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Wehner C, Fürst G, Vaskovich T, Andrukhov O, Vasak C, Moritz A, Rausch-Fan X. Effects of customized CAD/CAM abutments on cytokine levels in peri-implant crevicular fluid during early implant healing: a pilot study. Clin Oral Investig 2023; 27:2621-2628. [PMID: 36565371 PMCID: PMC10264526 DOI: 10.1007/s00784-022-04826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/04/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aimed to assess levels of biomarkers associated with inflammation and tissue destruction in peri-implant crevicular fluid (PICF) of implants provided with customized or standard healing abutments during early implant healing. MATERIALS AND METHODS Thirty implants were placed in 22 patients with partial posterior edentulism. Subsequently, test group implants (n=15) received one-piece titanium abutments that were fabricated using computer-aided design/computer-aided manufacturing (CAD/CAM). Control group implants (n=15) were provided with standard abutments. PICF collection and standardized periapical radiographs were carried out at suture removal one week later, following crown delivery after 3 months and at 6 months. Expression of C-reactive protein (CRP), interferon-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12A, IL-17A, macrophage inflammatory protein (MIP)-1α, matrix metalloproteinase (MMP)-13, osteopontin, osteoactivin, Receptor Activator of NF-κB (RANK), and TGF-β were analyzed using a multiplex ELISA kit. RESULTS Both groups showed a significant decrease in protein expression of CRP, IL-1β, IL-6, IL-8, MIP-1α, osteopontin, osteoactivin, and TGF-β, while MMP-13 levels increased during the observation period. A rise in OPG and RANK levels was detected among customized abutments. Expression of CRP was higher, whereas IL-1β, IL-1α, and MIP-1α were decreased in control compared to test group implants after 6 months. Marginal bone loss did not depend on abutment modality. CONCLUSIONS Both abutment types showed distinctive temporal expression of inflammatory biomarkers during 6 months following implant placement. TRIAL REGISTRATION ISRCTN98477184, registration date 18/05/2022 CLINICAL RELEVANCE: Customized healing abutments exert similar effects on inflammation during early implant healing compared to standard healing abutments.
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Affiliation(s)
- Christian Wehner
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Gabor Fürst
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Tom Vaskovich
- Dental Technician Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Oleh Andrukhov
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Christoph Vasak
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.
| | - Andreas Moritz
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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Torof E, Morrissey H, Ball PA. Antibiotic Use in Dental Implant Procedures: A Systematic Review and Meta-Analysis. Medicina (B Aires) 2023; 59:medicina59040713. [PMID: 37109671 PMCID: PMC10146405 DOI: 10.3390/medicina59040713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Background and Objectives: This project was developed from anecdotal evidence of varied practices around antibiotic prescribing in dental procedures. The aim of the study was to ascertain if there is evidence to support whether antibiotic (AB) use can effectively reduce postoperative infections after dental implant placements (DIPs). Materials and Methods: Following PRISMA-P© methodology, a systematic review of randomised controlled clinical trials was designed and registered on the PROSPERO© database. Searches were performed using PubMed®, Science Direct® and the Cochrane© Database, plus the bibliographies of studies identified. The efficacy of prophylactic antibiotics, independent of the regimen used, versus a placebo, control or no therapy based on implant failure due to infection was the primary measured outcome. Secondary outcomes were other post-surgical complications due to infection and AB adverse events. Results: Twelve RCTs were identified and analysed. Antibiotic use was reported to be statistically significant in preventing infection (p < 001). The prevention of complications was not statistically significant (p = 0.96), and the NNT was >5 (14 and 2523 respectively), which indicates that the intervention was not sufficiently effective to justify its use. The occurrence of side effects was not statistically significant (p = 0.63). NNH was 528 indicating that possible harm caused by the use of ABs is very small and does not negate the AB use when indicated. Conclusion: The routine use of prophylactic antibiotics to prevent infection in dental implant placement was found to be not sufficiently effective to justify routine use. Clear clinical assessment pathways, such as those used for medical conditions, based on the patients’ age, dental risk factors, such as oral health and bone health, physical risk factors, such as chronic or long-term conditions and modifiable health determinants, such as smoking, are required to prevent the unnecessary use of antibiotics.
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Affiliation(s)
- Elham Torof
- School of Pharmacy, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK
| | - Hana Morrissey
- School of Pharmacy, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK
| | - Patrick A. Ball
- School of Pharmacy, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK
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Tabrizi R, Zarchini R, Ozkan BT, Majdi S. Dental Implant Survival after Postoperative Infection. J Maxillofac Oral Surg 2022; 21:796-801. [PMID: 36274880 PMCID: PMC9474760 DOI: 10.1007/s12663-020-01460-6] [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: 05/10/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022] Open
Abstract
Purpose Early postoperative infection can lead to dental implant failure. This study aimed to evaluate the frequency of failed and survived implants after acute postoperative infection and the related factors. Materials and Methods This cross-sectional cohort evaluated early infection after dental implant surgery. The study variables included the site of implant placement, age and gender of patients, bone augmentation, postoperative antibiotic therapy, smoking, and time of infection occurrence or diagnosis. Failed and survived implants were the outcome of the study. The patients were studied in 2 groups of survived implants (group 1) and failed implants (group 2). Results Thirty-four (3.46%) out of 980 patients developed a postoperative infection following implant placement, which included 25 males and 9 females. Ten implants (29.4%) survived (group 1), and 24 implants (70.6%) failed (group 2). There were significant differences between the 2 groups regarding the number of smoker patients, fresh socket or delayed implant placement, patients who received bone graft, and the meantime of diagnosis (P < 0.05). Regarding the covariates, the Kaplan-Meier analysis showed that the risk of implant failure in patients who did not receive postoperative antibiotic therapy increased by 1.1 times (hazard ratio) when infection occurred four days after surgery. In patients who received postoperative antibiotics, the risk of failure increased when infection occurred after 6 days in smokers and after 9 days in non-smokers. Conclusion Considering the study results, it seems that smoking, early infection, fresh socket placement, and placement of implants along with bone substitutes may increase the failure rate after acute infection in dental implant placement.
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Affiliation(s)
- Reza Tabrizi
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Zarchini
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Birkan Taha Ozkan
- Institute of Health Science, Toros University, Toros, Mersin, Turkey
| | - Shobeir Majdi
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Karagah A, Tabrizi R, Mohammadhosseinzade P, Mirzadeh M, Tofangchiha M, Lajolo C, Patini R. Effect of Sinus Floor Augmentation with Platelet-Rich Fibrin Versus Allogeneic Bone Graft on Stability of One-Stage Dental Implants: A Split-Mouth Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159569. [PMID: 35954926 PMCID: PMC9367838 DOI: 10.3390/ijerph19159569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
Rehabilitation of an edentulous posterior maxilla with dental implants is challenging, and sinus floor augmentation could be considered as an important surgical procedure for bone augmentation in this region before implant placement. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with simplified processing: its application in sinus floor augmentation has been widely investigated in literature. However, the biological properties and actual efficacy of this product remain controversial. This study assessed the effect of sinus floor augmentation with PRF versus freeze-dried bone allograft (FDBA) on stability of one-stage dental implants. This split-mouth randomized clinical trial evaluated 10 patients who required bilateral sinus floor augmentation. PRF and L-PRF membrane were used in one quadrant while FDBA and collagen membrane were used in the other quadrant. Implant stability was assessed by resonance frequency analysis (RFA) immediately, and 2, 4, and 6 months after implant placement. The implant stability quotient (ISQ) was compared over time and between the two groups using repeated measures ANOVA and independent sample t-test. The mean ISQ significantly increased over time in both groups (p < 0.001). The increase was greater in the PRF group (p < 0.05). Within the limitations of this study, PRF yielded superior results compared with FDBA regarding the stability of one-stage dental implants.
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Affiliation(s)
- Aida Karagah
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran
| | - Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, Shahid Beheshti University of Medical Sciences, Tehran 11151-19857, Iran
| | | | - Monirsadat Mirzadeh
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran
| | - Maryam Tofangchiha
- Department of Oral and Maxillofacial Radiology, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran
- Correspondence: (M.T.); (C.L.); Tel.: +98-9121825156 (M.T.); +39-0630154286 (C.L.); Fax: +98-2833353066 (M.T)
| | - Carlo Lajolo
- Department of Head, Neck and Sense Organs “Fondazione Policlinico Universitario A. Gemelli-IRCCS”, School of Dentistry, Catholic University of Sacred Heart, 00168 Rome, Italy
- Correspondence: (M.T.); (C.L.); Tel.: +98-9121825156 (M.T.); +39-0630154286 (C.L.); Fax: +98-2833353066 (M.T)
| | - Romeo Patini
- Department of Head, Neck and Sense Organs “Fondazione Policlinico Universitario A. Gemelli-IRCCS”, School of Dentistry, Catholic University of Sacred Heart, 00168 Rome, Italy
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Immediate Implant Placement and Provisionalization in the Esthetic Zone: A 6.5-Year Follow-Up and Literature Review. Case Rep Dent 2021; 2021:4290193. [PMID: 34567810 PMCID: PMC8457954 DOI: 10.1155/2021/4290193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
The success of dental implant therapy in the esthetic zone requires not only functional osseointegration but also a satisfactory esthetic outcome. To establish harmony, balance, and continuity of gingival architecture between an implant restoration and the adjacent natural dentition is challenging. Immediate implant placement and provisionalization following tooth extraction have been documented as a predictable treatment modality, with fewer surgical interventions needed, to replace a missing tooth in the esthetic zone. This case report illustrates immediate implant placement and provisionalization to replace a failing maxillary right central incisor while maintaining optimal gingival esthetics. The maxillary right central incisor was extracted without flap elevation to minimize soft and hard tissue trauma. Immediately afterwards, the implant was installed using a surgical stent and restored with a provisional crown that had no occlusal contacts. During healing, no significant adverse effects were observed clinically or radiographically. This proposed treatment modality provided the patient with immediate esthetics, function, and comfort without any complications during a follow-up period of 6.5 years.
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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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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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Jain A, Rai A, Singh A, Taneja S. Efficacy of preoperative antibiotics in prevention of dental implant failure: a Meta-analysis of randomized controlled trials. Oral Maxillofac Surg 2020; 24:469-475. [PMID: 32643076 DOI: 10.1007/s10006-020-00872-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dental implants are commonly used for replacement of missing teeth. Despite the published data highlighting the high success rate of dental implants, failures do occur. Some of these failures are believed to be a result of bacterial contamination at the site of implant insertion. Various antibiotic regimens have already been suggested to prevent failure due to infection. OBJECTIVE This meta-analysis aims to examine the efficacy of preoperative antibiotics in prevention of dental implant failure secondary to infections. METHODOLOGY An exhaustive search was conducted on electronic database including PubMed Medline, Google Scholar, Scopus, and Cochrane on July 15, 2019. All the randomized controlled trials (RCT) comparing preoperative antibiotics with no antibiotics/placebo in dental implants were included in the study. The primary outcome for assessment was implant failure. A random effect meta-analysis was conducted for risk ratios of dichotomous data. RESULTS A total 8544 abstracts were screened following which 16 full text articles were reviewed and 5 RCTs were included in the analysis. Meta-analysis results indicated that the preoperative antibiotics resulted in statistically significantly lower number of implant failures. CONCLUSION Preoperative antibiotics effectively reduce the implant failure rate. However, it is recommended to conduct large-scale RCT to determine the efficacy of preoperative antibiotics in dental implants.
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Affiliation(s)
- Anuj Jain
- Consultant Oral and Maxillofacial Surgeon and Implantologist, Nagpur, India.
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
| | - Anshul Rai
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhinav Singh
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saumya Taneja
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
- Consultant Pediatric and Preventive Dentist, Delhi, India
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Cheng GL, Leblebicioglu B, Li J, Chien HH. Soft tissue healing around platform-switching and platform-matching single implants: A randomized clinical trial. J Periodontol 2020; 91:1609-1620. [PMID: 32474935 DOI: 10.1002/jper.20-0030] [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] [Received: 01/20/2020] [Revised: 03/16/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Implants with platform-switching (PS) design have been demonstrated to reduce marginal bone loss. However, the influence on peri-implant soft tissue healing is unclear. This study was designed to investigate its effect on peri-implant soft tissue healing after implant uncovery. METHODS Non-smokers needing two implants in different quadrants were recruited in this study. For each individual, one PS and one platform-matching (PM) implants were placed using two-stage protocol. Following 2 to 8 months of healing, all implants were uncovered and connected to the corresponding healing abutments. Clinical measurements and peri-implant crevicular fluid (PICF) were taken at 1-, 2-, 4-, and 6-week after 2nd stage surgery. The cytokine concentrations in PICF were analyzed. Peri-implant mucosa (1 × 2 × 2 mm) was harvested around the healing abutment for the analysis of gene expression at uncovery and 6-week post-uncovery. RESULTS Eighteen participants (nine males; 51.7 ± 14.9 years) were recruited. Compared to PM, PS showed significantly lower probing depth (PD) at 1- and 2-week as well as modified sulcus bleeding index (mSBI) at 1-, 4-, and 6-week (P < 0.05). Over time, a decrease in osteoprotegerin and interleukin-1β concentrations in PICF along with an increase in receptor activator of unclear factor kappa-B ligand, periostin, and peroxidasin gene expressions in peri-implant mucosa were noted within both groups (P < 0.05) without significant intergroup differences. CONCLUSION Within the limits, implants with PS design rendered significant benefits over PM design in PD and mSBI reduction during a 6-week healing. However, molecular changes within PICF and peri-implant mucosa as a response to PM and PS appear negligible.
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Affiliation(s)
- Guo-Liang Cheng
- Graduate Periodontics, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville, Louisville, Kentucky, USA.,Division of Periodontics, Department of Dentistry, Tri-Service General Hospital, Taipei, Taiwan
| | - Binnaz Leblebicioglu
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Jianrong Li
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Hua-Hong Chien
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
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Antimicrobial Prescription Habits of Dentists Performing Dental Implant Treatments in Santo Domingo, Dominican Republic. Antibiotics (Basel) 2020; 9:antibiotics9070376. [PMID: 32635270 PMCID: PMC7399993 DOI: 10.3390/antibiotics9070376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/13/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Abstract
The use of antibiotics in implant treatments is controversial. The purpose of this research was to study the behaviors of Santo Domingo dentists who prescribe antimicrobials to patients for the placement of dental implants. A total of 99 dentists participated in the study. A share of 1.2% of dentists prescribed antimicrobials solely in the preoperative period, 8.6% after surgery, 44.4% before and after, 19.8% only in specific situations, and 25.9% did not prescribe at all. Amoxicillin was the predominant antimicrobial of choice. A cross-sectional, observational, survey-based study was conducted. The items studied were demographics, self-assessment of knowledge about antibiotics and when they are used, as well as their recommended dosage and duration, in healthy and non-allergic patients. Notable variability was found in the prescription behaviors of antimicrobials. Bridging gaps in knowledge on the subject could help to standardize prescription guidelines.
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Inhibition of neutrophil inflammatory mediator expression by azithromycin. Clin Oral Investig 2020; 24:4493-4500. [PMID: 32436162 DOI: 10.1007/s00784-020-03314-4] [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: 06/11/2019] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Peri-implant tissues appear to exhibit a more vigorous inflammatory response during post-operative healing than periodontal tissues. There is evidence that a single dose of amoxicillin (AMX) prior to implant surgery reduces the risk of early peri-implant healing complications. This study compared the effects of AZM and AMX on neutrophil expression of mRNA for mediators involved in peri-implant healing. MATERIALS AND METHODS Neutrophils were isolated from healthy human donors and pre-incubated with AZM (4 or 8 μg/ml) or AMX (2 or 4 μg/ml). Cells were then incubated with LPS (1 μg/ml), TNF-α (10 ng/ml), or medium alone (control) for 1, 2, and 4 h. Total RNA was analyzed with qPCR to quantify changes in expression of the six inflammatory mediators. RESULTS LPS and TNF-α induced a similar pattern of IL-1β mRNA expression, with peak expression at 1 h. For most mediators, gene expression in neutrophils activated by LPS was markedly reduced in a dose-dependent manner by AZM. Therapeutic concentrations of AZM (8 μg/ml) consistently reduced expression of mediators tested in this study. AMX was effective only in a few cases and under certain conditions. Therefore, AZM was more effective in its direct anti-inflammatory action. CONCLUSION AZM is a consistent and effective inhibitor of neutrophil inflammatory mediator mRNA expression. CLINICAL RELEVANCE Given that a single dose of AZM produces higher and more sustained concentrations of this agent in periodontal tissues than AMX when used as a pre-operative prophylactic antibiotic, AZM has greater potential to inhibit inflammatory mediator expression at peri-implant wound sites than AMX.
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Braun RS, Chambrone L, Khouly I. Prophylactic antibiotic regimens in dental implant failure: A systematic review and meta-analysis. J Am Dent Assoc 2019; 150:e61-e91. [PMID: 31010572 DOI: 10.1016/j.adaj.2018.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this systematic review and meta-analysis, the authors examine the efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens for prevention of dental implant failure in patients who are healthy overall. TYPES OF STUDIES REVIEWED The authors independently conducted electronic database and manual searches to identify randomized controlled trials (RCTs). The authors selected articles on the basis of eligibility criteria and assessed for risk of bias by using the Cochrane Handbook. Implant failure was the primary outcome studied; perimucositis or implantitis, prosthetic failure, and adverse events were secondary outcomes studied. The authors conducted random effects meta-analysis for risk ratios of dichotomous data and used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of Public Health) for qualitative assessment of administration schedules. RESULTS With duplicates removed, the authors screened 1,022 abstracts, reviewed 21 full-text articles, and included 8 RCTs that included 2,869 implants in 1,585 patients. Meta-analysis results indicated that AP resulted in a statistically significantly lower number of implant failures for all regimens combined (implant, P = .005; patient, P = .002), as well as preoperative (implant, P = .01; patient, P = .007), pre- and postoperative (implant, P = .04), and postoperative AP only (implant, P = .02), compared with no antibiotics. The authors found no statistically significant differences in analysis of comparative antibiotic treatments or secondary outcomes. The authors identified confounding variables. CONCLUSIONS AND PRACTICAL IMPLICATIONS Although meta-analysis results suggested that AP may reduce implant failure, definitive conclusions cannot be achieved yet. The overall nonsignificant differences reported in individual trials, limitations discussed, implant infection outcomes, and antibiotic-associated risks must be considered. Thus, the results for implant failure outcomes may not warrant the indiscriminate use of antibiotics in patients who are healthy who are receiving dental implants. Investigators must conduct large-scale RCTs to determine the efficacy of AP and various regimens, independent of confounding variables.
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Kordbacheh Changi K, Finkelstein J, Papapanou PN. Peri‐implantitis prevalence, incidence rate, and risk factors: A study of electronic health records at a U.S. dental school. Clin Oral Implants Res 2019; 30:306-314. [DOI: 10.1111/clr.13416] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Khashayar Kordbacheh Changi
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences Columbia University College of Dental Medicine New York City New York
| | - Joseph Finkelstein
- Center for Bioinformatics and Data Analytics in Oral Health Columbia University College of Dental Medicine New York City New York
| | - Panos N. Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences Columbia University College of Dental Medicine New York City New York
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Khouly I, Braun RS, Chambrone L. Antibiotic prophylaxis may not be indicated for prevention of dental implant infections in healthy patients. A systematic review and meta-analysis. Clin Oral Investig 2019; 23:1525-1553. [DOI: 10.1007/s00784-018-2762-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/17/2018] [Indexed: 01/23/2023]
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15
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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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16
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Immediate placement of dental implants into infected versus noninfected sites in the esthetic zone: A systematic review and meta-analysis. J Prosthet Dent 2018; 120:658-667. [DOI: 10.1016/j.prosdent.2017.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 01/11/2023]
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17
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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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18
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Rodríguez Sánchez F, Rodríguez Andrés C, Arteagoitia I. Which antibiotic regimen prevents implant failure or infection after dental implant surgery? A systematic review and meta-analysis. J Craniomaxillofac Surg 2018; 46:722-736. [PMID: 29550218 DOI: 10.1016/j.jcms.2018.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/27/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To assess which antibiotic regimen prevents dental implant failures or postoperative infections following dental implant placement. MATERIALS AND METHODS Systematic review and meta-analysis. DATA SOURCES Pubmed, Cochrane, Science Direct, and EMBASE via OVID were searched up to August 2017. Only randomized controlled clinical trials (RCT) using antibiotics were included. Outcome measures were set on dental implant failures or postoperative infection incidence after dental implant surgery. Three reviewers independently undertook risk of bias assessment and data extraction. Stratified meta-analyses of binary data using fixed-effects models were performed using Stata 14.0. The risk ratio (RR) and 95% confidence interval (CI) were estimated. RESULTS Nine articles were included corresponding to 15 RCTs. All RCTs tested only oral amoxicillin. Implant-failure analysis: overall RR = 0.53 (P = .005, 95% CI: 0.34-0.82) and overall NNT = 55 (95% CI, 33-167). Single-dose oral amoxicillin preoperatively (SDOAP) is beneficial (RR = 0.50, CI: 0.29-0.86. P = .012), when compared to postoperative oral amoxicillin (POA): RR = 0.60, CI: 0.28-1.30. P = .197. Postoperative-infection analysis: overall RR = 0.76 (P = 0.250, 95% CI: 0.47-1.22). Neither SDOAP (RR = 0.82, CI = 0.46-1.45, P = .488) nor POA (RR = 0.64, CI = 0.27-1.51, P = .309) are beneficial. I2 = 0.0%, chi-squared tests P ≈ 1. CONCLUSION Only SDOAP is effective and efficacious at preventing implant failures, but it was not significant for postoperative infections following dental implant surgeries.
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Affiliation(s)
- Fabio Rodríguez Sánchez
- Epidemiology and Public Health Department, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena, s/n, 48940, Bilbao, Spain.
| | - Carlos Rodríguez Andrés
- School of Medicine and Nursing, University of the Basque Country (UPV/EHU) (Professor and Head of Epidemiology and Public Health Department), Barrio Sarriena, s/n, 48940, Bilbao, Spain.
| | - Iciar Arteagoitia
- Department of Stomatology, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena, s/n, 48940, Bilbao, Spain; BioCruces Health Research Institute Member, Cruces University Hospital, Plaza de Cruces, 48903, Barakaldo, Spain.
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19
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Jané-Salas E, Roselló-LLabrés X, Jané-Pallí E, Mishra S, Ayuso-Montero R, López-López J. Open flap versus flapless placement of dental implants. A randomized controlled pilot trial. Odontology 2018; 106:340-348. [DOI: 10.1007/s10266-018-0343-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/15/2017] [Indexed: 12/11/2022]
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20
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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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21
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Management of Limited Vertical Bone Height in the Posterior Mandible: Short Dental Implants Versus Nerve Lateralization With Standard Length Implants. J Craniofac Surg 2017; 27:578-85. [PMID: 26999693 DOI: 10.1097/scs.0000000000002459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Inferior alveolar nerve lateralization (IANL) and short dental implants (SDI) are 2 viable implant-based treatment approaches in the presence of atrophied posterior mandible. Despite the risks of dysfunction, infection, and pathologic fractures in IANL, it becomes possible to place standard implants. The purpose of this study was to compare SDI and IANL approaches from clinical and radiographic aspects. Fifteen subjects having unilateral atrophic mandibles were allocated to SDI and IANL treatment groups. Following surgical procedures, early postoperative complications, implant survival, and periimplant clinical and radiographic parameters including probing pocket depth, attachment level, keratinized tissue amount, vertical tissue recession, and marginal bone loss were recorded at baseline and 1-year after prosthetic rehabilitation. In both groups, no implant was lost. Except usual postoperative complications, 2 patients had transient paraesthesia after IANL. According to time-dependent evaluation, both groups showed significant increase in probing pocket depth and attachment level at 1-year follow-up compared with baseline (P < 0.05). Except a slight but significant increase in mesial surface of SDI group (P < 0.05), no remarkable time-dependent change was identified in vertical tissue recession. Keratinized tissue amount did not exhibit any inter- or intragroup difference during whole study period. Marginal bone loss did not show any difference between IANL and SDI groups at follow-up. SDI placement or standard length implant placement with IANL can be considered promising alternatives in the treatment of atrophic mandibular posterior regions. However, SDI may be preferred in terms of lower complication risk.
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22
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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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24
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Xu L, Wang Y, Nguyen VT, Chen J. Effects of Topical Antibiotic Prophylaxis on Wound Healing After Flapless Implant Surgery: A Pilot Study. J Periodontol 2016; 87:275-80. [DOI: 10.1902/jop.2015.150464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Sousa V, Mardas N, Farias B, Petrie A, Needleman I, Spratt D, Donos N. A systematic review of implant outcomes in treated periodontitis patients. Clin Oral Implants Res 2015; 27:787-844. [DOI: 10.1111/clr.12684] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Vanessa Sousa
- Department of Clinical Research; Periodontology Unit; UCL Eastman Dental Institute; London UK
| | - Nikos Mardas
- Centre for Adult Oral Health, Periodontology Unit; QMUL Bart's and The London School of Dentistry and Hospital; London UK
| | - Bruna Farias
- Federal University of Pernambuco; Recife-Pernambuco Brazil
| | - Aviva Petrie
- Biostatistics Unit; UCL Eastman Dental Institute; London UK
| | - Ian Needleman
- Department of Clinical Research; Periodontology Unit; UCL Eastman Dental Institute; London UK
- International Centre for Evidence-Based Oral Health; UCL Eastman Dental Institute; London UK
| | - David Spratt
- Department of Microbial Diseases; UCL Eastman Dental Institute; London UK
| | - Nikolaos Donos
- Department of Clinical Research; Periodontology Unit; UCL Eastman Dental Institute; London UK
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26
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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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27
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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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Deeb GR, Soung GY, Best AM, Laskin DM. Antibiotic Prescribing Habits of Oral and Maxillofacial Surgeons in Conjunction With Routine Dental Implant Placement. J Oral Maxillofac Surg 2015; 73:1926-31. [PMID: 26101074 DOI: 10.1016/j.joms.2015.05.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/28/2015] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Although various prophylactic systemic antibiotic regimens have been suggested to minimize failure after dental implant placement, the role of antibiotics in implant dentistry is still controversial. The purpose of the present survey was to determine the current antibiotic prescribing habits of oral and maxillofacial surgeons in conjunction with routine dental implant placement to determine whether any consensus has been reached among such practitioners. MATERIALS AND METHODS An electronic survey was sent by electronic mail to all members of the American College of Oral and Maxillofacial Surgeons. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. The survey participants were also asked to specify whether they were in solo private practice, group private practice, academia, military, or "other." The results were tabulated and analyzed using SAS software. Descriptive statistics and χ(2) analyses were used. RESULTS A total of 217 members responded to the survey. Overall, 112 of 217 (51.6%) prescribed antibiotics preoperatively (95% confidence interval [CI] 50.0 to 58.2%) and 152 of 213 (71.4%) prescribed antibiotics postoperatively (95% CI 65.0 to 77.0%) during routine dental implant placement. Also, 72 (34%) indicated that they prescribed antibiotics both pre- and postoperatively. The most common preoperative regimen used was amoxicillin 2 g given 1 hour before the procedure (32%, n = 36). The most common postoperative regimen used was amoxicillin 500 mg 3 times daily for 5 days (53%, n = 81). CONCLUSIONS We found no consensus among oral and maxillofacial surgeons regarding the use of antibiotics in association with routine dental implant placement, the type of regimen to use, or whether such use is even effective in preventing early implant loss. Furthermore, most of the antibiotic regimens being used are not in accordance with the recommendations current in the published data.
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Affiliation(s)
- George R Deeb
- Associate Professor, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond, VA.
| | - George Y Soung
- Resident, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond, VA
| | - Al M Best
- Director of Faculty Research Development, Virginia Commonwealth University School of Dentistry, Richmond, VA
| | - Daniel M Laskin
- Professor Emeritus, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University School of Dentistry, Richmond, VA
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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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30
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Datta R, Grewal Y, Batth JS, Singh A. Current Trend of Antimicrobial Prescription for Oral Implant Surgery Among Dentists in India. J Maxillofac Oral Surg 2014; 13:503-7. [PMID: 26225019 PMCID: PMC4518808 DOI: 10.1007/s12663-013-0567-7] [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: 04/27/2013] [Accepted: 08/07/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of our study was to evaluate antimicrobial prescription behaviour amongst dentists performing oral implant surgery in India. STUDY DESIGN Dentists performing oral implant surgery from different parts of India were personally approached during various national events such as conferences and academic meetings and information regarding their prescription habits for antimicrobial agents in routine oral implant surgery was collected using a structured questionnaire. RESULTS Out of a total sample of 332 dentists, 85.5 % prescribed 17 different groups or combinations of antibiotics routinely for oral implant surgery in the normal healthy patient. Majority preferred the peri-operative protocol of drug therapy (72.2 %) with variable and prolonged duration of therapy after surgery, ranging from 3 to 10 days. An antimicrobial mouthwash was routinely prescribed by all the doctors (14.5 %) not in favour of prescribing antimicrobials in a normal healthy patient. CONCLUSIONS Our findings suggest that there is a trend of antimicrobial agent misuse by dentists performing oral implant surgery in India, both in terms of drugs used and the protocols prescribed. The majority of these dentists prescribed a variety of antimicrobial agents for prolonged durations routinely even in the normal, healthy patients.
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Affiliation(s)
- Rahul Datta
- />Rayat Bahra Dental College and Hospital, Mohali, Punjab India
- />H No 416, Sector 37 A, Chandigarh, 160036 India
| | - Yasmin Grewal
- />Rayat Bahra Dental College and Hospital, Mohali, Punjab India
| | - J. S. Batth
- />Gian Sagar Dental College and Hospital, Rajpura, Punjab India
| | - Amandeep Singh
- />Gian Sagar Medical College and Hospital, Rajpura, Punjab India
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31
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Oswal S, Ravindra S, Sinha A, Manjunath S. Antibiotics in periodontal surgeries: A prospective randomised cross over clinical trial. J Indian Soc Periodontol 2014; 18:570-4. [PMID: 25425817 PMCID: PMC4239745 DOI: 10.4103/0972-124x.142443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 12/17/2013] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES (1) To evaluate the need of antibiotics in periodontal surgeries in reducing postsurgical infections and explore if antibiotics have any key role in reducing or eliminating inflammatory complications. (2) To establish the incidence of postoperative infections in relation to type of surgery and determine those factors, which may affect infection rates. MATERIALS AND METHODS A prospective randomized double-blind cross over clinical study was carried out for a period of 1-year with predefined inclusion and exclusion criteria. All the patients included in the study for any periodontal surgery were randomly divided into three categories: Group A (prophylactic), Group B (therapeutic), and Group C (no antibiotics). Patients were followed up for 1-week after surgery on the day of suture removal and were evaluated for pain, swelling, fever, infection, delayed wound healing and any other significant findings. Appropriate statistical analysis was carried out to evaluate the objectives and P < 0.05 was considered as statistically significant. RESULTS No infection was reported in any of 90 sites. Patients reported less pain and postoperative discomfort when prophylactic antibiotics were given. However, there were no statistical significant differences between the three groups. SUMMARY AND CONCLUSION There was no postoperative infection reported in all the 90 sites operated in this study. The prevalence of postoperative infections following periodontal surgery is <1% and this low risk does not justify the routine use of systemic antimicrobials just to prevent infections. Use of prophylactic antibiotics may have role in prevention of inflammatory complication, but again not infection.
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Affiliation(s)
- Sheetal Oswal
- Department of Periodontics and Implantology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, Karnataka, India
| | - Shivamurthy Ravindra
- Department of Periodontics and Implantology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, Karnataka, India
| | - Aditya Sinha
- Department of Periodontics and Implantology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, Karnataka, India
| | - Shaurya Manjunath
- Department of Periodontics and Implantology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, Karnataka, India
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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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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: 42] [Impact Index Per Article: 4.2] [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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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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Chrcanovic BR, Albrektsson T, Wennerberg A. Reasons for failures of oral implants. J Oral Rehabil 2014; 41:443-76. [PMID: 24612346 DOI: 10.1111/joor.12157] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2014] [Indexed: 12/18/2022]
Abstract
This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants.
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Affiliation(s)
- B R Chrcanovic
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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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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Canullo L, Peñarrocha D, Clementini M, Iannello G, Micarelli C. Impact of plasma of argon cleaning treatment on implant abutments in patients with a history of periodontal disease and thin biotype: radiographic results at 24-month follow-up of a RCT. Clin Oral Implants Res 2013; 26:8-14. [DOI: 10.1111/clr.12290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - David Peñarrocha
- Master of Oral Surgery and Implantology; Valencia University Medical and Dental School; Valencia Spain
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Borba AM, Souza DFM, Brozoski MA, Burim RA, Naclério-Homem MDG, Deboni MCZ. Can the use of antibiotics interfere with the success of dental osseointegrated implants in diabetic patients? J Contemp Dent Pract 2013; 14:1197-1201. [PMID: 24858776 DOI: 10.5005/jp-journals-10024-1476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The present review aims to discuss the last 10 years published data on the topic of the use of osseointegrated implants in diabetic subjects, particularly regarding the influence of antibiotics administration in the perioperative period. BACKGROUND In the last decades, oral rehabilitation significantly has evolved particularly with the use of osseointegrated implants. Increased life expectation of population is reflecting in a greater number of diabetic patients who might require dental osseointegrated implants rehabilitation. Diabetes was considered for a long time as a contraindication for oral implant placement. In this context, the use of antibiotics is still a controversial factor when we correlate it to implant success rate. REVIEW RESULTS Although 228 articles were initially selected for evaluation of proposed criteria, only 16 articles were considered valid. Among the 16 selected articles, only six articles represented clinical research that discussed the influence of the antibiotic in the success of osseointegration of dental implants in diabetic subjects. Five were retrospective studies and one a prospective research. CONCLUSION Data favors the use of antibiotics without significant side effects but clinical investigations of the need of prophylaxis antibiotic or therapeutic antibiotics are still scarce. The lack of adequate methodology is one of the main problems of the current articles. It is important to emphasize that studies should present detailed methodology in order to allow reproducibility. CLINICAL SIGNIFICANCE Permanent tooth loss is a pathological condition that affects millions of people worldwide. The possibility of successful treatment of edentulous areas through osseointegrated implants in those systemic compromised patients is a matter of scientific discussion. Although antimicrobial agents must be used rationally and carefully to avoid development of bacterial resistance, more studies are needed in order to support evidence regarding the influence of antibiotics in the success of dental implant surgery in diabetic patients.
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Affiliation(s)
- Alexandre Meireles Borba
- PhD Student, Department of Oral and Maxillofacial Surgery Traumatology and Prosthesis, Faculty of Dentistry of the University of Sao Paulo, USP, São Paulo, Brazil, e-mail:
| | - Daniel Falbo Martins Souza
- PhD Student, Department of Oral and Maxillofacial Surgery Traumatology and Prosthesis, Faculty of Dentistry of the University of Sao Paulo, USP, São Paulo, Brazil
| | - Mariana Aparecida Brozoski
- PhD Student, Department of Oral and Maxillofacial Surgery Traumatology and Prosthesis, Faculty of Dentistry of the University of Sao Paulo, USP, São Paulo, Brazil
| | - Rafael Augusto Burim
- MSc Student, Department of Oral and Maxillofacial Surgery Traumatology and Prosthesis, Faculty of Dentistry of the University of Sao Paulo, USP, São Paulo, Brazil
| | - Maria da Graça Naclério-Homem
- Associate Professor, Department of Oral and Maxillofacial Surgery Traumatology and Prosthesis, Faculty of Dentistry of the University of Sao Paulo, USP, São Paulo, Brazil
| | - Maria Cristina Zindel Deboni
- Associate Professor, Department of Oral and Maxillofacial Surgery Traumatology and Prosthesis, Faculty of Dentistry of the University of Sao Paulo, USP, São Paulo, Brazil
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Canullo L, Peñarrocha D, Peñarrocha M, Rocio AG, Penarrocha-Diago M. Piezoelectric vs. conventional drilling in implant site preparation: pilot controlled randomized clinical trial with crossover design. Clin Oral Implants Res 2013; 25:1336-43. [DOI: 10.1111/clr.12278] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 11/29/2022]
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Esposito M, Grusovin MG, Worthington HV. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev 2013; 2013:CD004152. [PMID: 23904048 PMCID: PMC6786879 DOI: 10.1002/14651858.cd004152.pub4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat, and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis; with reduced host-response; when surgery is performed in infected sites; in cases of extensive and prolonged surgical interventions; and when large foreign materials are implanted. A variety of prophylactic systemic antibiotic regimens have been suggested to minimise infections after dental implant placement. More recent protocols recommended short-term prophylaxis, if antibiotics have to be used. Adverse events may occur with the administration of antibiotics, and can range from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria. The use of prophylactic antibiotics in implant dentistry is controversial. OBJECTIVES To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic or placebo administration and, if antibiotics are beneficial, to determine which type, dosage and duration is the most effective. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 17 June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 5), MEDLINE via OVID (1946 to 17 June 2013) and EMBASE via OVID (1980 to 17 June 2013). There were no language or date restrictions placed on the searches of the electronic databases. SELECTION CRITERIA Randomised controlled clinical trials (RCTs) with a follow-up of at least three months, that compared the administration of various prophylactic antibiotic regimens versus no antibiotics to people undergoing dental implant placement. Outcome measures included prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc). DATA COLLECTION AND ANALYSIS Screening of eligible studies, assessment of the risk of bias of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes with 95% confidence intervals (CIs). Heterogeneity, including both clinical and methodological factors, was to be investigated. MAIN RESULTS Six RCTs with 1162 participants were included: three trials compared 2 g of preoperative amoxicillin versus placebo (927 participants), one compared 3 g of preoperative amoxicillin versus placebo (55 participants), one compared 1 g of preoperative amoxicillin plus 500 mg four times a day for two days versus no antibiotics (80 participants), and one compared four groups: (1) 2 g of preoperative amoxicillin; (2) 2 g of preoperative amoxicillin plus 1 g twice a day for seven days; (3) 1 g of postoperative amoxicillin twice a day for seven days, and (4) no antibiotics (100 participants). The overall body of evidence was considered to be of moderate quality. The meta-analyses of the six trials showed a statistically significant higher number of participants experiencing implant failures in the group not receiving antibiotics (RR 0.33; 95% CI 0.16 to 0.67, P value 0.002, heterogeneity: Tau(2) 0.00; Chi(2) 2.87, df = 5 (P value 0.57); I(2) 0%). The number needed to treat for one additional beneficial outcome (NNTB) to prevent one person having an implant failure is 25 (95% CI 14 to 100), based on an implant failure rate of 6% in participants not receiving antibiotics. There was borderline statistical significance for prosthesis failures (RR 0.44; 95% CI 0.19 to 1.00), with no statistically significant differences for infections (RR 0.69; 95% CI 0.36 to 1.35), or adverse events (RR 1; 95% CI 0.06 to 15.85) (only two minor adverse events were recorded, one in the placebo group). No conclusive information can be derived from the only trial that compared three different durations of antibiotic prophylaxis since no event (implant/prosthesis failures, infections or adverse events) occurred in any of the 25 participants included in each study group. There were no trials that evaluated different antibiotics or different antibiotic dosages. AUTHORS' CONCLUSIONS Scientific evidence suggests that, in general, antibiotics are beneficial for reducing failure of dental implants placed in ordinary conditions. Specifically 2 g or 3 g of amoxicillin given orally, as a single administration, one hour preoperatively significantly reduces failure of dental implants. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether postoperative antibiotics are beneficial, and which antibiotic is the most effective.
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Affiliation(s)
- Marco Esposito
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK.
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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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Waasdorp J, Feldman S. Bone Regeneration Around Immediate Implants Utilizing a Dense Polytetrafluoroethylene Membrane Without Primary Closure: A Report of 3 Cases. J ORAL IMPLANTOL 2013; 39:355-61. [DOI: 10.1563/aaid-joi-d-10-00128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Case reports document successful use of a high-density polytetrafluorethylene membrane to augment horizontal defects associated with immediately placed implants. This membrane, which is designed to withstand exposure (not require primary closure) to the oral cavity because it is impervious to bacteria, reduces the need for advanced flap management to attain primary closure. Thus, the surgical aspect is less complex and the mucogingival architecture of the area can be maintained. These cases demonstrate successful use of this application and provide evidence for controlled clinical trials to further evaluate this technique.
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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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Dursun E, Tulunoglu I, Ozbek SM, Uysal S, Akalın FA, Kilinc K, Karabulut E, Tözüm TF. The Influence of Platform Switching on Clinical, Laboratory, and Image-Based Measures: A Prospective Clinical Study. Clin Implant Dent Relat Res 2013; 16:936-46. [DOI: 10.1111/cid.12054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erhan Dursun
- Department of Periodontology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - Ibrahim Tulunoglu
- Department of Prosthodontics; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - S. Murat Ozbek
- Department of Dento-Maxillofacial Radiology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - Serdar Uysal
- Department of Dento-Maxillofacial Radiology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - F. Alev Akalın
- Department of Periodontology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
| | - Kamer Kilinc
- Department of Biochemistry; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Erdem Karabulut
- Department of Biostatistics; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Tolga F. Tözüm
- Department of Periodontology; Faculty of Dentistry; Hacettepe University; Ankara Turkey
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Nolan R, Kemmoona M, Polyzois I, Claffey N. The influence of prophylactic antibiotic administration on post-operative morbidity in dental implant surgery. A prospective double blind randomized controlled clinical trial. Clin Oral Implants Res 2013; 25:252-9. [DOI: 10.1111/clr.12124] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Rory Nolan
- Dublin Dental University Hospital; Retorative Dentistry and Periodontology; Dublin Ireland
| | - Maher Kemmoona
- Dublin Dental University Hospital; Retorative Dentistry and Periodontology; Dublin Ireland
| | - Ioannis Polyzois
- Dublin Dental University Hospital; Retorative Dentistry and Periodontology; Dublin Ireland
| | - Noel Claffey
- Dublin Dental University Hospital; Retorative Dentistry and Periodontology; Dublin Ireland
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Tan WC, Ong M, Han J, Mattheos N, Pjetursson BE, Tsai AYM, Sanz I, Wong MC, Lang NP. Effect of systemic antibiotics on clinical and patient-reported outcomes of implant therapy - a multicenter randomized controlled clinical trial. Clin Oral Implants Res 2013; 25:185-93. [DOI: 10.1111/clr.12098] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Wah Ching Tan
- National Dental Centre Singapore; Singapore Singapore
| | - Marianne Ong
- National Dental Centre Singapore; Singapore Singapore
| | - Jie Han
- Peking University School of Stomatology; Beijing China
| | - Nikos Mattheos
- Griffith University; Gold Coast Queensland Australia
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
| | | | - Alex Yi-Min Tsai
- Department of Periodontology; School of Dental Medicine; National Taiwan University; Taipei Taiwan
| | - Ignacio Sanz
- Universidad Complutense de Madrid; Madrid Spain
- ETEP Research Group
| | - May C.M. Wong
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
| | - Niklaus P. Lang
- Faculty of Dentistry; The University of Hong Kong; Hong Kong SAR China
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Cairo F, Sanz I, Matesanz P, Nieri M, Pagliaro U. Quality of reporting of randomized clinical trials in implant dentistry. A systematic review on critical aspects in design, outcome assessment and clinical relevance. J Clin Periodontol 2012; 39 Suppl 12:81-107. [DOI: 10.1111/j.1600-051x.2011.01839.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Francesco Cairo
- Department of Periodontology; University of Florence; Florence; Italy
| | - Ignacio Sanz
- Department of Periodontology; Universidad Complutense ; de; Madrid; Madrid; Spain
| | - Paula Matesanz
- Department of Periodontology; Universidad Complutense ; de; Madrid; Madrid; Spain
| | - Michele Nieri
- Department of Periodontology; University of Florence; Florence; Italy
| | - Umberto Pagliaro
- Department of Periodontology; University of Florence; Florence; Italy
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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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Caiazzo A, Casavecchia P, Barone A, Brugnami F. A Pilot Study to Determine the Effectiveness of Different Amoxicillin Regimens in Implant Surgery. J ORAL IMPLANTOL 2011; 37:691-6. [DOI: 10.1563/aaid-joi-d-09-00134.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to attempt to determine the minimum effective regimen of amoxicillin antibiotic prophylaxis for dental implant surgery. One hundred patients were randomly allocated to 4 different antibiotic prophylactic treatment groups. At second-stage surgery, only 2 implants failed in the nonantibiotic group. No statistically significant differences were found in the 4 groups, probably because of the limited number of the samples. Until a study with a larger population may definitely rule on the role of antibiotics in oral implant surgery, in may be prudent for the practitioner to adopt the single preoperative antibiotic dose as the minimal effective regimen.
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Affiliation(s)
| | | | - Antonio Barone
- Nanoworld Institute, Department of Oral Pathology, University of Genova, Liguria, Italy
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Canullo L, Iannello G, Penarocha M, Garcia B. Impact of implant diameter on bone level changes around platform switched implants: preliminary results of 18 months follow-up a prospective randomized match-paired controlled trial. Clin Oral Implants Res 2011; 23:1142-6. [DOI: 10.1111/j.1600-0501.2011.02297.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2011] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Miguel Penarocha
- Master of Oral Surgery and Implantology; Valencia University Medical and Dental School; Valencia; Spain
| | - Berta Garcia
- Master of Oral Surgery and Implantology; Valencia University Medical and Dental School; Valencia; Spain
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