Richard A. Plezia

Dental treatment and late prosthetic joint infections

Hospital and dental charts of 2,693 patients in whom total prosthetic joints had been placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as at The University of Michigan Hospital, were analyzed. Of the thirty (1.1%) late prosthetic joint infections (greater than 6 months after placement), only one (0.04%) could be temporally associated with dental treatment. A Fishers exact test of the data reflected that dental treatment in this population did not increase the incidence of late prosthetic joint infections (p value is 0.0005). Nine of the thirty late infections occurred in insulin-dependent diabetic patients and patients on long-term immunosuppressive therapy. An analysis of the organisms isolated from the late infections shows that 54% where Staphylococcus epidermidis and Staphylococcus aureus. These data do not support the practice of prescribing prophylactic antibiotic coverage of prosthetic hip and knee joints prior to all dental therapy. Rather, use of antibiotics during dental treatment appears warranted only if a chronic bacteremia is anticipated or where a predisposing systemic condition may exist.

Sarcoidosis: report of two cases with oral involvement

Sarcoidosis is a multisystem granulomatous disease in which pulmonary involvement is the most characteristic feature. Even though extrapulmonary manifestations occur infrequently in the area of the head and neck an occasional patient will have oral involvement. As we will demonstrate in these case reports, sarcoidosis should be included in the differential diagnosis of oral and perioral papular lesions noted on examinations of the head and neck.

Myositis ossificans traumatica of the masseter muscle

Abstract A case report demonstrating traumatic myositis ossificans of the left masseter muscle is presented. An update of the current literature, with treatment philosophy, is presented.

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.

Bone density: Its influence on implant stability after uncovering

Primary implant stability and bone density are variables that have long been considered to be essential to achieving predictable osseointegration and long-term clinical survival. Although the dentist can control most factors associated with implant survival, bone density is the one factor that cannot be controlled. Measuring implant stability would assist in determining if an implant has integrated and is ready for the fabrication of the final prosthesis. Changes in implant stability in each type of Bone Quality (BQ-1, -2, -3, and -4), which may occur with time, have not been studied. Such information could help identify well-integrated implants and identify changes associated with impending implant failure. Several studies have used the Periotest instrument to study implant stability. Use of the Periotest implant stability will be studied during each phase of implant treatment for each bone density, and a range for clinically satisfactory integration will be suggested. Implant stability changes over time, and the changes are different for each bone density as the bone surrounding the nonhydroxyapatite implant becomes denser. This is clearly demonstrated in a postmortem histological specimen. The changes in implant stability (Periotest Values [PTVs]) are more apparent in BQ-1 and BQ-2 bone and less apparent in BQ-3 and BQ-4 bone. The Periotest is capable of providing valuable information concerning favorable or unfavorable changes in the bone-implant interface after uncovering. In addition, it can help identify when an implant is ready to be loaded. A new range of PTVs (-5 to -2) is suggested for monitoring the status of implants. Implants with PTVs more positive than -2 would indicate a bone-implant complex that may be marginal.

Thoracic malignant fibrous histiocytoma metastatic to the tongue and skin of the face

A 60-year-old white man was found to to have metastatic malignant fibrous histocytoma in the tongue and facial skin 15 months after diagnosis of the primary lesion in the thorax. This is believed to be only the fourth reported case of this tumor metastatic to the oral cavity and the first lingual metastasis from outside the jaws.

Evaluation of osteogenesis following immediate and delayed reimplantation of frozen autogenous mandibular bone

A follow-up study of the feasibility of delayed reimplantation of frozen autogenous mandibles after ablative surgery for oral carcinomas with mandibular involvement was performed. Fifteen young adult mongrel dogs were used and evaluated clinically, bacteriologically, radiographically, histologically, and by radionuclide imaging. The animals were divided into two groups according to whether they underwent immediate or delayed reimplantation. These were subdivided into those who received grafts with and without autogenous marrow augmentation. The results were positive and suggested clinical evaluation. Twelve patients had undergone delayed reimplantation along with marrow augmentation over the past 3 years. Again, the results are most promising and we believe that, with further refinement, this technique will offer a new and acceptable modality for facial reconstruction in the cancer patient.

Cowden's disease (multiple hamartoma syndrome).

A case report of Cowdens disease has been presented along with a discussion of its multiple system involvement. Its association with thyroid and breast malignancy make its differentiation from other or similar disease entities vital.

Felty's syndrome

The clinical and pathologic findings of Feltys syndrome are discussed. A case is presented which demonstrates the nonspecific inflammatory oral lesions commonly seen with this syndrome. The role of the dentist in relating these nonspecific lesions to the basic disease process is emphasized.