Is Perioperative Antibiotic Necessary in Straightforward Implant Placement Procedures?

The purpose of this nonrandom retrospective cohort study was to evaluate the impact of perioperative antibiotic on early outcomes, including postoperative pain, swelling, bleeding, and cyanosis, in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 men, 30 women) who had completed dental implant placement were included in the study. Patients who used perioperative antibiotics comprised the experimental group, and those who did not comprised the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 hour before surgery and 1 g amoxicillin + clavulanic acid twice a day for 5 days after surgery. The control group received no perioperative antibiotic therapy. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration, and implant failure were analyzed on postoperative days 2, 7, and 14 and at week 12. No statistically significant difference was detected between the 2 groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 (P > .05), while the severity of pain and swelling were greater on day 2 than on days 7 and 14 and week 12 in both groups (P = .001 and P < .05, respectively). Similarly, no significant difference was found between the 2 groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the 2 groups with regard to the percentage of flap dehiscence assessed at other time points. Within the limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized controlled clinical studies with more patients and implants are needed to substantiate our findings.

Cleaning Efficacy of Poly-ether-ether-ketone Tips in Eliminating Cement Remnants Around Implants With Different Abutment Heights.

The excess cement not removed after the cementation of fixed implant-supported restorations may cause loss of peri-implant attachment or adjacent bone. The aims of this study were to evaluate the amount of residual cement at different abutment-crown connection levels and to test the cleaning efficacy of poly-ether-ether-ketone (PEEK) ultrasonic tips after cementation. One implant was placed in an anterior central tooth position 5 mm below the gingival margin in an acrylic model, and 32 stone models were obtained with implant analogs. Abutment heights of 1-2 and 2.5-4 mm were used on the vestibular and lingual sides, respectively. Crowns were cemented and cleaned, and half of the samples were cleaned again using PEEK tips. The abutment-crown suprastructure was then disconnected, and cleaning efficacy was evaluated. Varying amounts of excess cement were found on all specimens except for the PEEK group with abutment-crown connections 1 mm below the gingival margin. An increase of undetected cement remnants was observed when the restoration margins were located deeper subgingivally. Various amounts of excess cement associated with margin location were detected on the abutment-restoration complex despite meticulous cleaning efforts. Ultrasonic PEEK tips were effective at cleaning the cement remnants around implants to a certain depth.

Preference of Suture Specifications in a Selected Periodontal and Implant Surgeries in Turkey.

OBJECTIVE: Various suture materials and needles are now available for use in the dental surgery. The aim of this study was to determine the preference of suture materials among Turkish dentists by a dental survey. MATERIALS AND METHODS: The survey was prepared and sent electronically to Turkish dentists through e-mail and/or Facebook. Dentists were asked to report their graduation year from dental school and their specialty if they have one. In addition, the type periodontal/implant operations and the frequency of those operations applied by them were questioned. The participants were to indicate their suture preferences for these procedures in a multiple-choice questionnaire. RESULTS: Fifty-seven regular dentists, 49 periodontists, 22 oral surgeons, and 8 other specialists completed a self-administered survey. The majority of clinicians worked in private practice (77.9%). Nonabsorbable sutures were the most preferred for all procedures except periodontal plastic surgery. In regenerative surgeries, monofilament, 5-0 diameter suture material on a reverse cutting, 3/8 circle needle was preferred. In addition, for mucogingival surgery, 5-0 diameter suture material on a reverse cutting and 3/8 circle needle was favored. For dental implants, 4-0 diameter suture material on a reverse cutting and 3/8 circle needle was preferred. Monofilament and braided sutures were selected almost equally for implant operations. CONCLUSIONS: In periodontal and implant surgeries, dentists highly preferred the use of nonabsorbable sutures. In addition, the shape and diameter of needle had an important role in the selection of suture material. The present study's results may serve as a guide for the future studies.

Oral hygiene habits and oral health status of female adolescents under state protection: a pilot study.

PURPOSE: The aim of this study is to evaluate oral health status and oral hygiene practices of female adolescents under state protection. SUBJECTS AND METHODS: Fifty-five female participants between the age of 12 and 18 who are under the care of The Child Protection Institution were included in this study. Self-administered questionnaires were used to obtain information regarding knowledge of oral health and habits. Dental caries status was scored according to the criteria of the World Health Organization (WHO), using the indices of Decayed (D), Missing (M), Filled (F), Surfaces (S) (DMFS). In addition, Gingival Index (GI) and Plaque Index (PI) were recorded during periodontal assessment. Data was statistically analyzed by using Oneway analysis of variance, Tukey's HSD and Student's t tests. RESULTS: Fourteen children had dental fear and 52.7% of them were not satisfied with their esthetic appearance. Although 78.2% of the children knew that brushing prevents dental caries, only 18 of them were brushing regularly twice per day. Mean DMFS, GI and PI scores were 13.18±5.68, 1.35±0.37 and 1.33±0.45, respectively. Only 20% of the children were using dental floss. There was statistically no significant difference between the DMFS scores of the children in terms of flossing. However, the difference between the mean GI and PI of the same group was found to be statistically significant (p<0.05). CONCLUSION: Children under state protection were found to have a reasonable knowledge of the causes of dental caries and gum bleeding. Therefore, adequate management of this positive attitude can significantly improve the oral health of this population.

Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications?

PURPOSE: There are concerns regarding appropriate use of antibiotics in dentistry practice. Data on dental antibiotic prescribing patterns by dentists is relatively limited. This nationwide study aimed to examine dentists' antibiotic prescriptions in a diagnosis-based manner in Turkey. METHODS: This retrospective study on utilization of systemic antibiotics for dental problems was based on the national health data of the dentists obtained from Prescription Information System between January 2013 and August 2015. Only those prescriptions containing single diagnosis and at least one systemic antibiotic were included in the study. Antibiotic prescribing was compared by diagnoses and expertise of dentists. RESULTS: A total of 9,293,410 antibiotics were detected in 9,214,956 prescriptions that contained "single diagnosis and at least one antibiotic." The number of antibiotics per prescription was 1.01. "Periapical abscess without sinus" (28.1%), "dental examination" (20.7%), and "dental caries" (16.2%) were the three most common indications in which antibiotics were prescribed by dentists. While only 3.4% of antibiotics were prescribed upon the single and appropriate "cellulitis and abscess of mouth" diagnosis, the remaining 96.6% was prescribed for irrational/uncertain indications. Consistent in all diagnoses, "amoxicillin + enzyme inhibitor" (58.6%) was the mainly prescribed antibiotic. Analysis of the most preferred "amoxicillin + enzyme inhibitor" prescriptions by expertise of dentists showed significantly much higher prescription rates among Group A specialists and Group B specialists (67.0 and 67.8%, respectively) than those in unidentified dental practitioners (58.2%, p < 0.0001). CONCLUSIONS: This study showed that dentists prescribed antibiotics in an arbitrary and mostly unnecessary manner. In general, their antibiotic choices for examined diagnoses could be regarded as irrational. These results indicate the urgent need for improvement of rational antibiotic prescribing habits of dentists.

Clinical evaluation of free gingival graft shrinkage in horizontal and vertical dimensions.

PURPOSE: To assess the shrinkage of Free Gingival Graft (FGG) in horizontal and vertical dimensions and calculate the changes in the surface area of the transplanted tissue in a 3 months period. MATERIALS AND METHODS: total of 30 FGG were placed aiming to increase attached gingiva around recession sites. Vertical recessions, horizontal recessions, surface area, plaque index, gingival index, periodontal probing depth and clinical attachment level were assesed at baseline, 1 and 3 months postoperatively. RESULTS: Graft shrinkage between baseline and 1 month was more evident than 1 to 3 months in either dimensions. Both horizontal and vertical dimensions were significantly decreased (p<0.001) at 1 and 3 months post operatively. There was no significant change in PI and GI scores postoperatively compared to baseline (p>0.05). CONCLUSION: The shrinkage of vertical and horizontal dimensions of the grafts were almost equal unlike the literature. In addition, the different dimensional changes observed in individual level deserve further research.

Full-mouth rehabilitation of a patient with ectodermal dysplasia with dental implants.

Oral findings in patients with ectodermal dysplasia (ED) include complete or partial hypodontia, anodontia, loss of vertical dimension of occlusion, protuberant lips, malformed and widely spaced conical-shaped teeth, and underdeveloped alveolar ridges. These patients present a substantial challenge in dental treatment. This case report presents oral rehabilitation of a 22-year-old male patient diagnosed with ED using an implant tooth-supported telescopic partial denture at the mandible and a tooth-supported telescopic partial denture at the maxilla. Implants in the mandible were placed at the sites of the right and left lateral incisor teeth. Following implant placement, the remaining buccal bone dehiscence was filled with deproteinized bovine bone graft and covered with resorbable membrane. To manage the vestibular insufficiency and to increase the keratinized mucosa in maxilla, bilateral acellular dermal matrix allograft was used on the right and left buccal aspects. The treatment described here improved the patient's functional and esthetic status while significantly restoring his oral health and self-esteem.

Immune thrombocytopenic purpura presenting as unprovoked gingival hemorrhage: a case report.

Immune thrombocytopenic purpura is an autoimmune disease characterized by auto-antibody induced platelet destruction and reduced platelet production, leading to low blood platelet count. In this case report, the clinical diagnose of a patient with immune thrombocytopenic purpura and spontaneous gingival hemorrhage by a dentist is presented. The patient did not have any systemic disease that would cause any spontaneous hemorrhage. The patient was referred to a hematologist urgently and her thrombocyte number was found to be 2000/µL. Other test results were in normal range and immune thrombocytopenic purpura diagnose was verified. Then hematological treatment was performed and patient's health improved without further problems. Hematologic diseases like immune thrombocytopenic purpura, in some cases may appear firstly in the oral cavity and dentists must be conscious of unexplained gingival hemorrhage. In addition, the dental treatment of immune thrombocytopenic purpura patients must be planned with a hematologist.

Comparison of manual toothbrushes with different bristle designs in terms of cleaning efficacy and potential role on gingival recession.

OBJECTIVE: The aim was to compare the efficacy of plaque control and potential effects on gingival recession of the toothbrushes with angled and straight bristles. MATERIALS AND METHODS: A total of 40 healthy dental students (25 females and 15 males; age range: 23-25 years) participated and two study groups were constituted. Participants were randomly distributed into two groups to use either angled or standard design manual tooth brushes with soft bristles. Oral hygiene indicators and soft tissue levels were monitored for 6 months. Plaque index, gingival index (GI), probing depth, clinical attachment level, and bleeding on probing were measured at six sites. Vertical recession (VR) and horizontal recession (HR) were also recorded. All measurements were repeated at 3 and 6 months. RESULTS: Plaque scores were reduced significantly at 6 months compared to baseline in both groups (P < 0.05 and P < 0.005 in criss-cross and standard design brushes, respectively). Mean GI scores of the criss-cross design were reduced significantly at 6 months (P < 0.05). Inter-group comparisons revealed that gingival recession (GR) values were not statistically significant (P > 0.05) at baseline, 3 and 6 months suggesting no pronounced impact of bristle design in terms of GR (VR = 0.596, HR = 0.572; VR = 0.884, HR = 0.572; VR = 0.884, HR = 0.572 in the groups). CONCLUSIONS: Bristle design has little impact on plaque removal capacity of a toothbrush. Both designs are safe enough to prevent GR as long as soft bristle material is used.