Peri-implantitis Microbiota

Dental implant surgery has been a successful therapeutic option for the rehabilitation of partially or completely edentulous jaws for many years. However, evidence regarding the causative factors of peri-implant disease is still lacking. Peri-implantitis is an inflammatory disease affecting the soft and hard tissues surrounding osseointegrated implant associated with the formation of a bacterial biofilm on the implant surface close to the marginal tissues. The aim of this chapter is to summarize the knowledge regarding the microbiota associated with peri-implant infection and to review the different microbial diagnostic tests to understand the peri-implant microbiota, as well as summarize the present knowledge regarding management of peri-implantitis and propose further recommendations for future studies. This chapter shows that the scientific data regarding the microbiota responsible for peri-implantitis initiation and progression are still inconclusive. A microbiological test may thus be one diagnostic method to be used to understand the complexity of microbiota associated with the peri-implant sulcus. However, in order to resolve inflammation and arrest disease progression, the understanding of the biofilm development is essential

Antibiotics in Implant Dentistry

Antibiotics have been recommended either as an extended treatment for several days or as a single antibiotic prophylaxis dose since the development of dental implant osseointegration technique in the 1970s. It is also performed as part of surgical protocol during the peri-operative phase in the treatment of peri-implantitis. To date, there is a lack of scientific evidence regarding the additive effect of antibiotics in the treatment of dental implant. This has thus left the clinician with inconclusive recommendations, leading to increase antibiotic prescription. With this increase, the development of antibiotic resistance is becoming a threat to modern healthcare that requires revisiting of current indications and implementation of rational treatment strategies. Therefore, more studies are needed to assess the benefit of antibiotic prescription and whether it is safe to refrain from its use

Prophylactic antibiotics for staged bone augmentation in implant dentistry

Background: The objective of the study was to assess the effect of prophylactic antibiotics on the outcome of bone augmentation and subsequent dental implant placement by combining the recommended quality assessment methods for systematic reviews and primary studies. Materials and methods: This is a complex systematic review in which systematic reviews as well as primary studies are scrutinised. A search of Medline (OVID), The Cochrane Library (Wiley) and EMBASE, PubMed and Health technology assessment (HTA) organisations as-well as a complementary hand-search was carried out. Selected primary studies were assessed using GRADE. Each study was reviewed by three authors independently. Results: Abstract screening yielded six potential systematic reviews allocated for full-text inspection. A total of ten primary studies were read in full-text. No relevant systematic reviews regarding the topic of this article were found. The quality assessment resulted in two primary studies with a moderate risk of bias. Of the two studies with a moderate risk of bias, one compared a single dose of clindamycin 600 mg preoperatively with the same preoperative dose followed by four doses of 300 mg every 6 h. The second study compared a single dose prophylaxis of two different types of antibiotic compounds. Conclusion: In conclusion, the scientific evidence regarding the use of antibiotic prophylaxis for reducing the risk of infection in conjunction with bone augmentation procedures during dental implant placement is very limited. The infection rate as compared to nonusage of prophylactic antibiotics, selection of the most suitable compound, and the optimal duration of prophylactic treatment is still unknown.publishedVersio

Healthcare Challenges and Future Solutions in Dental Practice: Assessing Oral Antibiotic Resistances by Contemporary Point-Of-Care Approaches

Antibiotic resistance poses a global threat, which is being acknowledged at several levels, including research, clinical implementation, regulation, as well as by the World Health Organization. In the field of oral health, however, the issue of antibiotic resistances, as well as of accurate diagnosis, is underrepresented. Oral diseases in general were ranked third in terms of expenditures among the EU-28 member states in 2015. Yet, the diagnosis and patient management of oral infections, in particular, still depend primarily on empiric means. On the contrary, on the global scale, the field of medical infections has more readily adopted the integration of molecular-based systems in the diagnostic, patient management, and antibiotic stewardship workflows. In this perspective review, we emphasize the clinical significance of supporting in the future antibiotic resistance screening in dental practice with novel integrated and point-of-care operating tools that can greatly support the rapid, accurate, and efficient administration of oral antibioticspublishedVersio

Factors affecting peri-implant tissue reactions

Screw- shaped titanium implants are today routinely used m the substitution of lost teeth. In this thesis some of the biological factors related to the long-term survival and maintenance of dental implants were studied. The first arm of these studies was to evaluate the neutrophil activation around teeth and dental implants (Papers I & II). Secondly we wanted to evaluate the clinical radiographic and microbiological status of implants after long-term. function m partly edentulous patients (Paper III). The long-term treatment outcome of implant treatment m fully edentulous was also compared to that m partially edentulous patients (Papers III & IV). The third and final purpose of these studies was to investigate the influence of smoking, a history of periodontitis and a specific host-response pattern on the occurrence of late fixture loss and marginal bone loss around dental implants (Papers IV & V). Papers I and II showed that the inflammation around implants m partly edentulous patients induced a stronger neutrophil reaction than did the inflammation around implants m edentulous patients albeit similar clinical appearance and absence of significant differences m the microbiota. Paper III, showed that marginal bone loss around implants after ten years of function in partly edentulous patients was limited and comparable to that m edentulous jaws. There was no major difference in the microbiota colonising teeth and implants. In Paper IV, 143 consecutively treated patients were evaluated retrospectively after five years of function of implants. Only 2% of the fixtures were lost during function. No correlation was found between bone loss around implants and teeth. A history of periodontitis did not influence mar~ bone loss around implants Smoking was not found to correlate with marginal bone loss at neither implants nor teeth. In Paper V a site-specific inflammatory reaction around implants with peri- implantitis rather than a patient-associated host-response was found in patients with failing implants Patients with peri-implantitis harboured high levels of periodontal pathogens, Actinobacillus actinomycetemcomitans Porphyromonas gingivalis Prevotella intermedia, Bacteroides forsythus and Treponema denticola. In conclusion Although the inflammation around implants m partly edentulous patients induces a stronger neutrophil reaction, than M m the edentulous ones, the marginal bone loss after long-term function in the former is limited and similar to that in edentulous jaws. In patients treated for periodontal disease stable periodontal and peri-implant conditions can be maintained during long term function The periodontally-associated microbiota constitute a risk for future development of peri-implantitis In patients with a history of periodontitis Le. individuals who previously have shown a tissue destructive inflammatory response, this risk is more pronounced

Effect of governmental strategies on antibiotic prescription in dentistry

Objective: To study the effect of governmental strategies, to constitute and publish recommendations on antibiotic usage in dentistry, on the antibiotic consumption. Material and methods: Descriptive statistics regarding antibiotic prescription between 2009 and 2017 was retrieved from two national registers, the Swedish Prescribed Drug Register and the Dental Health register, both administered by the National Board of Health and Welfare. Age standardization was applied to alleviate the comparison between gender, different regions and years. Results: The number of dispatched prescriptions of antibiotics from dentists was reduced with 31% during the study period. 10% of the visits to a dentist generated an antibiotic prescription corresponding to 7% of the total number of antibiotic prescriptions. A decline in prescription was observed after publication of national recommendations for antibiotics prophylaxis in 2012 and antibiotic treatment in 2014. Unexplained geographical and gender differences in the rates of prescription were seen. Conclusions: Data indicates a correlation between introduction of governmental strategies to reduce antibiotic usage and declining antibiotic prescription. Although a marked reduction in prescription was observed, the results indicate that there is further potential for improvement of antibiotic stewardship in odontology

Complex systematic review : Perioperative antibiotics in conjunction with dental implant placement

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

Is routine antibiotic prophylaxis warranted in dental implant surgery to prevent early implant failure? – a systematic review

Abstract Background The question of whether antibiotic prophylaxis should be administered routinely for dental implant surgery is unresolved. Despite the lack of conclusive supportive evidence, antibiotics are often administered to reduce the risk of infection, which could lead to early implant failure. Increasing antibiotic resistance is a major concern and it is therefore important to reduce the overall use of antibiotics, including in dentistry. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of preoperative antibiotics in preventing early implant failure, in overall healthy patients undergoing dental implant surgery. Methods An electronic search was undertaken of PubMed (Medline), Web of Science and the Cochrane Library up to October 1st, 2023, to identify randomized clinical trials (RCTs). All RCTs comparing antibiotic prophylaxis with no antibiotics/placebo in overall healthy patients receiving dental implants were included. The primary outcome was patients with early implant failure. Risk of bias was assessed, data were extracted, a meta-analysis was done, and GRADE certainty-of-evidence ratings were determined. The risk ratio (RR), the risk difference (RD) and 95% confidence intervals (CI) were estimated. Results After removal of duplicates, 1086 abstracts were screened, and 17 articles were reviewed in full text. Seven RCTs with moderate or low risk of bias and with a total of 1859 patients and 3014 implants were included in the meta-analysis. With reference to early implant failure at patient level, the meta-analysis failed to disclose any statistically significant difference (RR: 0.66, 95% CI: 0.30-1.47) between antibiotic prophylaxis and a placebo. The risk difference was -0.007 (95% CI: -0.035-0.020) leading to a number needed to treat (NNT) of 143. Conclusion Antibiotic prophylaxis for dental implant surgery does not seem to have any substantial effect on early implant failure ( ). The results do not support routine antibiotic prophylaxis for dental implant surgery