Preoperative administration of amoxicillin is not recommended in healthy patients undergoing implant surgery.

Design A multicentre, prospective, randomised, placebo-controlled, double-blinded clinical trial reported the early implant failure and postoperative infections of healthy or relatively healthy patients receiving 2 grams of amoxicillin one hour preoperatively from their scheduled dental implant placement. The registration of the study protocol in EudraCT and Clinical Trials.gov (#NCT03412305) followed the ethical principles of the Declaration of Helsinki and the CONSORT guidelines for clinical trials.Case selection Several trial drugs expired before recruiting the intended 1,000 patients calculated based on previous trials reporting 2% and 5% early implant loss, with and without antibiotic prophylaxis. Thus, the study cohort (age >18 years, not planned for immediate loading, not requiring substantial bone augmentation, with an absence of severe diseases or immunosuppression or immunodeficiency) received 757 implants in total between November 2014 and April 2018, consisting of the prophylactic antibiotic therapy group (patients n = 235) and the placebo group (patients n = 235), with a fair sex distribution and a mean age of 57.4 ± 13.9 years. A computer-generated list of random numbers assisted the randomisation (test or control group) with a block-size six. For the clinical procedures, bone augmentation was limited to autogenous bone chips and bone debris. One- and two-stage surgery protocols were used in maxillary or mandibular single or multiple dental implants. The utilised implant systems were Straumann SLA (Straumann Implants, Switzerland), Astra Tech Dental Implant Systems (Dentsply Sirona, Sweden), Nobel Biocare (Sweden) and Southern Implants (Ltd, South Africa). Chlorhexidine 0.2% was prescribed preoperatively and/or postoperatively. Implant failure was the main measured outcome, whereas postoperative infections and adverse events were the secondary outcomes postoperatively assessed at 7-14-day (first follow-up) and 3-6-month (second follow-up) intervals.Data analysis The sample size calculation (type one error: 0.05; power: 80%) estimated 500 patients in each group. Proportional differences and relative risk (RR) with a 95% confidence interval (CI) were calculated. Implant failure was the dependent variable for the multiple logistic regression (MLR) model examining the indicator variables smoking (yes or no), and age (<50 years; 50-64; and ≥65), as well as the independent variables bone augmentation (yes or no), number of implants (1, 2-3 and ≥4), and treatment group (antibiotic prophylaxis or placebo). P-values <0.05 or 95% CIs for ratios not including one were deemed statistically significant. The analyses were carried out using statistical software for data science (STATA).Results Overall, six (2.5%) and seven patients (3.0%) from the amoxicillin and placebo groups had implant failures, respectively. Thus, the intergroup difference was not significant (RR: 0.85; 95% CI: 0.29-2.48, p = 0.75). Absolute risk reduction was 0.46%, with a number needed to treat (NNT) of 219. In other words, one in every 219 patients will benefit from receiving prophylactic antibiotics. In addition, no variable was associated with implant failure. Two (0.8%) and five patients (2.1%) from the amoxicillin and placebo groups, respectively, had postoperative infections at the first follow-up interval. Thus, the intergroup difference was not significant (RR: 0.29; 95% CI: 0.08-2.01, p = 0.25). Five (2.1%) and seven patients (3.0%) from the amoxicillin and placebo groups, respectively, had postoperative infections at the second follow-up interval. Thus, the intergroup difference was not significant (RR: 0.70; 95% CI: 0.23-2.18, p = 0.54). No adverse events were reported.Conclusion Prophylactic antibiotic treatment for dental implant surgery to prevent implant loss may not be appropriate. Each dose must be prescribed based on evidence-based guidelines to avoid overuse and misuse of antibiotics promoting resistant bacteria.

[Clinical aspects and microbiology of peritoneal dyalisis-related peritonitis]. / Manifestaciones clínicas y bacteriológicas de la peritonitis asociada con la diálisis peritoneal.

OBJECTIVE: The aim of this study was to describe the clinical and bacteriological characteristics of patients with peritoneal dyalisis-related peritonitis. METHODS: A cross-sectional, descriptive study conducted at an Instituto Mexicano del Seguro Social hospital, in Zacapetec, Morelos, Mexico. The sample included was non-probabilistic and consecutive. All the patients with current registration, and diagnosed with peritoneal dyalisis-related peritonitis were included in the sample. RESULTS: During the study period there were 30 cases of peritoneal dyalisis-related peritonitis, most commonly associated with continuous ambulatory peritoneal dialysis patients, with a high incidence in intermittent dialysis. The main characteristics of patients with peritonitis were turbid liquid (100 %), abdominal pain (73 %) and fever (43 %). Gram staining revealed that 53 % was gram-positive, and 10 % was gram-negative. Bacterial cultures showed that 53.3 % of the obtained peritoneal cultures were positive. The most frequent bacterial specimen was Staphylococcus aureus. CONCLUSIONS: Rates of infection and percentage of negative cultures were higher than reported previously. The symptoms are in accord with the international literature. Preventive measures must be employed to reduce the incidence of infections related to peritoneal dialysis.

OBJETIVO: describir las características clínicas y bacteriológicas de los pacientes con peritonitis relacionada con diálisis peritoneal. MÉTODOS: se realizó un estudio transversal, descriptivo, que abarcó de diciembre de 2010 a junio de 2011. El muestreo fue no probabilístico, consecutivo. Se incluyeron todos los pacientes con afiliación vigente y el diagnóstico de peritonitis relacionada con diálisis peritoneal, atendidos en un hospital del Instituto Mexicano del Seguro Social en Zacatepec, Morelos, México. RESULTADOS: durante el periodo estudiado se presentaron 30 casos. La modalidad de la diálisis peritoneal más frecuente fue la continua ambulatoria, con alta incidencia para la intermitente. Las principales manifestaciones en los pacientes fueron líquido turbio (100 %), dolor abdominal (73 %) y fiebre (43 %); en 53 % se identificaron bacterias grampositivas y en 10 %, gramnegativas. De los cultivos positivos, 53.3 % se obtuvo del líquido peritoneal. CONCLUSIONES: las tasas de peritonitis y los porcentajes de los cultivos negativos fueron superiores a los recomendados. La sintomatología fue similar a la informada en la literatura internacional. Se requieren medidas preventivas para reducir la incidencia y reincidencia de la peritonitis relacionada con la diálisis peritoneal.

Predictable immediate loading of mandibular implants.

Technological advancements have resulted in modern dental implant protocols that provide the possibility to immediately load implants in fresh extraction sockets. This article briefly addresses various aspects to be considered such as computed tomography (CT), surgical guides, implant considerations for the edentulous patient, and considerations for immediate implant placement and loading. In this clinical case, immediate post-extraction implant placement with immediate loading was performed accurately because of the planning done with the CT scan. The use of a stereolithographic model and a surgical guide prevented technical difficulties and improved the predictability during the prosthetically driven surgery.