Javier Ata-Ali

Do antibiotics decrease implant failure and postoperative infections? A systematic review and meta-analysis

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.

Clinical, microbiological, and immunological aspects of healthy versus peri-implantitis tissue in full arch reconstruction patients: a prospective cross-sectional study

BackgroundDue to the world-wide increase in treatments involving implant placement, the incidence of peri-implant disease is increasing. Late implant failure is the result of the inability to maintain osseointegration, whose most important cause is peri-implantitis. The aim of this study was to analyze the clinical, microbiological, and immunological aspects in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and patients with peri-implantitis.MethodsPISF samples were obtained from 24 peri-implantitis sites and 54 healthy peri-implant sites in this prospective cross-sectional study. The clinical parameters recorded were: modified gingival index (mGI), modified plaque index (mPI) and probing pocket depth (PPD). The periodontopathogenic bacteria Tannerella forsythia, Treponema denticola and Porphyromonas gingivalis were evaluated, together with the total bacterial load (TBL). PISF samples were analyzed for the quantification of Interleukin (IL)-8, IL-1β, IL-6, IL-10 and Tumor Necrosis Factor (TNF)-α using flow cytometry (FACS).ResultsThe mGI and PPD scores in the peri-implantitis group were significantly higher than the healthy group (p < 0.001). A total of 61.5% of the patients with peri-implantitis had both arches rehabilitated, compared with 22.7% of patients with healthy peri-implant tissues; there was no implant with peri-implantitis in cases that received mandibular treatment exclusively (p < 0.05). Concentrations of Porphyromonas gingivalis (p < 0.01), association with bacteria Porphyromonas gingivalis and Treponema denticola (p < 0.05), as well as the TBL (p < 0.05) are significantly higher in the peri-implantitis group. IL-1β (p < 0.01), IL-6 (p < 0.01), IL-10 (p < 0.05) and TNF-α (p < 0.01) are significantly higher at the sites with peri-implantitis compared to healthy peri-implant tissue, while IL-8 did not increase significantly.ConclusionThe results of the present study involving a limited patient sample suggest that the peri-implant microbiota and which dental arch was rehabilitated involved could contribute to bone loss in peri-implantitis. A significant relationship is observed between the concentration of cytokines (interleukins 1β, 6 and 10 and TNF-α) and the inflammatory response in peri-implantitis tissue.

Oral rehabilitation with tilted dental implants: A metaanalysis

Objective: To compare the course of patients treated with tilted implants versus those treated conventionally with axial implants, analyzing the success rate and marginal bone loss. Material and Methods: A PubMed search was made using the key words “tilted implants”, “angled implants”, “angulated implants”, “inclined implants” and “maxillary atrophy.” A review was made of the articles published between 1999-2010. The inclusion criteria were the use of tilted implants, clinical series involving at least 10 patients, and a minimum follow-up of 12 months after prosthetic loading. The exclusion criteria were isolated clinical cases, studies with missing data, and publications in languages other than English or Spanish. The metaanalysis finally included 13 articles: 7 retrospective studies and 6 prospective studies. Results: On analyzing the success rate in the retrospective studies, two reported a higher success rate with tilted implants; one a higher success rate with axial implants; and two reported similar success rates with both implants. On analyzing the success rate in the prospective studies, two reported a higher success rate with tilted implants; two a higher success rate with axial implants; and two reported similar success rates with both implants. On examining marginal bone loss, three studies reported greater bone loss with axial implants and one with tilted implants. Conclusions: There was no evidence of differences in success rate between tilted and axial implants in either the prospective or retrospective studies subjected to review. The marginal bone loss observed with the tilted and axial implants likewise proved very similar. It thus can be deduced that tilted implants exhibit the same evolutive behavior as axial implants. Key words:Axial implants, tilted implants, maxillary atrophy, tilted implants.

The effect of orally administered probiotic Lactobacillus reuteri‐containing tablets in peri‐implant mucositis: a double‐blind randomized controlled trial

BACKGROUND AND OBJECTIVES Probiotics create a biofilm and protect the oral tissues against the action of periodontal pathogenic bacteria. The aim of this study was to evaluate the effects of the oral probiotic Lactobacillus reuteri Prodentis upon the peri-implant health of edentulous patients with dental implants and peri-implant mucositis, establishing comparisons vs implants without peri-implant disease. MATERIAL AND METHODS A double-blind, placebo-controlled, prospective cross-over study was made. The patients were all edentulous and were divided into two groups, (A) no peri-implant disease, and (B) peri-implant mucositis affecting one or more implants. Patients with peri-implantitis were excluded. The dosage was one tablet every 24 h over 30 d. All patients in both groups initially received the oral probiotic Lactobacillus reuteri Prodentis, followed by placebo. Patients started with probiotic treatment during 30 d, followed by a 6 mo washout period and the administration of placebo for the same period. The following parameters were studied: crevicular fluid volume, modified plaque index, probing depth, modified gingival index, and concentrations of interleukin 1β, interleukin 6 and interleukin 8. RESULTS A total of 77 implants were evaluated in 34 patients. Group A involved 22 patients with 54 implants without peri-implant alterations, and group B, 12 patients with mucositis affecting one or more implants (23 implants). After treatment with the probiotic, both the patients with mucositis and the patients without peri-implant disease showed improvements in the clinical parameters, with reductions in cytokine levels. In contrast, no such changes were observed with placebo. CONCLUSIONS After treatment with the probiotic Lactobacillus reuteri in patients with implants presenting mucositis, the clinical parameters improved, and the cytokine levels decreased - in contraposition to the observations in the placebo group. Probiotic administration may be regarded as a good alternative for both the treatment of peri-implant mucositis and its prevention, as it also improved clinical parameters in the healthy individuals. Further studies involving larger patient series are needed regarding the effects of probiotics upon peri-implant health.

Prevalence, etiology, diagnosis, treatment and complications of supernumerary teeth

The aim of this article was to review the literature on supernumerary teeth, analyzing their prevalence, etiology, diagnosis, treatment and possible complications. An electronic search was made in the Pubmed-Medline database up to January 2014 using the key search terms “multiple supernumerary teeth” (n=279), “prevalence supernumerary teeth” (n=361), and “supernumerary teeth” (n=2412). In addition to the articles initially identified, others were included in the review proceeding from a manual search and from any references considered of relevance. Supernumerary teeth are those that exceed the normal dental formula. They are more common in men, more common in the upper maxilla, and more prevalent in permanent dentition. Complications associated with supernumerary teeth include dental impaction, delayed eruption, ectopic eruption, overcrowding, spacing anomalies and the formation of follicular cysts. The treatment of supernumerary teeth depends on their type, position, and possible complications, detected clinically and radiographically. No clear consensus exists as to the best time to extract unerupted supernumerary teeth. Key words:Hyperdoncia, supernumerary teeth, impacted teeth, treatment, permanent teeth, deciduous teeth.

Rehabilitation of the Atrophic Maxilla With Tilted Implants: Review of the Literature

We review the evidence-based literature on the use of tilted implants in the rehabilitation of patients with maxillary atrophy. Studies from 1999 to 2010 on patients with atrophic maxilla rehabilitated with tilted implants were reviewed. Clinical series with at least 10 patients rehabilitated using tilted implants and a follow-up of at least 12 months after prosthetic load were included. Case reports and studies with missing data were excluded. In each study the following was assessed: surgical technique, prosthesis type, timing of implant loading, success rate and marginal bone loss of tilted and axial implants, complications and patient satisfaction level. Thirteen studies were included, reporting a total of 782 tilted and 666 axial implants in 319 patients. Success rates went from 91.3% to 100% for axial implants and from 92.1% to 100% for tilted implants; radiographic marginal bone loss went from 0.4 mm to 0.92 mm in tilted implants and from 0.35 mm to 1.21 mm in axial implants. No statistically significant differences were found in any of the studies. No surgical complications and only minor prosthetic complications were reported. High patient satisfaction was found with all types of prosthesis (full-arch fixed, partial fixed and overdentures) placed over tilted implants. The literature on tilted implants shows that implants placed with this technique, both used alone and combined with axially placed implants, and rehabilitated with different prosthetic options have high success rates, minimal complications and high patient satisfaction. However, lack of homogeneity among studies and relatively short follow-up periods for most studies make necessary more studies.

Clinical, microbiologic, and host response characteristics in patients with peri-implant mucositis.

PURPOSE To analyze the clinical, microbiologic, and host response characteristics (interleukins 1β and 6) in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and with peri-implant mucositis. MATERIALS AND METHODS Clinical parameters (modified Gingival Index [mGI], modified Plaque Index [mPI], probing pocket depth [PPD], and absence or presence of radiologic bone loss) were recorded, and PISF samples were obtained from peri-implant sites showing mucositis as well as healthy sites. The periodontopathogenic bacteria Tannerella forsythia (Tf), Treponema denticola (Td), and Porphyromonas gingivalis (Pg) were evaluated, together with the total bacterial load (TBL) and the interleukin (IL) 1β and IL-6 values. RESULTS The study population consisted of 34 individuals, and 77 dental implants were evaluated during the study (23 mucositis and 54 healthy peri-implant sites). The mGI, mPI, and PPD scores of the peri-implant mucositis group were significantly greater than in the healthy group. No differences in detection frequency were found for putative periodontal pathogens and TBL between the healthy peri-implant sites and mucositis sites. The mucositis group showed a significantly greater expression of IL-6 than the healthy group (P < .05). Although IL-1β was increased in the mucositis group, there was no statistically significant difference versus the healthy implant group. CONCLUSIONS An analysis was made of the clinical, microbiologic, and host response characteristics in implants with peri-implant mucositis, establishing comparisons with healthy implants. In the patients studied, bacterial plaque induced an inflammatory response that can lead to the development of peri-implant mucositis. Adequate plaque control is therefore able to increase peri-implant health, avoiding the risk of future complications. No specific association to the studied bacterial species was established.

Long-term survival rates of implants supporting overdentures.

The study aims were to evaluate survival rates of dental implants in patients wearing maxillary and mandibular overdentures in relation to age, sex, smoking, implant splinting or non-splinting, the maxilla rehabilitated, and number of implants per dental arch. This was a prospective study of patients who were completely edentulous in either mandible or maxilla or both, rehabilitated with implant-retained overdentures, with a follow-up of at least 3 years. 95 patients with 107 overdentures were supported by 360 implants were included in the study. Rehabilitations were monitored over an average of 95 ± 20.3 months (range 36-159). Implant survival in the maxilla was 91.9% and in the mandible 98.6%, representing a statistically significant difference (P < .05). Age, sex and implant splinting did not influence survival rates significantly. Smokers presented a lower survival rate. Implant numbers in the maxilla had a significant influence on survival, 100% for 6 but 85.7% for 4. Three mandibular implants achieved higher survival rates (100%) but with 2 (96.6%) or 4 (99%) survival was lower, although without significant difference. Long-term results suggest that 3-implant mandibular overdentures have an equivalent survival rate to 4-implant overdentures. In the maxilla, results showed that 6 implants may be the best treatment strategy. For smokers with fewer implants retaining the overdentures, there were higher numbers of implant failures.

Immediate versus conventional loading for the maxilla with implants placed into fresh and healed extraction sites to support a full-arch fixed prosthesis: nonrandomized controlled clinical study.

PURPOSE To compare immediate and conventional loading of fixed full-arch maxillary prostheses supported by implants placed in healed and fresh postextraction sites. MATERIALS AND METHODS This prospective, controlled, nonrandomized 12-month study included 30 consecutive patients requiring fixed full-arch maxillary prostheses supported by implants placed in healed and fresh extraction sites. Fifteen patients were treated with conventional loading (control group), and 15 were treated with immediate loading (test group). Each patient received six to eight implants; implants with insertion torque < 35 Ncm were conventionally loaded and excluded from the analysis. Implant success, biologic and prosthetic complications, success of the immediately loaded provisional prostheses, and marginal bone loss were assessed and analyzed statistically. RESULTS One test group patient failed to attend recall visits and was excluded from the study, and 16 implants did not achieve insertion torque of 35 Ncm and were excluded from analyses. The final sample included 29 patients and 193 implants (94 test implants, 99 control implants). Implant success rates were 96.8% (test) and 99.0% (control). In the test group, the most common complications were screw loosening and tooth fractures; in the control group, dentures caused discomfort and soft tissue irritation. The success rate of the immediately loaded prostheses was 100%. Average bone loss was 0.61 ± 0.21 mm for test implants and 0.53 ± 0.18 mm for control implants. Differences between loading protocols were not statistically significant. CONCLUSIONS No significant differences in implant success and peri-implant marginal bone loss were seen in the current 12-month comparison of immediate and conventional loading of maxillary fixed full-arch prostheses. Biologic and prosthetic complications were rare with both loading protocols, and all immediately loaded provisional fixed prostheses performed successfully.

Treatment of periimplant mucositis: a systematic review of randomized controlled trials.

Objective:To determine the most effective treatment for periimplant mucositis in patients with dental implants compared with a control group. Materials and Methods:A PubMed (MEDLINE) literature search was made of articles published up until October 2013. Randomized controlled trials (RCTs) were stratified according to their level of quality using the Jadad scale and levels of evidence (University of Oxford). Results:The combinations of search terms resulted in a list of 371 titles. Of these, 114 references were finally reviewed. Finally, 7 RCTs fulfilled the inclusion criteria and were thus selected for inclusion in the systematic review. Chlorhexidine, the administration of azithromycin, and glycine powder air polishing are not effective for the treatment of periimplant mucositis. The only effective treatment seems to be the use of toothpaste with 0.3% triclosan. Conclusion:Definitions of periimplant mucositis vary in the literature, and no clear criteria have been established regarding the diagnosis and treatment of this disorder. It highlights our lack of uniform treatment and need to establish additional research to fully provide effective treatments for this common condition. More, larger, and longer-term RCTs are needed in this periimplant disease.