379 DOI: 10.1111/jicd.12383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022]
Abstract
AIM The aim of the present study was to investigate current trends in antibiotic prescription behavior among dentists performing implant surgery. METHODS A cross-sectional observational study was conducted among 133 dental specialists in Saudi Arabia. A self-administered questionnaire comprising of 21 questions related to basic demographic details (ie, sex, age, nationality, undergraduate training, type of specialty, clinical, and implant practice experience) made up the first part of the questionnaire. The second part of the questionnaire consisted of 12 close-ended questions concerning knowledge and opinions of the dental specialists related to antibiotic prescription patterns pre- or post-implant surgeries. Data were compiled and analyzed using SPSS version 20. Descriptive statistics were employed to calculate the means and percentages for demographic data and preoperative and postoperative antibiotic-prescribing habits in dental implant placement. RESULTS All practicing dentists prescribed antibiotics preoperatively prior to routine dental implant placement; 41.4% (N = 55) of participants were in favor of recommending antibiotics after routine dental implant placement (postoperatively). CONCLUSION Antibiotic-prescribing patterns in implant surgery among Saudi dentists are diverse and inconsistent. Further studies are required to investigate the effect of prophylactic antibiotics in lowering the risk of implant failure.
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Affiliation(s)
- Reem Al-Kattan
- Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Al-Shibani
- Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia
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Microflora of normal maxillary sinuses: does it justify perioperative antibiotic treatment in sinus augmentation procedures. Clin Oral Investig 2018; 23:2173-2177. [PMID: 30280325 DOI: 10.1007/s00784-018-2662-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/25/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate bacterial flora of normal maxillary sinuses in order to facilitate perioperative antibiotic management in sinus augmentation procedures. MATERIALS AND METHODS Specimens of maxillary sinus mucosa were harvested during planned orthognatic surgery in 18 patients with no evidence of rhinosinusitis. The samples were processed according to hospital routine for aerobic and anaerobic cultures. RESULTS Ten maxillary sinuses were found sterile. Twenty-six (72%) maxillary mucosa specimens were culture-positive. Aerobes were recovered in 21 sinus samples (58%), predominantly as polymicrobial flora (18 cultures, 50% of all specimens), S. aureus in 2 sinuses of the same patient (6% of the samples), and Bacillus sp. in 1 sinus (3%). Anaerobes were isolated in 20 of 26 culture-positive specimens (56% of all sinus samples). They were recovered alone in 5 samples. Fifteen anaerobic cultures were polymicrobial (42% of all samples). Propionibacterium acnes was isolated from another 5 sinuses (14%) of 3 patients. CONCLUSIONS Our data support the policy of perioperative antibiotic prophylaxis in sinus augmentation procedures where Schneiderian membrane is perforated. CLINICAL RELEVANCE Evaluating the need of a perioperative antibiotic therapy in sinus augmentation procedures.
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Kamolratanakul P, Jansisyanont P. A review of antibiotic prophylaxis protocols in oral and maxillofacial surgery. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Bosco F, Cidin S, Maceri F, Ghilli M, Roncella M, De Simone L. An integrated approach with homeopathic medicine and electro-acupuncture in anaesthesiology during breast cancer surgery: Case reports. J Pharmacopuncture 2018; 21:126-131. [PMID: 30151314 PMCID: PMC6054085 DOI: 10.3831/kpi.2018.21.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/20/2018] [Accepted: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
This study investigates the effect of a combination of homeopathic medicine and electro-acupuncture in two patients with breast cancer and severe liver disease who could not receive standard anaesthesia therapy due to liver problems. Specifically, measurable and quantifiable parameters were used to evaluate whether an integrated approach-consisting of electro-acupuncture and a homeopathic medicine diluted above Avogadro's limit (that is, above a potency of 12CH) during the pre-surgical, surgical and post-surgical phases--can improve general well-being of a patient undergoing breast cancer surgery. In breast cancer surgery, we employed an integrated approach consisting of induction with hypnotics and muscle relaxants, followed by maintenance with anaesthetic gas, combined with a homeopathic treatment (Arnica montana 15CH and Apis mellifica 15CH) before and after surgery and an electro-acupuncture treatment performed in the pre- and post-surgical phases without any analgesic/pain relieving medications. Both of the patients treated with the integrated approach improved their overall condition without need for other common pain relieving medicines. Additionally, thanks to their rapid awakening, the patients were not relocated to a protected area and the hospitalization was shorter. A multidisciplinary approach incorporating homeopathic medicine and electro-acupuncture can be a solution for patients who need or ask about a different and/or safer alternative to the standard treatment. This approach can offer a safe, much less expensive, non-invasive and viable alternative for such cases. Moreover it can be useful for an opioids free anesthesia.
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Affiliation(s)
- F Bosco
- S.D. Anaesthesia and Intensive Care MiSC AOUP Complementary Medicine Oncology Integrated Breast Unit, University Hospital Trust ofPisa, Via Roma 67, 56126, Pisa,
Italy
| | - S Cidin
- S.D. Anaesthesia and Intensive Care MiSC AOUP Complementary Medicine Oncology Integrated Breast Unit, University Hospital Trust ofPisa, Via Roma 67, 56126, Pisa,
Italy
| | - F Maceri
- S.D. Anaesthesia and Intensive Care MiSC AOUP Complementary Medicine Oncology Integrated Breast Unit, University Hospital Trust ofPisa, Via Roma 67, 56126, Pisa,
Italy
| | - M Ghilli
- Breast Cancer Surgical Unit, University Hospital Trust of Pisa, Via Roma 67, 56126, Pisa,
Italy
| | - M Roncella
- Breast Cancer Surgical Unit, University Hospital Trust of Pisa, Via Roma 67, 56126, Pisa,
Italy
| | - L De Simone
- S.D. Anaesthesia and Intensive Care MiSC AOUP Complementary Medicine Oncology Integrated Breast Unit, University Hospital Trust ofPisa, Via Roma 67, 56126, Pisa,
Italy
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Pattern of Antibiotic Prescription for Oral Implant Treatment Among Dentists in Saudi Arabia. IMPLANT DENT 2018; 27:317-323. [DOI: 10.1097/id.0000000000000748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Park J, Tennant M, Walsh LJ, Kruger E. Is there a consensus on antibiotic usage for dental implant placement in healthy patients? Aust Dent J 2017; 63:25-33. [PMID: 28543332 DOI: 10.1111/adj.12535] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/30/2022]
Abstract
This systematic review aimed to determine whether there is consensus for antibiotic prescription in healthy patients undergoing implant placement. A search of PubMed, Embase and Medline databases was conducted in January 2016 to find published journal articles on the use of antibiotics in implant placement, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were prospective human clinical trials investigating antibiotic usage during implant placement. Fifteen studies were deemed suitable. In 13 studies, no statistical difference was found between antibiotic use and the incidence of prosthetic failure, implant failure and early postoperative infections. These were rated as having low to high risk bias. Contrary results were reported in two studies, both of which were rated as having a high potential for bias. In conclusion, antibiotic use in healthy patients for the prophylaxis of surgical infection associated with dental implant placement does not appear to improve clinical outcomes. Practitioners should apply principles of antimicrobial stewardship and not use antibiotics as a routine measure in healthy patients.
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Affiliation(s)
- J Park
- School of Dentistry, The University of Western Australia, Perth, Western Australia, Australia
| | - M Tennant
- Department of Anatomy, Physiology and Human Biology, International Research Collaborative, Oral Health and Equity, The University of Western Australia, Perth, Western Australia, Australia
| | - L J Walsh
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - E Kruger
- Department of Anatomy, Physiology and Human Biology, International Research Collaborative, Oral Health and Equity, The University of Western Australia, Perth, Western Australia, Australia
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Reddy CM, Brock AW, Coleman BG, Erley KJ, Johnson TM. Should Perioperative Antibiotics Be Prescribed Prophylactically for Uncomplicated Single Implant Surgeries? Clin Adv Periodontics 2017. [DOI: 10.1902/cap.2017.160040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Caitlin M. Reddy
- United States Army Advanced Education Program in Periodontics, Fort Gordon, GA
| | - Adam W. Brock
- United States Army Advanced Education Program in Periodontics, Fort Gordon, GA
| | - Brandon G. Coleman
- United States Army Advanced Education Program in Periodontics, Fort Gordon, GA
| | - Kenneth J. Erley
- United States Army Advanced Education Program in Periodontics, Fort Gordon, GA
| | - Thomas M. Johnson
- United States Army Advanced Education Program in Periodontics, Fort Gordon, GA
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Krasny M, Krasny K, Zadurska M, Fiedor P. Evaluation of treatment outcomes and clinical indications for antibiotic prophylaxis in patients undergoing implantation procedures. Adv Med Sci 2016; 61:113-6. [PMID: 26651128 DOI: 10.1016/j.advms.2015.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/27/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The use of antibiotic therapy during implantation to reduce the risk of an early implant failure is widely discussed among clinicists. However, half an hour after the procedure a quarter of patients show bacteremia which could decrease the efficacy of the surgery. Implant failure is associated with destruction of bone tissue within the alveolar process and may lead to an alternative but compromised treatment plan. The aim of the study was to evaluate the influence of perioperative antibiotic protection on success of implantation. MATERIAL AND METHODS The retrospective study involved 1915 patients (females: 57.3%, males: 42.7%) with no systemic or local diseases, who required antibiotic therapy during surgical procedures. Group 1 comprised 203 patients with diagnosed vertical or horizontal bone atrophy within the alveolar ridge requiring reconstruction procedure before implantation. Group 2 included 1712 patients who did not need any surgical procedures before implantation. All the subjects took three types of antibiotics twice a day for 7 days. The data were statistically analyzed. RESULTS A total number of 3309 implants were placed. Implantation efficacy in group 1 amounted to 98.53% and in group 2 it was 99.24%. Complications occurred most commonly after administration of cephalosporin which proved to be statistically significant for the patients who underwent augmentation with a bone block before the implant procedure (p 0.0209). CONCLUSIONS Perioperative use of antibiotic therapy beneficially influences tissue healing, provides safety and success of the surgical procedure, as well as translates into high efficacy of implantation (99.52%).
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Givens E, Bencharit S, Byrd WC, Phillips C, Hosseini B, Tyndall D. Immediate Placement and Provisionalization of Implants Into Sites With Periradicular Infection With and Without Antibiotics: An Exploratory Study. J ORAL IMPLANTOL 2015; 41:299-305. [DOI: 10.1563/aaid-joi-d-13-00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study explored the necessity of perioperative antibiotics on survival rates of implants immediately placed and provisionalized into sites with infection. Subjects were randomly assigned into antibiotic or placebo groups. Extraction, immediate placement, and provisionalization of an implant were performed. Eight subjects received placebo and five subjects received both a pre- and post-operative antibiotic regimen. One implant from each group failed. Perioperative antibiotic therapy may not be needed in selected immediate implant therapy.
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Affiliation(s)
- Edward Givens
- Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Sompop Bencharit
- Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
- Department of Pharmacology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Warren C. Byrd
- School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Ceib Phillips
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Bashir Hosseini
- Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Donald Tyndall
- Department of Diagnostic Sciences, School of Dentistry, University of North Carolina, Chapel Hill, NC
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Antimicrobial prophylaxis in dentistry. J Glob Antimicrob Resist 2014; 2:232-238. [PMID: 27873681 DOI: 10.1016/j.jgar.2014.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 12/19/2022] Open
Abstract
Use of antibiotics both in humans and animals runs along with effects that can contribute to the spread of antibiotic resistance. Although several available guidelines for antibiotic treatment have been published to date, clinical practice in dentistry and particularly in oral surgery is not free from controversies regarding antibiotic prophylaxis. Antibiotic coverage to prevent infectious endocarditis, joint prostheses infections or local infections requires a careful evaluation of the patient condition, associated risks and other aspects that could influence the decision. It is of great relevancy for oral surgeons and for dentists in general to know exactly what they are up against. Here we review the literature regarding prophylactic use of antimicrobials in dentistry.
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Khalil D, Hultin M, Andersson Fred L, Parkbring Olsson N, Lund B. Antibiotic prescription patterns among Swedish dentists working with dental implant surgery: adherence to recommendations. Clin Oral Implants Res 2014; 26:1064-9. [PMID: 24730684 DOI: 10.1111/clr.12402] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate antibiotic prophylaxis prescription behaviors among Swedish dentists working with dental implant surgery and the influence of scientific reviews. MATERIAL AND METHODS An observational questionnaire study was conducted in 2008 and 2012. Dental clinic addresses were found through online search services of Swedish telephone directories. The questionnaires were posted to eligible dentists (120 in 2008, 161 in 2012) in the Stockholm region, Sweden. Absolute frequencies were used to describe the data. Chi-square tests were applied to assess statistically significant differences. RESULTS The response rate was 75% in 2008 and 88% in 2012. In 2008, 88% of the dentists routinely prescribed antibiotic prophylaxis when performing implant surgery and 74% in 2012 (P = 0.01). There was a significant reduction in the dentists prescription patterns as 65% prescribed a single dose in 2012, compared to 49% in 2008 (P = 0.04). Amoxicillin was the drug of choice for 47% of the respondents in 2012, and 21% in 2008 (P = 0.01). Dentists without postgraduate clinical training were significantly more prone to extend antibiotic administration after surgery (P < 0.009). CONCLUSIONS There is a wide variation in the choice of compound and prescription patterns of prophylactic antibiotic prior to implant insertion. A reduction in antibiotic prescription to a single dose was observed comparing 2008 and 2012, probably influenced by scientific reviews. Dentists with postgraduate education are more likely to limit antibiotic usage.
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Affiliation(s)
- Dalia Khalil
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Margareta Hultin
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | | | | | - Bodil Lund
- Department of Dental Medicine, Division of Orofacial Diagnostics and Surgery, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
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Efficacy of two antibiotic regimens in the reduction of early dental implant failure: a pilot study. Int J Oral Maxillofac Surg 2014; 43:487-90. [DOI: 10.1016/j.ijom.2013.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 07/11/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022]
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An investigation of antibiotic prophylaxis in implant practice in the UK. Br Dent J 2013; 213:E14. [PMID: 23099724 DOI: 10.1038/sj.bdj.2012.960] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice. METHOD An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated. RESULTS One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia. CONCLUSIONS Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic overprescribing and misuse.
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Ata-Ali J, Ata-Ali F, Ata-Ali F. Do antibiotics decrease implant failure and postoperative infections? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2013; 43:68-74. [PMID: 23809986 DOI: 10.1016/j.ijom.2013.05.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/14/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to systematically review and perform a comprehensive meta-analysis of the current literature to answer the following question: among patients receiving dental implants, does the use of antibiotics, when compared with a control group, reduce the frequency of implant failure and postoperative infection? A manual and electronic PubMed search of the literature was made to identify randomized controlled trials (RCTs) on the efficacy of antibiotics compared with a control group (not receiving antibiotics or receiving placebo). Four RCTs were included in the final review. These four RCTs grouped a total of 2063 implants and a total of 1002 patients. Antibiotic use significantly lowered the implant failure rate (P = 0.003), with an odds ratio of 0.331, implying that antibiotic treatment reduced the odds of failure by 66.9%. The number needed to treat (NNT) to prevent one patient from having an implant failure was 48 (95% confidence interval 31-109). In contrast, antibiotic use did not significantly reduce the incidence of postoperative infection (P = 0.754). Based on the results of this meta-analysis, and pending further research in the field, it can be concluded that there is evidence in favour of systematic antibiotic use in patients receiving dental implants, since such treatment significantly reduces implant failure. In contrast, antibiotic use does not exert a significant preventive effect against postoperative infection. Our recommendations for future research focus on the performance of large-scale RCTs to identify the best choice of antibiotic, timing of administration, and dose. Increased effort is also required to reach consensus and define the most effective antibiotic treatment protocol for patients who are allergic to beta-lactams and for those who are not.
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Affiliation(s)
- J Ata-Ali
- Public Dental Health Service, Valencia University Medical and Dental School, Valencia, Spain.
| | - F Ata-Ali
- Public Dental Health Service, Valencia University Medical and Dental School, Valencia, Spain
| | - F Ata-Ali
- Public Dental Health Service, Valencia University Medical and Dental School, Valencia, Spain
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Mazzocchi A, Montanaro F. Observational study of the use of Symphytum 5CH in the management of pain and swelling after dental implant surgery. HOMEOPATHY 2013; 101:211-6. [PMID: 23089216 DOI: 10.1016/j.homp.2012.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 03/31/2012] [Accepted: 07/24/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the effect of Symphytum 5CH on the postoperative pain and swelling after placement of a titanium dental implant. MATERIAL AND METHODS Data on pain and swelling following pure titanium implants were reviewed. Patients were treated postoperatively with ketoprofen only or ketoprofen and Symphytum 5CH, according to the treating dentist's usual practice. Demographics and baseline characteristics were recorded and compared. Pain and swelling were compared between the two treatment groups using the Wilcoxon rank sum test and ordinal logistic regression, estimating odds ratios and confidence intervals. RESULTS 100 implants in 57 patients (28 males, 29 females) were treated with ketoprofen alone; 100 implants in 60 patients (14 males, 46 females) with ketoprofen and Symphytum. The group treated with ketoprofen and Symphytum appeared to have a better response in terms of both pain and swelling. Ordinal logistic regression: pain 0.23, 95% CI 0.13-0.41; swelling 0.24, 95% CI 0.13-0.44. Correction for demographics and implant characteristics greatly widened the confidence intervals so that the results were no longer statistically significant (pain: OR = 0.15, 95% CI 0.07-34.56; swelling OR = 0.18, 95% CI 0.07-46.78). CONCLUSIONS Adding Symphytum 5CH to conventional analgesia may reduce pain and swelling after minor dental implant surgery. No firm conclusion can be drawn since the results are confounded by baseline differences, principally gender. Further, randomized, studies should be conducted.
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Abstract
BACKGROUND Secondary antimicrobial prophylaxis involves the use of ≥ 1 antimicrobial agent just prior to the time when a diagnostic/therapeutic procedure, which may induce infection, is to be performed. In the context of this article, antimicrobial agent(s) are administered to patients with ≥ 1 implanted prosthetic device in order to prevent metastatic seeding of the device(s) during bacteremia induced by a diagnostic/therapeutic procedure. Antimicrobial agents used in this context are only administered periprocedurally. Secondary antimicrobial prophylaxis of endocarditis in recipients of cardiac prosthetic materials (including valves, shunts, conduits, and patches) has been reasonably well established. However, secondary antimicrobial prophylaxis in recipients of other types of prosthetic devices has been the subject of much controversy, with a wide variety of recommendations being made. OBJECTIVES The purpose of this article was to conduct a narrative review of the published literature on the topic of secondary antimicrobial prophylaxis in recipients of noncardiac prosthetic devices and make evidence-based recommendations for each type of device, where possible. METHODS Medline/PubMed and EMBASE databases were searched for English-language articles published from 1950 to the present (January 2012). Search terms included "prophylaxis," "antibiotics," "antimicrobials," "prosthetic devices," "prosthesis-related infections," "bacteremia," the names of the individual types of prosthetic devices, and the names of the individual procedures potentially inducing bacteremia. Articles dealing with any aspect relevant to this topic were eligible for review. The bibliographies of retrieved articles were also carefully scanned to identify any articles not previously identified. RESULTS Based on review of the available literature, secondary antimicrobial prophylaxis is justified in only a few specific circumstances. For recipients of prosthetic vascular grafts/stents, hemodialysis arteriovenous shunts, and ventriculoatrial/ventriculovenous shunts, prophylaxis is warranted during the initial 6 months, initial 6 weeks, and at all times after implantation/revision, respectively, when dental procedures capable of inducing high-level bacteremia are planned. Prosthetic joint recipients should receive prophylaxis in the following 3 circumstances: 1) patient is to undergo dental procedure(s) capable of inducing high-level bacteremia plus either the patient is still within 2 years of device implantation/revision or the patient has ≥ 1 risk factor for hematogenous prosthetic joint infection; 2) patient is to undergo genitourinary tract procedure(s) capable of inducing high-level bacteremia plus the patient has ≥ 1 risk factor for high-risk bacteriuria; and 3) patient is to undergo perforating dermatologic surgery on the oral mucosa or at skin sites at increased risk for surgical site infection plus patient has ≥ 1 risk factor for hematogenous prosthetic joint infection. The data are inadequate to justify secondary antimicrobial prophylaxis for recipients of other types of prosthetic devices. On the basis of 9 surveys of prescriber behavior, it is apparent that there exists, over a wide geographic area, a wide disconnect between clinical practice and the secondary antimicrobial prophylaxis guidelines issued by the professional organizations representing these prescribers. Antimicrobial agent overuse was especially problematic among orthopedic and colorectal surgeons, urologists, and family practitioners. Dentists and maxillofacial surgeons followed guidelines more closely. CONCLUSION Device-, procedure-, and patient characteristic-dependent factors elicited over many years have narrowed down the secondary antimicrobial prophylaxis recommendations for noncardiac prosthetic devices to a small number. Despite this, physician prescribers frequently do not follow prophylaxis guidelines established by their own professional organizations. Risk-benefit and cost-effectiveness studies have found that no prophylaxis is actually superior to universal prophylaxis, likely due to known antimicrobial toxicities, such as anaphylactic/anaphylactoid reactions and Clostridium difficile-associated disease. Much work remains in establishing and extending the scientific basis for secondary antimicrobial prophylaxis and transforming this knowledge into appropriate action by the clinician.
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Affiliation(s)
- David R Guay
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
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Ahmad N, Saad N. Effects of antibiotics on dental implants: a review. J Clin Med Res 2012; 4:1-6. [PMID: 22383920 PMCID: PMC3279494 DOI: 10.4021/jocmr658w] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2011] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED There are many reasons for dental implant failure, the development of bacteremia is concern for dentists. This is due to the possibility of unfavorable result such as implant loss or the need for re-treatment. In general, antibiotic prophylaxis is recommended for high risk patients such as individuals with an immunodeficiency, infectious endocarditis, or previous prosthetic instrumentation. However regarding clinically healthy, low and moderate risk individuals the use of antibiotics in implant dentistry is controversial. Another major concern regarding the over prescription of antibiotics is the selection of antibiotic resistant bacteria. A better understanding of the efficacy of prophylactic treatments regarding dental implantation is crucial. Thus a literature review and comparison of survival rates of dental implants with regimens of no, pre or post prophylaxis was performed using systematic literature review using reliable electronic databases. Retrospective or prospective controlled studies were examined for the influence of preoperative and/or postoperative or no antibiosis on dental implant success rate. Of the 11406 implants used in this literature review, cases with no antibiotics had a 92 % success rate, cases with pre-op antibiotic alone had a 96% success rate, cases with post-op antibiotic alone had a 97% success rate and cases with both pre and post-op antibiotic had a success rate of 96%. Thus, the results from this literature review show a > 90% success rate when antibiotics are used compared to when they are not used. Thus, no benefit is seen from the use of antibiotic prophylaxis in low and moderate risk dental implant patients. KEYWORDS Dental implants; Pre-operative prophylactics; Post-operative prophylactics; Success rate.
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Affiliation(s)
- Nabeel Ahmad
- Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
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Yi JY, Kim JH, Han DH. Immediate implant placement into extraction sites with periapical lesions in the esthetic zone: a case report. ACTA ACUST UNITED AC 2012. [DOI: 10.4047/jkap.2012.50.3.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Jae-Young Yi
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jee-Hwan Kim
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Dong-Hoo Han
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea
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AbuKaraky AE, Afifeh KA, Khatib AA, Khdairi NO, Habarneh HM, Ahmad WKH, Hamdan AAS, Sawair FA. Antibiotics prescribing practices in oral implantology among jordanian dentists. A cross sectional, observational study. BMC Res Notes 2011; 4:266. [PMID: 21798040 PMCID: PMC3160395 DOI: 10.1186/1756-0500-4-266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/28/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In oral implantology, there is no consensus on the most appropriate regimen for antibiotics prescribing, the decision to prescribe antibiotic is usually based on procedure, patient and clinician related factors. The aim of this study was to investigate the rationale of antibiotic prescribing among Jordanian clinicians who practice oral implantology. FINDINGS The target sample for the study was the 250 Jordan Dental Implant Group members. A five page questionnaire contained 41 questions, both closed and open questions were used to collect data. Statistical analysis was performed using SPSS Windows 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were generated.The response rate was (70.4%) 176/250. Mean age was 37.2 yrs, 49.4% always prescribe antibiotics mainly oral amoxicillin and amoxicillin with clavulinic acid. Antibiotics prescribing increased with flap raising, multiple implants and sinus or bone augmentation. Patient medical condition, periodontitis and oral hygiene were the most important clinical factors in antibiotic prescribing, non-clinical factors were; reading scientific materials, courses and lectures, knowledge gained during training, and the effectiveness and previous experience with the drug. CONCLUSIONS Wide variations in antibiotics types, routes, dose and duration of administration were found. Recommendations on antibiotic prescribing are needed to prevent antibiotic overprescribing and misuse.
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Affiliation(s)
- Ashraf E AbuKaraky
- Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology, and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | | | - Adel A Khatib
- Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | | | | | - Waleed KH Ahmad
- Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Ahmad AS Hamdan
- Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology, and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Faleh A Sawair
- Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology, and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, Jordan
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Jo KH, Yoon KH, Park KS, Bae JH, You KH, Han JH, Shin JM, Baik JS, Jeon IS, Cheong JK. Thermally induced bone necrosis during implant surgery: 3 case reports. J Korean Assoc Oral Maxillofac Surg 2011. [DOI: 10.5125/jkaoms.2011.37.5.406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kyu-Hong Jo
- Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Kyh-Ho Yoon
- Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Kwan-Soo Park
- Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jung-Ho Bae
- Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Kyung-Ha You
- Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Ji-Hoon Han
- Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jae-Myung Shin
- Department of Oral and Maxillofacial Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Jee-Seon Baik
- Department of Oral and Maxillofacial Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | | | - Jeong-Kwon Cheong
- Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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Waasdorp JA, Evian CI, Mandracchia M. Immediate Placement of Implants Into Infected Sites: A Systematic Review of the Literature. J Periodontol 2010; 81:801-8. [DOI: 10.1902/jop.2010.090706] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bashutski JD, D'Silva NJ, Wang HL. Implant Compression Necrosis: Current Understanding and Case Report. J Periodontol 2009; 80:700-4. [DOI: 10.1902/jop.2009.080581] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ozan O, Turkyilmaz I, Ersoy AE, McGlumphy EA, Rosenstiel SF. Clinical Accuracy of 3 Different Types of Computed Tomography-Derived Stereolithographic Surgical Guides in Implant Placement. J Oral Maxillofac Surg 2009; 67:394-401. [DOI: 10.1016/j.joms.2008.09.033] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 09/09/2008] [Indexed: 11/24/2022]
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