Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review.
ABSTRACT CONFLICT-OF-INTEREST STATEMENT: Marco Esposito is the first author of two of the included studies; however, he was not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications' published in The Cochrane Library (see http://www.cochrane.org for more information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane Review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration.
To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2 June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Meta-analyses were conducted.
Four RCTs were identified: three comparing 2 g of preoperative amoxicillin versus placebo (927 patients) and the other comparing 1 g of preoperative amoxicillin plus 500 mg four times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the four trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics: risk ratio=0.40 (95% confidence interval (CI) 0.19 to 0.84). The number needed to treat (NNT) to prevent one patient having an implant failure is 33 (95% CI 17-100), based on a patient implant failure rate of 5% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one in the placebo group.
There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduce failures of dental implants placed in ordinary conditions. 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 post-operative antibiotics are beneficial, and which is the most effective antibiotic.
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ABSTRACT: Despite morbidity factors that include pain and complications with healing, there is currently little available guidance regarding optimal pre-and post-operative protocols for dental implant placement. While the first paper of this two-part series discussed the management of post-operative pain, the second instalment reviews pre- and post-operative means of managing early complications associated with dental implant placement.British dental journal. 08/2014; 217(4):171-6.
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ABSTRACT: Dental implants placed under favorable conditions in healthy patients have success rates of over 95%, even after 15 years of follow up. In spite of this excellent outcome, technical, biologic and esthetic complications do occur (17, 27, 30, 31). Moreover, the outcome can be less desirable if dental implants are placed in patients affected with sys-temic diseases or other compromising conditions (2, 4, 13, 22, 25). Metabolic disorders or immune deficiencies can, for example, give rise to surgical complications and may also interfere with bone apposition and/or remodeling at the implant–bone interface. Similarly, radiation therapy in the surgical area may significantly reduce cellularity and vascu-larity, and hence affect the healing of oral implants. In compromised patients, implant-based treatment may be a questionable choice. Medica-tion, such as biphosphonates and/or anticoagu-lants, may also affect the outcome of implant placement or increase the frequency of postopera-tive complications. The placement of dental implants in such patients must adhere to strict treatment protocols (19, 20). The clinical protocol for the placement of dental implants has changed significantly over the past 40 years (Table 1). From the initial 'biocompatibility'-oriented protocol, aiming at osseointegration and long-term success, there has been an evolution toward less stringent criteria for implant placement in order to 'speed the healing process' and 'improve the esthetic results', although it is still questionable whether patients will ultimately bene-fit from these changes. The purpose of this volume of Periodontology 2000 is to evaluate the new developments in implantology, review their scien-tific evidence and analyze their indications, advan-tages and disadvantages. It is organized into 16 chapters dealing with diagnostic and therapeutic concepts, from the use of current three-dimensional radiographic techniques to guided surgical implantation and enhanced surgical protocols. The overall goal is to guide the clinician in decision making around implant therapy and to provide an understanding of the etiology and therapy of peri-implant diseases. Indication/treatment planning Whereas initially only fully edentulous patients with optimal jaw bone dimensions (width and height) were the basic indication for implant therapy, now nearly every edentulous space is considered as suit-able for implant placement. In situations where insufficient bone is available for implant therapy, bone-augmentation techniques are routinely consid-ered. Benic & H€ ammerle (3) concluded that such techniques are highly predictable if the proper indi-cations are respected and appropriate healing time is allowed for bone regeneration. Another approach is the use of the zygoma when the maxillary bone is severely atrophic. As discussed by Aparicio et al. (1), the zygomatic implant technique offers the possibil-ity to treat highly complex situations with low mor-bidity. The bone height in the posterior maxilla is often limited and a sinus lift procedure is recom-mended. Besides the conventional lateral window technique, a less invasive transalveolar approach is described by Pjetursson & Lang (26). As an alterna-tive to surgical bone regeneration, various studies have reported successful outcome with the use of short implants in the mandible as well as in the maxilla. Nisand & Renouard (24) discuss the indica-tions and evidence-based efficacy of the use of short and narrow implants. The esthetic outcome of implant therapy is addressed by Merheb et al. (21) and Thoma et al. (34). Merheb et al. (21) review the optimal implant-placement within the bone 7Periodontology 2000 01/2014; 66(1). · 4.01 Impact Factor
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ABSTRACT: Objective The purpose of this retrospective, noninterventional, open cohort study is to report on the long-term survival of dental implants, in private practice representing the daily realities of implant treatment. The data are analyzed to discern statistical relationships between explanatory variables and implant failure.Materials and methodsA total of 4591 Straumann implants were placed in 2060 patients between 1999 and 2012. Patients were evaluated after 2–3 months, 1, 3, 5, and 7 years and, in some cases, up to 10 years. The cumulative survival rate (CSR) was calculated according to the life table method and illustrated with Kaplan–Meier survival curves. Univariate analysis was performed to investigate the association between study variables and time to implant-failure. Variables with P -value < 0.15 were further selected for a multivariate analysis. Statistical methods which take into account the fact that some patients have more than one implant (therefore, dependency between implants within mouth) had been applied.ResultsAt the implant level, the cumulative survival rates at 3, 5, and 7 years were 99.3%, 99.0%, and 98.4%, respectively, and at the patient level, they were 98.6%, 97.7%, and 95.9%, respectively. After adjustment to possible confounders, the multivariate analysis identified a relationship between the following risk indicators for implant failure: implant location, length and design, timing of implantation, bone grafting procedures and gender. Tissue-Level implants (n = 3863) had a very high survival rate of 99% at 3 years, which was maintained over the entire study period. Bone-Level implants (n = 600) were as predictable with a survival rate of 99% up to 3 years, while Tapered Effect implants (n = 128) demonstrated a lower survival rate of 95% at 5 years. Short 6-mm implants in the mandibular posterior sites had a high survival rate of 100%, while in maxillary posterior positions a survival rate of only 87% was achieved. Patient factors such as smoking, autoimmune disease, and penicillin allergy were tending to associate with higher failure rates.Conclusion High long-term survival rates were observed for a large cohort of Straumann implants. Tissue- and Bone-Level implants had higher survival rates than Tapered Effect implants, and although short implants faired well in the mandibular posterior sites, they faired less well in the maxillary posterior sites. The study represents private practice insight into large-scale, long-term implant results.Clinical Oral Implants Research 08/2014; · 3.43 Impact Factor