| Rapid Search Terms | |
| patient selection | Implants in patients with periodontitis |
| risk factors for implants | Diabetes |
| Smoking | Oral Bisphosphonates |
| Radiation | osteoporosis |
| prophylactic antibiotics | NSAIDS |
Medical History: medical conditions + drugs that may affect implant and surgical outcome; Risk factors
Misch and Resnik. Medical Evaluation of the Dental Implant Patient (CH 20). pp 406-420. Contemporary Implant Dentistry, Misch, C.E., 3rd Edition, 2008, Mosby Year Book.
Rose L and Mealey B. Implant complications associated with systemic disorders and medications. (CH 2) pp 9-45.
Sugerman, P., Barber, M.: Patient selection for endossous dental implants; Oral and systemic considerations. Int J Oral Maxillofac Implants. 2002 Mar-Apr; 17(2):191-201
Ong, C et al: Systematic Review of Implant Outcomes in Treated Periodontitis Subjects. J Clin Periodontol 2008; 35:438
Rasperini G, Siciliano VI, et al. Crestal bone changes at teeth and implants in periodontally healthy and periodontally compromised patients. A 10-year comparative case-series study. J Periodontol. 2013 Nov 11. [Epub ahead of print]
Klokkevold P, Han T: How do smoking, diabetes and periodontits affect outcomes of implant treatment? Int J Oral Maxillofac Implants. 2007; 22 (suppl)173-202
Dowel, S et al: Implant success in people with type 2 diabetes mellitus with varying glycemic control. A pilot study. JADA: 138:2007:355-361
Strietzel FP, Reichart PA, et al. Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. J Clin Periodontol. 2007 Jun;34(6):523-44. Review.
Bain CA Implant installation in the smoking patient. Periodontol 2000. 2003;33:185-93. Review.
Fugazzotto, P et al: Implant Placement with or without Simultaneous Tooth Extraction in Patients Taking Oral Bisphosphonates: Postoperative Healing, Early Follow up and Incidence of Complications in Two Private Practices. J Periodontol 2007; 78:1664-1669
Colella, Cannavale, Pentenero, Gandolfo: Oral implants in radiated patients: A systematic review. Int J Orla Maxillofac Implants 2007; 22(4):616-623
Holahan, C et al: Effect of osteoporotic status on the survival of titanium dental implants. Int J Oral Maxillofac Implants. 2008:Sep-Oct; 23(5)905-10
Claudy MP, Miguens SA Jr, et al Time Interval after Radiotherapy and Dental Implant Failure: Systematic Review of Observational Studies and Meta-Analysis. Clin Implant Dent Relat Res. 2013 Jun 7. [Epub ahead of print]
Sharaf B, Dodson TB. Does the use of prophylactic antibiotics decrease implant failure? Oral Maxillofac Surg Clin North Am. 2011 Nov;23(4):547-50
Ahmad N, Saad N. Effects of antibiotics on dental implants: a review. J Clin Med Res. 2012 Feb;4(1):1-6.
Esposito M, Grusovin MG, Worthington HV. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev. 2013 Jul 31;7:CD004152.
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 Jun 25. pii: S0901-5027(13)00258-0. doi: 10.1016/j.ijom.2013.05.019. [Epub ahead of print]
Alissa R, Sakka S, Oliver R, et al. Influence of ibuprofen on bone healing around dental implants: a randomised double-blind placebo-controlled clinical study. Eur J Oral Implantol. 2009 Autumn;2(3):185-99.
Topic: Patient selection
Author: Sugerman, P., Barber, M
Title: Patient selection for endossous dental implants; Oral and systemic considerations.
Source: J Oral Maxillofac Implants. 2002 Mar-Apr; 17(2):191-201
Type: Discussion
Rating: Good
Keywords: patient selection, endossous dental implant, oral, systemic consideration
Purpose:
The aims of this article were to define “reasonable health” for dental implant
treatment and to provide a systematic approach to the selection of dental
implant patients.
Discussion:
TITANIUM TOXICOLOGY The survival or success of endosseous dental implants may be influenced by a number of local and systemic conditions. Some of these conditions affect the process of osseointegration directly. The following are noted in particular.
PHYSICAL STATUS
The American Society for Anesthesiology (ASA) has defined a 6-point scale of physical status
AGE
Younger patients may show greater crestal bone resorption around dental implants. It is therefore recommended that implant placement be delayed until growth and development have ceased or are minimal
However, implant failure does not correlate with age or sex. Increasing age has no effect on osseointegration or the rate of crestal bone resorption around dental implants.
PATIENT EXPECTATION
Although dental implants can enhance esthetics, phonetics, and bite force, it is important to identify unrealistic expectations that patients may have about implants and implant- retained prostheses.
HYPOHIDROTIC ECTODERMAL DYSPLASIA is characterized by hypodontia, hypotrichosis, and hypohidrosis. Dental implants have been used successfully in patients with severe hypodontia associated with ectodermal dysplasia. In a recent prospective study, implant placement and prosthetic rehabilitation in young children with ectodermal dysplasia did not restrict transverse or sagittal growth. However, vertical alveolar growth resulted in the occasional submergence of endosseous implants, necessitating revision and the placement of longer abutments.
SMOKING: Many studies have shown that smoking interferes with osseointegration and accelerates bone resorption around dental implants
OSTEOPOROSIS: osteoporosis appears not to influence implant survival. Moreover, endosseous dental implants may actually stimulate mandibular bone formation in a load-dependent manner.
DIABETES MELLITUS: endosseous dental implants are usually successful in patients with diabetes, although uncontrolled diabetes contraindicates dental implant placement. Consideration should be given to antibiotic prophylaxis for surgical procedures in diabetic patients.
SCLERODERMA: little is known about dental implants in patients with scleroderma. Endosseous dental implants may improve prosthesis function and comfort in scleroderma patients, although access for implant surgery and for oral hygiene may be compromised.
SJÖGREN SYNDROME: Implant-supported prostheses were shown to considerably increase prosthetic comfort and function in patients with Sjögren syndrome, preferable to soft tissue-supported prostheses.
MULTIPLE MYELOMA: Implant success has been reported in a patient with multiple myeloma. Unmanaged malignant disease in general must be considered a contraindication for the placement of endosseous dental implants.
PARKINSON’S DISEASE: Implant- supported prostheses should be considered in patients with Parkinson’s disease and other diseases affecting orofacial motor function.
BONE MARROW TRANSPLANTATION: Implant placement should be delayed until cytotoxic chemotherapy has ended and the mar- row graft has taken. Bone marrow transplant patients may develop oral graft-versus-host disease that is clinically similar to oral lichen planus
HIV: endosseous dental implants have been placed successfully in HIV-positive patients
SYSTEMIC DRUGS: Consultation with the patient’s physician prior to dental implant placement is desirable for patients on anticoagulants or long-term systemic corticosteroids.
CHRONICALLY INFECTED IMPLANT SITES: Periodontitis and periapical lesions should be diagnosed and treated prior to dental implant placement.
ORAL LICHEN PLANUS Endosseous dental implants may be used in patients with nonerosive forms of OLP, although patients should be warned of possible lesion exacerbation related to surgery and possible implant failure if gingival lesions become erosive
HEAD AND NECK RADIOTHERAPY: Implant placement following head and neck radiotherapy is associated with a significant risk of osteoradionecrosis, especially with irradiation above 50 Gy. Recommended a 6- to 12-month recovery period after irradiation prior to dental implant placement
Presurgical hyperbaric oxygen may reduce the dental implant failure rate in irradiated jawbone from 60% to 5%
TARDIVE DYSKINESIAS Tardive dyskinesia may complicate dental implant therapy. Alternatives to endosseous dental implants should be considered for patients with neurologic disorders including orofacial dyskinesia, trigeminal neuralgia, or orofacial dysesthesia.
Topic: Implants in patients with periodontitis
Tittle: Systematic Review of Implant Outcomes in Treated Periodontitis Subjects.
Source: J Clin Periodontol 2008; 35:438
Type: Systematic Review
Rating: Good
Keywords: periimplantitis, failure
Purpose: To determine implant outcomes in partially dentate patients who have been treated for periodontitis compared with periodontally healthy patients.
Methods:
All longitudinal studies (until March 2006) of endosseous dental implants of at least 6 months of loading were searched. Studies presented with one or more of the outcome measures (implant survival, success, bone-level change, peri-implantitis) were included. Screening, data abstraction and quality assessment were conducted independently and in duplicate.
Results:
From 4448 citations, 546 full-text papers were screened and nine studies were included. Overall, the non-periodontitis patients demonstrated better outcomes than treated periodontitis patients. However, the strength of evidence showed that the studies included were at a medium to high risk of bias, with lack of appropriate reporting and analysis of outcomes plus lack of accounting for confounders, especially smoking. Furthermore, the studies showed variability in the definitions of treated and non-periodontitis, outcome criteria and quality of supportive periodontal therapy. Meta-analysis could not be performed due to heterogeneity of the chief study characteristics.
Conclusion:
There is some evidence that patients treated for periodontitis may experience more implant loss and complications around implants than non-periodontitis patients. Evidence is stronger for implant survival than implant success; methodological issues limit the potential to draw robust conclusions.
Topic: crestal bone height change
Authors: Rasperini G, Siciliano VI
Title: Crestal bone changes at teeth and implants in periodontally healthy and periodontally compromised patients. A 10-year comparative case-series study.
Source: J Periodontol. 2013 Nov 11.
Type: Comparative case-series
Rating: Good
Keywords: alveolar bone loss, peri-implantitis, periodontitis, smoking
Purpose:
To compare the 10 year radiographic crestal bone changes around teeth and
implants in periodontally compromised and periodontally healthy patients.
Methods: 120 patients (60 with prev hx of perio, 60 healthy) were followed for 10 years post loading for radiographic crestal bone height of dental implants and adjacent teeth. 10 patients were smokers. Digital films were calibrated. Radiographic crestal bone change was calculated by subtracting the creatl BL at baseline from the crestal BL at the 10 year follow up.
Results: After 10 years, implant survival was 80-95% and 100% for teeth. In all categories evaluated, natural teeth were significantly more stable radiographically compared to implants. Adjacent teeth did not seem to be influenced by the presence or absence of bone loss ≥3mm at adjacent implants.
Conclusion:
Long-term results show that natural teeth have greater survival and less
marginal bone loss compared to dental implants. This was still true when looking
at teeth with reduced periodontal attachment (treated and maintained). The
decision to extract teeth in favor of dental implants should be carefully
considered in partially edentulous patients.
Topic: Risk factors for implants
Title: How do smoking, diabetes and periodontits affect outcomes of implant treatment?
Source: Int J Oral Maxillofac Implants. 2007; 22 (suppl)173-202
Type: Review
Rating: Good
Keywords: dental implants, dental implant survival, diabetes, periodontitis, smoking, tobacco
Purpose: To evaluate
the available literature to assess whether smoking, diabetes, and periodontitis
have an adverse effect on the outcomes of implants placed in patients with these
conditions.
Method: The dental literature was searched using the MEDLINE, Cochrane Collaboration, and EMBASE databases. Using specific inclusion and exclusion criteria, 2 reviewers evaluated titles, abstracts, and full articles to identify articles relevant to this review. All searches were conducted for articles published through May 2005. Data from included articles for each of the risk factor groups, smoking, diabetes, and periodontitis, were abstracted and analyzed.
Results: A detailed search of the literature and evaluation of relevant articles identified 35 articles for inclusion in this systematic review. Nineteen articles were identified for smoking, 4 articles were identified for diabetes, and 13 articles were identified for periodontitis. One article met the criteria for both smoking and periodontitis. Implant survival and success rates were reported for smokers versus nonsmokers; diabetic patients versus nondiabetic patients; and patients with a history of treated periodontitis versus patients with no history of periodontitis. The findings revealed statistically significant differences in survival and success rates for smokers (better for nonsmokers), with greater differences observed when the data were analyzed according to bone quality (less for loose trabecular bone). No difference in implant survival rate was found between patients with and without diabetes. Likewise, no difference in implant survival rates was found between patients with a history of treated periodontitis compared to patients with no history of periodontitis.
Conclusion: The results of this systematic review of the literature demonstrated that smoking has an adverse effect on implant survival and success. The effect of smoking on implant survival appeared to be more pronounced in areas of loose trabecular bone. Type 2 diabetes may have an adverse effect on implant survival rates, but the limited number of studies included in this review do not permit a definitive conclusion. A history of treated periodontitis does not appear to adversely affect implant survival rates but it may have a negative influence on implant success rates, particularly over longer periods.
Topic: Diabetes
Title: Implant success in people with type 2 diabetes mellitus with varying glycemic control. A pilot study.
Source: JADA: 138:2007:355-361
Type: Cohort study
Rating: Good
Keywords: Diabetes, dental implants, implant success
Purpose: The authors conducted a prospective cohort study to explore the relationship between implant success and glycemic control in patients with type 2 diabetes mellitus.
Methods: The authors used a two-phased enrollment, stratified by glycated hemoglobin (HbA1c) levels, to evaluate 50 implants in 35 subjects. The authors assessed nonsubmerged, nonrestored implants after placement, during healing and at abutment placement (35 newton centimeters) for restoration after four months. Outcomes assessed included implant success or failure, clinical complications and adverse events.
Results: The HbA1c levels of the subjects ranged from 4.5 to 13.8 percent. All 50 implants were integrated clinically. The authors identified three minor complications in three patients having HbA1c levels ranging from 7.4 to 8.3 percent. None of these complications affected the clinical management of the cases, and the authors did not identify any adverse events.
Conclusion: There was no evidence of diminished clinical success or significant early healing complications associated with implant therapy based on the glycemic control levels of subjects with type 2 diabetes mellitus. These findings support the continued investigation of the effects of glycemic control on implant therapy toward the development of therapeutic guidelines that will optimize implant therapy in patients with diabetes.
Topic: smoking and implant
Authors: Strietzel FP, Reichart PA, et al.
Title: Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis.
Source: J Clin Periodontol. 2007 Jun;34(6):523-44. Review.
Type: Retrospective Study
Rating: Good
Keywords: dental implants; meta-analysis;odds ratio; smoking; success rate; survival rate
P:
To investigate if smoking interferes with the prognosis of implants with and
without accompanying augmentation procedures compared with non-smokers.
M&M: A systematic electronic and handsearch (1989 and 2005; English and German language; search terms "dental or oral implants and smoking"; "dental or oral implants and tobacco") was performed to identify publications providing numbers of failed implants, related to the numbers of smokers and non-smokers for meta-analysis. Publications providing statistically examined data of implant failures or biologic complications among smokers compared with non-smokers were included for systematic review.
R: Of 139 publications identified, 29 were considered for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure among smokers [implant-related odds ratio (OR) 2.25, confidence interval (CI(95%)) 1.96-2.59; patient-related OR 2.64; CI(95%) 1.70-4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI(95%) 2.26-5.77, implant related). The systematic review indicated significantly enhanced risks of biologic complications among smokers. Five studies revealed no significant impact of smoking on prognosis of implants with particle-blasted, acid-etched or anodic oxidized surfaces.
C: Smoking is a significant risk factor for dental implant therapy and augmentation procedures accompanying implantations.
Topic: smoking and implant
Title: Implant installation in the smoking patient.
Source: Periodontol 2000. 2003;33:185-93.
Type: Review.
Rating: good
Keywords: implant, failure, smoking,
Purpose:
to review the association between smoking and implant failure; potential
mechanisms, and benefits of smoking cessation.
Discussion:
Effects of smoking on general health: smoking has been shown to affect health in many ways such as; cancers especially lung cancer, chronic lung disease, myocardial infarctions, strokes and ischemic heart disease. Research show that 50% of smokers die from a smoking related disease, and life expectancy of smokers is reduced by 7.5 years. Smoking also has been shown to have an adverse effect on bone density.
Effects of smoking on wound healing: smoking is a complicating factor in post-surgical wound healing. Smokers show less reduction in PD after SRP, poorer healing after mucogingival surgeries, less favorable healing following OFD, greater loss of bone height, reduction in post-ext socket fill and more painful ext socket. Smoking compromises healing of duodenal ulcers. Also, in a study about healing after orthopedic surgery, it was shown than there are more delayed union or non-unions in smokers.
Influence of smoking on the actions of polymorphonuclear leukocyte, macrophages, circulation and blood flow: Several studies have shown that smoking causes reduced phagocytosis, delayed margination and diapedesis as well as compromised aggregation and adhesion of leukocytes to the endothelium in venules and arteries. Peripheral endothelial dysfunction, vessel wall injury and capillary loss is common in smokers, also reactive hyperemia and sequestration of blood cells in the microcirculation. Coronary flow reserve is also decreases after smoking high-nicotine cigarettes.
Smoking and implant failure:
Smoking and particularly heavy smoking increases the failure rates for machined titanium implants, likely due to a compromise of the blood supply in bone during early healing
This increased failure rate clusters largely in the maxilla, with much smaller differences between smokers and non-smokers for implant in the mandible.
Smoking is associated with a particularly high failure rate for implants placed into grafted maxillary sinuses. Some operators may consider this to be too great a risk to take, if the patient is unable or unwilling to stop smoking.
What happens if the potential implant patient stops smoking: Smoking cessation has been demonstrated to improve success rates in machined implant patients. In fact, implant placement may well be an effective motivator in assisting a smoker with cessation.
Bone density, smoking and implant success: There appears to be a relationship between heavy smoking and reduced bone density. This is seen in various areas of medicine, as well as in implant surgery and might explain high failure rates in Type 4 bone
Do different materials and surfaces make a difference: There is early evidence that rough surface implants, prepared with a double acid etched technique, have a high success rate in smokers. With success rates around 10% better overall (98.7% vs. 88.7%) and 15% better in the maxilla (97.3% vs. 82.1%) than our original results with machined Branemark implants in smokers, these are at present considered to be the implant of choice in smokers who cannot or will not stop smoking for implant placement.
Topic: Oral Bisphosphonates
Title: Implant Placement with or without Simultaneous Tooth Extraction in Patients Taking Oral Bisphosphonates: Postoperative Healing, Early Follow up and Incidence of Complications in Two Private Practices
Source: J Periodontol 2007; 78:1664-1669
Type: Retrospective study
Rating: Good
Keywords: Bisphosphonates; dental implants; osteonecrosis
Purpose: The purpose of this article was to document the results of treatment of patients with a history of oral bisphosphonate therapy in two private periodontal practices.
Methods: 61 female patients were treated in two private offices. All patients were receiving oral bisphosphonate therapy in the form of alendronate or risedronate, 35 or 70 mg/week. All these participants were treated with implant placement and restoration or tooth extraction, immediate placement, and restoration. These patients were then followed for 12 to 24 months after implant placement. The incidence of hard and soft tissue complications, including the development of osteonecrosis were noted.
Results: There were no reported cases of osteonecrosis immediately postoperatively during the follow-up period in any of the 61 patients. One patient demonstrated a small tissue dehiscence at the 1-week postoperative exam. No other complications occurred. All implants were functioning successfully by the Albrektsson criteria 12 to 24 months post-insertion.
Discussion: While the concern with BON is very much real with IV bisphosphonate. A history of oral bisphosphonate use for a mean period of 3.3 years was not found to be a contributing factor to the development of osteonecrosis following implant placement. Due to the size of the patient population, larger controlled studies and retrospective studies are needed.
Topic: Radiation
Authors: Colella, Cannavale, Pentenero, Gandolfo:
Title: Oral implants in radiated patients: A systematic review
Source: Int J Orla Maxillofac Implants 2007; 22(4):616-623
Type: Systematic review
Rating: Good
Keywords: Dental implants, oral cancer, radiation therapy
Purpose:
To evaluate and compare the effects of pre- and post-implant radiation
therapy. Incidence of implant failure was linked to multiple variables and
assessed.
Methods: A thorough review of the relevant literature was performed. Studies were original studies based in humans from 1990- 2006. The man outcome considered was implant failure, defined as implant mobility, implant removal necessitated by progressive marginal bone loss or infection (biologic failure). Restorative status was not considered a determinate of success (sleeping implants were considered a positive outcome). Overall implant failure rate was compared for pre-implantation radiation therapy vs. post-implantation. Four variables were considered: implant location (maxilla vs. mandible), dose of radiation, delay from radiation to implant placement, and timing of implant failure.
Results: 18 articles were considered eligible for inclusion in the review. Implant failure in post-implantation radiation therapy: 6 studies overall reported 124 implants with 4 failures (3.2%). Implant failure in pre-implantation radiation therapy: An overall failure rate of 5.4% was reported, which was not significantly different from post-implantation. 22/46 failures reported the cause of failure, with 9 due to lack of osseointegration, 12 due to marginal bone loss, and 1 due to biting trauma. Implant failure in the maxilla was 17.5% and 4.4% in the mandible, a difference that was significant. Vascularized free flaps were associated with the lowest rate of implant failure. Radiation dose: Radiation doses lower than 45 Gy were associated with the lowest rate of implant failure, with 5% being reported at higher doses. Delay of radiation treatment to implant placement: All implant failures occurred within 36 months after treatment. Timing of implant failure: No failures occurred within one month, 3.1% failed within the first month and 0.8% failed after 1 year.
Discussion: Based on this study, the timing of implant placement (pre- or post-therapy)is not linked to a significant difference in implant failure rate, however significantly better outcomes were noted in the mandible.
Topic:
osteoporosis
Authors:
Holahan, C et al
Title:
Effect of osteoporotic status
on the survival of titanium dental implants.
Source: Int J Oral Maxillofac Implants. 2008:Sep-Oct; 23(5)905-10
Type:
Rating: Good
Keywords: dental implants, implant survival, osteoporosis
Purpose:
Primary Objective is to perform a retrospective chart review to determine the
effect of osteoporotic status on survival of dental implants in postmenopausal
women. Secondary Objectives included assessing the effects of smoking status,
age, and arch location on implant survival as a function of osteoporotic status.
Method: a retrospective chart review was completed on all women who were 50 years of age or older at the time of dental implant placement at the Mayo Clinic between Oct 1, 1983 and Dec 31, 2004. The medical and dental charts were evaluated to collect the following:
BMD T-score within 3 years of implant placement
Osteoporotic diagnosis based on BMD T-score
Arch location of the implants
Smoking status at time of implant placement
Any implant failures (implant removal due to any reason other than infection or manufacturing defects)
The review resulted in 192 patients (646 implants). Implant survival was estimated using the Kaplan-Meier method. Follow up duration was calculated from date of implant placement to date of failure or last follow up.
Results:
The Kaplan-Meier t- and 10-year survival rates for the 64 implants in 192 patients were 93.8% and 92.5% respectively. The mean follow up was 5.4 years (range 11 days to 20.4 years). Mean age of women studied was 63.4 years (range 50.3 to 84.9 years)
Osteoporotic diagnosis of patients based on BMD T-score was: 49% diagnosed as non-OP, 29.7% had osteopenia and 21.4% had osteoporosis. 37 implant failures were found: 10 implant failures in the osteoporosis group, 10 implant failures in the osteopenia group and the other 17 failures occurred in patients with non-OP diagnosis.
No significant association between arch location and implant failure was identified.
12.5% of patients were smoking at the time of implant placement. Smoking had a significant effect on implant failure. Implants in smokers were 2.6 times more likely to fail (5- and 10- year implant survival rate for smokers was 87.3%). Non-smokers had 94.6% and 93.1% survival rates.
Conclusion:
Dental implant survival rates in this group of patients were encouraging with a 10-year survival rate of 92.5%.
Implants placed in smokers were 2.6 times more likely to fail than those placed in nonsmokers. The difference between those were most evident in the first year after implant placement.
A diagnosis of osteoporosis or osteopenia is not a contraindication to dental implant therapy.
Topic: Biological Principles
Title: Time interval after radiotherapy and dental implant failure: systematic review of observational studies and meta-analysis
Source: Clinical implant dentistry 2013;1-10
Type: Systematic Review
Rating: Good
Keywords: dental implants, meta-analysis, osseointegration, osteoradionecrosis, radiotherapy
Purpose: To compare the risk of failure of dental implants placed within 6 and 12 months after the end of radiotherapy versus the risk of those implants placed after 12 months from the end of radiotherapy.
Materials and method
Four electronic databases were searched for articles published until February 2013 without language restriction: Lilacs, Medline, Scopus and the Cochrane Central Register of Controlled Trials. Two reviewers independently assessed the eligibility criteria and extracted data. Meta-analysis was performed.
Results: Overall 3,749 observational studies were identified. After the screening of titles and abstracts, 236 publications were selected, and finally 10 articles were included in the analysis. The Relative Risk of failure (1.34) was higher in individuals who had dental implants installed between 6 and 12 months after receiving radiotherapy.
Discussion: The main finding was that placement of dental implants between 6 and 12 months postradiotherapy was associated with 34% higher risk of failure. This is statistically significant and clinically relevant. Literature suggests that patients treated with radiation doses exceeding 50 Gray Units (Gy) are at increased risk of failure of osseointegration because of the loss of ability to repair and neovascularize the irradiated bone. Hyperbaric Oxygen therapy (HBO) reduces the risk of failure of the implant because it increases the number of capillaries and fibroblasts. However, this was not observed in this review which agrees with results of Esposito who found that HBO is not essential.
Conclusion:
Minimum waiting period of 6 months postradiotherapy prior to dental implant placement is unlikely to be the most suitable, and healing periods with duration over 1 year may be beneficial.
Topic: prophylactic antibiotics
Title: Does the use of prophylactic antibiotics decrease implant failure?
Source: Oral Maxillofac Surg Clin North Am. 2011 Nov;23(4):547-50
Type: literature review
Rating: high quality evidence used
Keywords: antibiotic use, implant failure
Background:
Despite the high success rate, implant failures do occur. Failure can
attributable to implant-related, patient-related, and surgical technique-related
factors. Bacterial colonization of the implant surface and surgical site
infection have be implicated in early implant failure. Once an infection ensues
at the implant site, its eradication is usually difficult, and may lead to
removal of the implant. For this reason, various regimens have been suggested to
minimize early infections after implant placement. However routine use of
antibiotics is not without risk.
Purpose: to answer the question, “in patients receiving dental implants, does the administration of prophylactic antibiotics reduce early implant failure?”
Materials and Methods: The authors searched using the following Medical Subject Headings (MeSH): antimicrobial agents, antibiotics or prophylactic antibiotics, and dental implants. Inclusion criteria: 1) randomized controlled clinical trials, (2) meta-analysis or systematic review. The primary predictor variable was antibiotic therapy, classified as a preoperative dose of antibiotics, preoperative and postoperative antibiotic treatment, and no antibiotics. The primary outcome variable was implant failure. The secondary outcome variable was post- operative infection. Each article was reviewed and data summarized for the following variables: sample size, antibiotic use, implant failure, and postoperative infections. The treatment effect was measured using absolute risk reduction (ARR), which is defined as the absolute difference in failure rates between the intervention and control groups. The number needed to treat (NNT), calculated as the reciprocal of ARR, is defined as the number of implants that must be placed with antibiotic use to prevent 1 implant failure. Five articles were selected for review. Four studies were randomized controlled trials.
Results: a meta-analysis of the 4 RCTs included 1007 patients receiving a total of 2020 implants showed more implant failures in the groups not receiving antibiotics, with a statistically significant difference. The number of patients that needed to be treated with antibiotics to prevent 1 patient from having implant failure was 33.
Bottom Line: in the authors opinion, based on their review - significant reduction in implant failure was observed when patients received 2g Amoxicillin 1 hr preoperatively or 1 g amoxicillin 1 hr preoperatively followed by 500mg 4 times daily for 2 days postoperatively.
Critique: There are some drawbacks to the RCTs reviewed. The follow-up time varied from 3 months in 1 trial and 4 months in 2 trials to 5 months in 1 trial. Decreasing the follow-up period may decrease the number of failed implants and may overestimate the effect of antibiotics on the primary outcome variable: implant failure. Another drawback is the use of bone substitutes and other bone-regenerative procedures at the time of implant placement, which may affect implant healing and failure rates. The use of bone-regenerative procedures was reported in 2 studies. In addition, the effect of timing of implant placement (delayed or immediately after extraction) may potentially increase implant failure rates. Esposito and colleagues demonstrated in a logistic regression analysis that patients in the RCT who received immediate post-extraction implants had a 9% failure rate versus 2% in the delayed group, regardless of antibiotic use (P<.001).
Topic: Antibiotics
Title: Effects of antibiotics on dental implants: a review.
Source: J Clin Med Res. 2012 Feb;4(1):1-6.
Type: Systematic review
Rating: Good
Keywords: antibiotic, success rate, dental implants.
Purpose:
to review the current literature and information on dental implants and
prophylaxis. Our objectives are to ask whether or not antibiotics are beneficial
to implants, and in what instances pre- and/or postoperative antibiotic regimes
should be prescribed.
Material and methods: The systematic literature review was completed using the electronic databases, Pubmed, Medpilot and Medline. Retrospective or prospective controlled studies which met the inclusion criterion, were English studies conducted between 1955 to January 2009. Administrations of various prophylactic antibiotics regimens were accepted. An unsuccessful dental implant was characterized by any implant which failed within the first 3 months, and studies with follow ups within the first 5 months were included. Studies with loading were not included and only studies using low risk patients were included.
Results: Out of 853 studies, only 6 studies were included in this systematic review that met the criteria. 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
Conclusion: The cost-benefit ratio of any therapy, including all potential adverse effects, must be determined. The negative effects associated with use of antibiotic therapy must be assessed in comparison to the costs and morbidity related to treating infective endocarditis or infected prosthetic materials.
Critics: many studies were excluded because they did not include comparisons between no antibiotics, pre-op, post-op antibiotic use.
Topic: Antibiotics
Authors: Esposito M, Grusovin MG, Worthington HV.
Tittle: Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications.
Source: Cochrane Database Syst Rev. 2013 Jul 31;7:CD004152.
Type: Systematic Review
Rating: Good
Keywords: antibiotics, failure, survival
Purpose:
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.
Methods:
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). Selection criteria: 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.
Results:
Six RCTs with 1162 participants were included:
3 trials compared 2 g of preoperative amoxicillin versus placebo (927 participants)
1 compared 3 g of preoperative amoxicillin versus placebo (55 participants),
1 compared 1 g of preoperative amoxicillin plus 500 mg four times a day for two days versus no antibiotics (80 participants), and
1 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 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. The number needed to treat for one additional beneficial outcome (NNTB) to prevent one person having an implant failure is 25, based on an implant failure rate of 6% in participants not receiving antibiotics. There was borderline statistical significance for prosthesis failures, with no statistically significant differences for infections, or adverse events. 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.
Conclusion:
Scientific evidence suggests that antibiotics are beneficial for reducing failure of dental implants. Specifically 2 g or 3 g of amoxicillin given orally, as a single administration, one hour preoperatively significantly reduces failure of dental implants. 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.
Topic: antibiotics and implant failures/infections
Authors: Ata-Ali J, Ata-Ali F, Ata-Ali F.
Title: Do antibiotics decrease implant failure and postoperative infections? A systematic review and meta-analysis.
Source: Int J Oral Maxillofac Surg. 2013 Jun 25.
Type: Systematic review and meta-analysis
Rating: Good
Keywords: dental implants, infection, disease, antibiotic, meta-analysis, implant surgery
Purpose:
To systematically review and perform a meta-analysis to determine does the use
of antibiotics reduce the frequency of implant failure and postoperative
infection.
Methods: A manual and PubMed electronic search was conducted for RCTs that met the inclusion criteria with a control group that did not receive antibiotics. Four RCTs were included in the final review.
Results: Four RCTs included had a total of 2063 implants in a total of 1002 patients. Antibiotic use significantly lowered implant failure rate with an OR 0.331. One needs to treat 48 patients in order to prevent one patient from having an implant failure. In contrast, antibiotic use did not significantly reduce the incidence of post op infection. The meta-analysis found that there is evidence in favor of systemic antibiotic use in patients receiving dental implants.
Conclusion: Future research with large scale RCT should be performed to find the best choice of antibiotic, timing of administration, and dose.
Topic: NSAIDS - ibuprofen
Authors: Alissa R, Sakka S, Oliver R, et al
Title: Influence of ibuprofen on bone healing around dental implants: a randomised double-blind placebo-controlled clinical study
Source: Eur J Oral Implantol. 2009 Autumn;2(3):185-99.
Type: Clinical
Rating: Good
Keywords: ibuprofen, dental implants
Purpose: To
investigate the effect of a one-week post-operative course of 600 mg of
ibuprofen taken four times a day on marginal bone level around dental implants.
Method: A total of 61 patients were allocated to the ibuprofen (31 patients) or placebo group (30 patients). Overall, 132 implants were inserted, 67 implants in the ibuprofen group and 65 implants in the placebo group. Preparation of the implant sites was carried out with an intermittent drilling sequence adapted to the fixture diameter and the local bone quality according to the Astra Tech implant installation guide. The primary outcome measure was the change in marginal bone level around dental implants from the baseline (2 weeks post-placement) to the 3- and 6-month radiographic examinations. The paralleling technique and a film holder coupled to a beam aiming device were used to take the periapical radiographs. Measurement of changes in bone level was made using a viewing box and x8 magnifier.
Results: Two patients from the ibuprofen group were unable to complete the prescribed course of ibuprofen owing to a minor self-reported stomach upset. A patient from the control group did not attend any of the scheduled appointments following implant placement. A total of three patients dropped out. All implants survived in either group during the 6-month observation period. The mean marginal bone level changes from the baseline were (-0.33 mm) at the 3-month and (-0.29 mm) at the 6-month follow-up for the ibuprofen group while the corresponding values for the placebo group were (-0.12 mm) and (-0.30 mm). There were no statistically significant differences between groups for mean marginal bone level changes at 3 months or 6 months.
Conclusion: Administration of a short course of systemic ibuprofen for post-operative pain management subsequent to implant placement may not have a significant effect on the marginal bone around dental implants in the early healing period.
Designed By Steven J. Spindler, DDS LLC