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Prospective observational study on the clinical behaviour of dental implants in patients with haemophilia. Preliminary results. Br J Oral Maxillofac Surg 2021; 60:157-161. [PMID: 34916098 DOI: 10.1016/j.bjoms.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/25/2021] [Indexed: 11/20/2022]
Abstract
Haemophilia is a recessive congenital hereditary haemorrhagic disorder characterised by the decrease in, or absence of, the functional activity of factor VIII (Haemophilia A) or factor IX (Haemophilia B). The haematological medical treatment for these patients is systemic replacement therapy with factor VIII or factor IX concentrates. Dental implants are considered the gold standard for the replacement of missing teeth. There is no evidence or safe protocol for their use in patients with haemophilia. The objective of this study was to evaluate the clinical osseointegration and the incidence of postoperative bleeding in patients with haemophilia. The patients included in this study were over 18 years old with a diagnosis of haemophilia. A surgical implant protocol was implemented, supported by systemic and local haemostatic measures. Age, type of haemophilia, pre- and post-factor levels, gingival index, surgical duration, oedema, and pain were recorded for each case. In the event of haemorrhage, the bleeding index was determined. At four months, the success of the implant was evaluated using the absence of pain, suppuration, and clinical mobility as parameters. Fifteen surgeries were performed and 21 implants were placed in 10 patients. All the implants were successful in terms of the evaluated parameters. Among the 15 surgeries performed, bleeding was detected in three. The preliminary results found in this study seem to establish that the proposed surgical implant and haemostatic protocol is a predictable treatment for the placement of dental implants in patients with haemophilia.
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2
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Antibiotic prophylaxis for implant placement: a systematic review of effects on reduction of implant failure. Br Dent J 2021; 228:943-951. [PMID: 32591710 PMCID: PMC7319948 DOI: 10.1038/s41415-020-1649-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Despite excellent reviews in the past several years, the use of antibiotics as prophylaxis for implant placement remains controversial. Aim To assess the literature on the efficacy of prophylactic antibiotics prescribed prior to and immediately following implant surgery (PIFS). Outcomes Whether administration of antibiotics reduced implant failure and post-operative complications. Design Databases searched were PubMed and Medline via Ovid (1946 to February 2018), Cochrane Library (Wiley) and Google Scholar. Materials and methods Quality assessment, meta-analysis with a forest plot and incorporated assessment of heterogeneity. A two-tailed paired t-test was performed, analysing differences in mean failure rates between groups. Results Fourteen publications were collected; 5,334 implants were placed with pre-operative antibiotics, 82 implants with antibiotics PIFS and 3,862 placed with no antibiotics. The overall risk ratio (RR) was 0.47 (95% CI 0.39-0.58), with the implant failure rates significantly affected by pre-operative intervention (Z = 7.00, P <0.00001). The number needed to treat (NNT) was 35 (95% CI 26.3-48.2). The difference between mean failure rates was statistically significant (P = 0.0335). Conclusion Administering prophylactic antibiotics reduced the risk of implant failures. Further investigations are recommended to establish a standardised protocol for the proper use of antibiotic regimen.
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3
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Milic T, Raidoo P, Gebauer D. Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review. Br J Oral Maxillofac Surg 2020; 59:633-642. [PMID: 34016464 DOI: 10.1016/j.bjoms.2020.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022]
Abstract
Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients' risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients.
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Affiliation(s)
- T Milic
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
| | - P Raidoo
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
| | - D Gebauer
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
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Abstract
This article explores how to prevent and manage complications of dentoalveolar surgery. Many complications are avoidable. Surgical skills and knowledge of anatomy play an important role in prevention of complications. Prevention starts with detailed history and physical examination of the patient. Key to perioperative management of patients is risk assessment. Without a proper history and physical examination, the clinician is unable to assess the risk of performing surgery and anesthesia for each patient. Some illnesses and medications increase the risk of complications. The following complications are discussed: alveolar osteitis, displacement, fracture, hemorrhage, infection, nonhealing wound, oroantral communication, swelling, and trismus.
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Affiliation(s)
- Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, 1919 7th Avenue South, SDB 419, Birmingham, AL 35294, USA.
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5
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Romandini M, De Tullio I, Congedi F, Kalemaj Z, D'Ambrosio M, Laforí A, Quaranta C, Buti J, Perfetti G. Antibiotic prophylaxis at dental implant placement: Which is the best protocol? A systematic review and network meta-analysis. J Clin Periodontol 2019; 46:382-395. [PMID: 30729548 DOI: 10.1111/jcpe.13080] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/28/2019] [Accepted: 02/02/2019] [Indexed: 11/29/2022]
Abstract
AIM This systematic review of randomized controlled trials (RCTs) aims to answer to the following question: "In patients undergoing dental implant placement, which is the best antibiotic prophylaxis protocol to prevent early failures?" MATERIALS AND METHODS The MEDLINE, SCOPUS, CENTRAL and Web of Knowledge electronic databases were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through (i) handsearching on both relevant journals and reference lists, and (ii) searching in databases for grey literature. A network meta-analysis (NMA) was conducted, and the probability that each protocol is the "Best" was estimated. RESULTS Nine RCTs were included, with a total of 1,693 participants. Due to the few events reported, it was not possible to conduct a NMA for adverse events, therefore it was conducted only for implant failures (IF). The protocol with the highest probability (32.5%) of being the "Best" one to prevent IF was the single dose of 3 g of amoxicillin administered 1 hr pre-operatively. Even if the single pre-operative dose of 2 g of amoxicillin is the most used, it achieved only a probability of 0.2% to be the "Best" one. CONCLUSIONS Basing on the available RCTs, the use of antibiotic prophylaxis is protective against early implant failures. Whenever an antibiotic prophylaxis is needed, there is still insufficient evidence to confidently recommend a specific dosage. The use of post-operative courses does not seem however to be justified by the available literature. Prospero registration number: CRD42015029708.
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Affiliation(s)
- Mario Romandini
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.,Institute of Dentistry and Maxillofacial, Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.,PhD Candidate and Postgraduate Student in the EFP Program in Periodontology at Complutense University, Madrid, Spain
| | - Ilaria De Tullio
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Francesca Congedi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | | | - Mattia D'Ambrosio
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.,Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Ciro Quaranta
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Buti
- Unit of Periodontology, Eastman Dental Institute - University College London, London, UK
| | - Giorgio Perfetti
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
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6
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A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery. Infection 2019; 47:519-555. [DOI: 10.1007/s15010-019-01303-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/27/2019] [Indexed: 01/23/2023]
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7
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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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8
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Garcia-Blanco M, Gualtieri AF, Puia SA. A randomized controlled trial comparing nerve block and mandibular infiltration techniques in posterior mandible implant surgeries. J Clin Exp Dent 2018; 10:e1003-e1010. [PMID: 30386507 PMCID: PMC6203906 DOI: 10.4317/jced.54330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 08/14/2018] [Indexed: 11/05/2022] Open
Abstract
Background To compare global surgical pain under nerve block and mandibular infiltration anesthesia techniques, and to evaluate pain during drilling and the distance to the mandibular canal in posterior mandible implant surgeries. Material and Methods A prospective, randomized, controlled, double-blind, clinical trial was conducted to compare nerve block (Group A) to mandibular infiltration (Group B) techniques for dental implant placement. Global surgical pain (VAS = visual analogue scale), pain during drilling or implant placement (MPQ = McGill pain questionnaire) and distance to the mandibular canal (Image J) were statically analyzed. Age, gender, anxiety levels, tooth to be replaced, implant size, adjacent teeth and duration of surgery were also analyzed. Results 172 patients were included and 283 dental implants were analyzed. VAS values were significantly higher in Group B (p<0.05). In Group A, 99% of the surgeries were performed painlessly during drilling and implant placement, but in Group B, 11.6% of implant placements (17 implants) felt pain during these surgical steps. Mean distance to mandibular canal (3.8 mm, range: 0.0 to 7.0) in those 17 implants placed under mandibular infiltration was clinically and statistically similar to the mean distance (3.0 mm, range: 0.0 to 9.0) of 130 implants placed painless (p=0.10). Pain during drilling under mandibular infiltration was significantly associated with the duration of surgery (p<0.05) and to both adjacent teeth being present (p<0.05). Conclusions Although both techniques are safe and effective for placing implants in the posterior mandible, nerve block provides a more profound analgesia than mandibular infiltration. When placing implants under mandibular infiltration, as getting closer to the canal does not increase the feeling of pain, it is not recommended to use the presence of pain as a preventive resource to avoid inferior alveolar nerve injuries. Key words:Dental implant, mandibular infiltration anesthesia, nerve block, pain, nerve injury.
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Affiliation(s)
- Matias Garcia-Blanco
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial I. Buenos Aires, Argentina
| | - Ariel-Felix Gualtieri
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Biofísica y Bioestadística. Buenos Aires, Argentina
| | - Sebastian-Ariel Puia
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial I. Buenos Aires, Argentina
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9
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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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10
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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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11
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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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12
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Zhao B, van der Mei HC, Rustema-Abbing M, Busscher HJ, Ren Y. Osteoblast integration of dental implant materials after challenge by sub-gingival pathogens: a co-culture study in vitro. Int J Oral Sci 2015; 7:250-8. [PMID: 26674427 PMCID: PMC5153598 DOI: 10.1038/ijos.2015.45] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 11/18/2022] Open
Abstract
Sub-gingival anaerobic pathogens can colonize an implant surface to compromise osseointegration of dental implants once the soft tissue seal around the neck of an implant is broken. In vitro evaluations of implant materials are usually done in monoculture studies involving either tissue integration or bacterial colonization. Co-culture models, in which tissue cells and bacteria battle simultaneously for estate on an implant surface, have been demonstrated to provide a better in vitro mimic of the clinical situation. Here we aim to compare the surface coverage by U2OS osteoblasts cells prior to and after challenge by two anaerobic sub-gingival pathogens in a co-culture model on differently modified titanium (Ti), titanium-zirconium (TiZr) alloys and zirconia surfaces. Monoculture studies with either U2OS osteoblasts or bacteria were also carried out and indicated significant differences in biofilm formation between the implant materials, but interactions with U2OS osteoblasts were favourable on all materials. Adhering U2OS osteoblasts cells, however, were significantly more displaced from differently modified Ti surfaces by challenging sub-gingival pathogens than from TiZr alloys and zirconia variants. Combined with previous work employing a co-culture model consisting of human gingival fibroblasts and supra-gingival oral bacteria, results point to a different material selection to stimulate the formation of a soft tissue seal as compared to preservation of osseointegration under the unsterile conditions of the oral cavity.
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Affiliation(s)
- Bingran Zhao
- Department of Orthodontics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Henny C van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Minie Rustema-Abbing
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J Busscher
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Yijin Ren
- Department of Orthodontics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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13
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Escalante MG, Eubank TD, Leblebicioglu B, Walters JD. Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation. J Periodontol 2015; 86:1190-200. [PMID: 26252749 DOI: 10.1902/jop.2015.150024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Studies suggest that a single prophylactic dose of amoxicillin reduces early implant complications, but it is unclear whether other antibiotics are also effective. This study compared the local antimicrobial and anti-inflammatory effects resulting from a single dose of azithromycin or amoxicillin before surgical placement of one-stage dental implants. METHODS Healthy adult patients requiring one-stage dental implant placement were allocated randomly to receive either 2 g amoxicillin (n = 7) or 500 mg azithromycin (n = 6) before surgery. Peri-implant crevicular fluid (PICF) samples from the new implant and gingival crevicular fluid (GCF) from adjacent teeth were sampled on postoperative days 6, 13, and 20. Inflammatory mediators in the samples were analyzed by immunoassay, and antibiotic levels were measured by bioassay. RESULTS On day 6, azithromycin concentrations in GCF and PICF were 3.39 ± 0.73 and 2.77 ± 0.90 μg/mL, respectively, whereas amoxicillin was below the limit of detection. During early healing, patents in the azithromycin group exhibited a significantly greater decrease in GCF volume (P = 0.03, analysis of variance). At specific times during healing, the azithromycin group exhibited significantly lower levels of interleukin (IL)-6 and IL-8 in GCF than the amoxicillin group and exhibited significantly lower levels of granulocyte colony stimulating factor, IL-8, macrophage inflammatory protein-1β, and interferon-gamma-inducible protein-10 in PICF. CONCLUSIONS Azithromycin was available at the surgical site for a longer period of time than amoxicillin, and patients taking azithromycin exhibited lower levels of specific proinflammatory cytokines and chemokines in GCF and PICF. Thus, preoperative azithromycin may enhance resolution of postoperative inflammation to a greater extent than amoxicillin.
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Affiliation(s)
- Mariana Gil Escalante
- Division of Periodontology, College of Dentistry, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Tim D Eubank
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine; Department of Internal Medicine; The Ohio State University Wexner Medical Center
| | - Binnaz Leblebicioglu
- Division of Periodontology, College of Dentistry, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John D Walters
- Division of Periodontology, College of Dentistry, The Ohio State University Wexner Medical Center, Columbus, OH
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14
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Lund B, Hultin M, Tranaeus S, Naimi-Akbar A, Klinge B. Complex systematic review - Perioperative antibiotics in conjunction with dental implant placement. Clin Oral Implants Res 2015; 26 Suppl 11:1-14. [PMID: 26080862 DOI: 10.1111/clr.12637] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews. MATERIAL AND METHODS A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed. RESULTS The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking. CONCLUSION Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient.
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Affiliation(s)
- Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Sofia Tranaeus
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Swedish Council on Health Technology Assessment, Stockholm, Sweden.,Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden
| | - Aron Naimi-Akbar
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Björn Klinge
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden
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15
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Chrcanovic BR, Albrektsson T, Wennerberg A. Prophylactic antibiotic regimen and dental implant failure: a meta-analysis. J Oral Rehabil 2014; 41:941-56. [PMID: 25040894 DOI: 10.1111/joor.12211] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 12/20/2022]
Abstract
The aim of this meta-analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post-operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I(2) statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed- or random-effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non-use of antibiotics) significantly affected the implant failure rates (P = 0.0002), with a RR of 0.55 (95% CI 0.41-0.75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33-100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post-operative infections in healthy patients receiving implants (P = 0.520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.
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Affiliation(s)
- B R Chrcanovic
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö
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16
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Flapless versus conventional flapped dental implant surgery: a meta-analysis. PLoS One 2014; 9:e100624. [PMID: 24950053 PMCID: PMC4065043 DOI: 10.1371/journal.pone.0100624] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/29/2014] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 23 publications. The I2 statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used for random-effects model or fixed-effects model, when indicated. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. Sixteen studies were judged to be at high risk of bias, whereas two studies were considered of moderate risk of bias, and five studies of low risk of bias. The funnel plots indicated absence of publication bias for the three outcomes analyzed. The test for overall effect showed that the difference between the procedures (flapless vs. open flap surgery) significantly affect the implant failure rates (P = 0.03), with a RR of 1.75 (95% CI 1.07–2.86). However, a sensitivity analysis revealed differences when studies of high and low risk of bias were pooled separately. Thus, the results must be interpreted carefully. No apparent significant effects of flapless technique on the occurrence of postoperative infection (P = 0.96; RR 0.96, 95% CI 0.23–4.03) or on the marginal bone loss (P = 0.16; MD −0.07 mm, 95% CI −0.16–0.03) were observed.
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17
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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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18
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Amoxicillin Administrations and Its Influence on Bone Repair Around Osseointegrated Implants. J Oral Maxillofac Surg 2014; 72:305.e1-5. [DOI: 10.1016/j.joms.2013.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/19/2013] [Accepted: 10/21/2013] [Indexed: 11/24/2022]
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19
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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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Emecen-Huja P, Eubank TD, Shapiro V, Yildiz V, Tatakis DN, Leblebicioglu B. Peri-implant versus periodontal wound healing. J Clin Periodontol 2013; 40:816-24. [PMID: 23772674 DOI: 10.1111/jcpe.12127] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 11/29/2022]
Abstract
AIM Peri-implant gingival healing following one-stage implant placement was investigated and compared to periodontal healing. METHODS Healing at surgical sites [implant (I) and adjacent teeth (T+)] was compared to non-operated tooth (T-) in non-smokers receiving one-stage implant. Periodontal Indices (PI, GI) were recorded at surgery and up to 12 weeks post-operatively. Peri-implant (PICF) and gingival crevicular fluids (GCF) were analysed for cytokines, collagenases and inhibitors. Data were analysed by linear mixed model regression analysis and repeated measures anova. RESULTS Forty patients (22 females; 21-74 years old) completed the study. Surgical site GI, increased at week 1, decreased significantly during early healing (weeks 1-3; p = 0.0003) and continually decreased during late healing (weeks 6-12) for I (p < 0.01). PICF volume decreased threefold by week 12 (p = 0.0003). IL-6, IL-8, MIP-1β and TIMP-1 levels significantly increased at surgical sites at week one, significantly decreasing thereafter (p < 0.016). Week one IL-6, IL-8 and MIP-1β levels were ~threefold higher and TIMP-1 levels 63% higher, at I compared to T+ (p = 0.001). CONCLUSION Peri-implant gingival healing, as determined by crevicular fluid molecular composition, differs from periodontal healing. The observed differences suggest that peri-implant tissues, compared to periodontal tissues, represent a higher pro-inflammatory state.
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Affiliation(s)
- Pinar Emecen-Huja
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
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Franceschetti G, Farina R, Stacchi C, Di Lenarda R, Di Raimondo R, Trombelli L. Radiographic outcomes of transcrestal sinus floor elevation performed with a minimally invasive technique in smoker and non-smoker patients. Clin Oral Implants Res 2013; 25:493-9. [PMID: 23656234 DOI: 10.1111/clr.12188] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the association between smoking status and the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive technique (Smart Lift). METHODS Forty-five implants were placed in 25 non-smoker (NS) and 20 smoker (S) patients in conjunction with the tSFE procedure. In all cases, an additional graft, chosen among different hydroxyapatite-based or ß-tricalcium phosphate-based biomaterials, was pushed into the sinus by gradual increments. Immediately after surgery, residual bone height, implant penetration into the sinus, extent of sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs. At 6 months after surgery, SL and aGH were reassessed. RESULTS (i) The Smart Lift procedure resulted in substantial 6-month SL and aGH in both treatment groups; (ii) smoking status did not significantly affect the 6-month radiographic outcomes; (iii) a similarly low incidence of intra- and postoperative complications was observed in NS and S patients. CONCLUSIONS Smoking has a limited impact on the outcomes of tSFE performed with the Smart Lift technique.
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Affiliation(s)
- Giovanni Franceschetti
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
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Ramu C, Padmanabhan TV. Indications of antibiotic prophylaxis in dental practice- review. Asian Pac J Trop Biomed 2012; 2:749-54. [PMID: 23570007 PMCID: PMC3609373 DOI: 10.1016/s2221-1691(12)60222-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 01/22/2012] [Accepted: 03/14/2012] [Indexed: 11/24/2022] Open
Abstract
Antibiotics are frequently used in dental practice. Clinical and bacteriological epidemiological factors determine the indications of antibiotics in dentistry. Antibiotics are used in addition to appropriate treatment to aid the host defences in the elimination of remaining bacteria. It is indicated when there is evidence of clinical sign involvement and spread of infection. Antibiotics are prescribed in dental practice for treating odontoge nic infections, non-odontogenic infections, as prophylaxis against focal and local infection. Special care needs to be addressed to patients with organ transplants, poorly controlled diabetes and pregnancy. Antibiotics should be used only as an adjunct to dental treatment and never alone as the first line of care. The present paper reviews the indications of antibiotics in dental practice.
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Affiliation(s)
- C Ramu
- *Corresponding author: Dr. C Ramu, MDS, Senior lecturer, Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra University,Porur, Chennai-600116, India. Tel: +919442322777 E-mail:
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Does the Use of Prophylactic Antibiotics Decrease Implant Failure? Oral Maxillofac Surg Clin North Am 2011; 23:547-50, vi. [DOI: 10.1016/j.coms.2011.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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