C. Daniel Dent

The Influence of Preoperative Antibiotics on Success of Endosseous Implants Up to and Including Stage II Surgery: A Study of 2,641 Implants

According to the American College of Surgeons, complex oral surgical procedures, including the transoral placement of endosseous implants, are of the type that may require prophylactic antibiotics. However, the routine use of prophylactic antibiotics in the field of dental implantology continues to be controversial, and their utilization varies widely. No data from a randomized prospective clinical study of the prophylactic use of antibiotics in implant surgery have been previously published. As part of the comprehensive Dental Implant Clinical Research Group clinical implant study, the preoperative or postoperative use of antibiotics, the type used, and the duration of coverage was left to the discretion of the surgeon. These data were recorded and correlated with failure of osseointegration during healing (stage I) and at stage II surgery (uncovering). The results showed that significantly fewer failures occurred when preoperative antibiotics were used.

AICRG, Part III: The Influence of Antibiotic Use on the Survival of a New Implant Design

PURPOSE The American College of Surgeons guidelines suggest that complex oral surgery may benefit from prophylactic antibiotic coverage. The use of preoperative antibiotics, postoperative antibiotics, or both during implant placement is a widely accepted practice in the United States, whereas dentists in other countries rarely use antibiotics. PURPOSE The purpose of this study was to determine if antibiotic coverage at the time of implant placement improves the survival of the Ankylos implant. METHODS As part of a comprehensive, multicentered, multidisciplinary, prospective, independent, international clinical study, designed and coordinated in the United States by the Ankylos Implant Clinical Research Group (AICRG), the use of preoperative (several regimens) and postoperative antibiotics (yes/no) were carefully documented to assess their influence on improving survival. A total of 1500 Ankylos implants were placed and followed for a period of 3 to 5 years. The decision to use antibiotics and the regimen to be employed was made by the treating surgeon. Failure was defined as removal of the implant for any reason. All data were entered into a computerized database for analysis. RESULTS The use of preoperative antibiotics produced no significant improvement (P = .21, Fishers exact test) in survival compared with those placed without antibiotic coverage. There was no significant difference between the regimens defined as AHA-1990, AHA-1997, and Petersons recommendations. CONCLUSIONS The results of this study suggest that there was little or no advantage to providing antibiotic coverage when placing this implant. These findings also suggest that the use of antibiotics for implant placement may not be as beneficial as once believed. If validated by other studies, the elimination of this practice for routine implant placement would represent a small but significant step forward in the reduction of unnecessary antibiotic use.

Proliferative myositis of the head and neck. Report of a case and review of the literature.

A case of proliferative myositis arising in the tongue is described. Light and electron micrographs revealed the characteristic infiltrative growth pattern and cellular pleomorphism of this lesion. A review of the literature disclosed 50 reported cases of proliferative myositis, including 10 that originated in the head and neck. The rapid growth rate and unusual gross and histologic appearance of this infiltrative lesion have contributed to its relatively frequent misdiagnosis and inappropriate treatment. Consequently it is hoped that this report will help clarify its benign nature.

Small cell carcinoma of the lung metastatic to the wall of a radicular cyst

This case report details the unusual presentation of small cell carcinoma at the periapex of a maxillary left lateral incisor. The initial clinical presentation was that of a symptomatic, nonhealing, well-circumscribed radiolucency about the periapex of the tooth. The biopsy specimen submitted by the endodontist was diagnosed as small cell carcinoma. This report stresses the need for submission of all tissue removed from the oral cavity for histopathological examination.