The effect of preoperative clindamycin in reducing early oral implant failure: a randomised placebo-controlled clinical trial.

OBJECTIVES: To assess the effect of preoperative oral clindamycin in reducing early implant failure in healthy adults undergoing conventional implant placement. MATERIALS AND METHODS: We conducted a prospective, randomised, double-blind, placebo-controlled clinical trial in accordance with the ethical principles and Consolidated Standards of Reporting Trials statement. We included healthy adults who underwent a single oral implant without previous infection of the surgical bed or the need for bone grafting. They were randomly treated with a single dose of oral clindamycin (600 mg) 1 h before surgery or a placebo. All surgical procedures were performed by one surgeon. A single trained observer evaluated all patients on postoperative days 1, 7, 14, 28, and 56. Early dental implant failure was defined as the loss or removal of an implant for any reason. We recorded the clinical, radiological, and surgical variables, adverse events, and postoperative complications. The study outcomes were statistically analysed to evaluate differences between the groups. Furthermore, we calculated the number required to treat or harm (NNT/NNH). RESULTS: Both the control group and clindamycin group had 31 patients each. Two implant failures occurred in the clindamycin group (NNH = 15, p = 0.246). Three patients had postoperative infections, namely two placebo-treated and one clindamycin-treated, which failed (relative risk: 0.5, CI: 0.05-5.23, absolute risk reduction = 0.03, confidence interval: - 0.07-0.13, NNT = 31, CI: 7.2-∞, and p = 0.5). One clindamycin-treated patient experienced gastrointestinal disturbances and diarrhoea. CONCLUSIONS: Preoperative clindamycin administration during oral implant surgery in healthy adults may not reduce implant failure or post-surgical-complications. CLINICAL RELEVANCE: Oral clindamycin is not efficacy. TRIAL REGISTRATION: The present trial was registered (EudraCT number: 2017-002,168-42). It was approved by the Committee for the Ethics of Research with Medicines of Euskadi (CEIm-E) on 31 October 2018 (internal code number: 201862) and the Spanish Agency of Medicines and Medical Devices (AEMPS) on 18 December 2018.

Antimicrobial Mechanisms of Leucocyte- and Platelet Rich Fibrin Exudate Against Planktonic Porphyromonas gingivalis and Within Multi-Species Biofilm: A Pilot Study.

Leucocyte- and platelet rich fibrin (L-PRF) is an autologous biomaterial used in regenerative procedures. It has an antimicrobial activity against P. gingivalis although the mechanism is not fully understood. It was hypothesized that L-PRF exudate releases hydrogen peroxide and antimicrobial peptides that inhibit P. gingivalis growth. Agar plate and planktonic culture experiments showed that the antimicrobial effect of L-PRF exudate against P. gingivalis was supressed by peroxidase or pepsin exposure. In developing multi-species biofilms, the antimicrobial effect of L-PRF exudate was blocked only by peroxidase, increasing P. gingivalis growth with 1.3 log genome equivalents. However, no effect was shown on other bacteria. Pre-formed multi-species biofilm trials showed no antimicrobial effect of L-PRF exudate against P. gingivalis or other species. Our findings showed that L-PRF exudate may release peroxide and peptides, which may be responsible for its antimicrobial effect against P. gingivalis. In addition, L-PRF exudate had an antimicrobial effect against P. gingivalis in an in vitro developing multi-species biofilm.

Antibiotic dosage prescribed in oral implant surgery: A meta-analysis of cross-sectional surveys.

This study aimed to assess the dosage and types of antibiotics prescribed in oral implant surgery, compare them among the different subpopulations (country and prescription regimens) and against the evidence-based recommended dosage: a 2-gram single preoperative dose of amoxicillin. A meta-analysis of cross-sectional surveys was conducted, which reports the overall dosage (and type) of antibiotics prescribed in combination with implant placement. PubMed, Cochrane, Science, Direct, and EMBASE via OVID were searched until April 2019. Three reviewers independently undertook data extraction and risk of bias assessment. The outcome variable was set on the average of prophylactic antibiotics prescribed per oral implant surgery. Overall, 726 participants from five cross-sectional surveys, representing five different countries were finally included. Amoxicillin was the most prescribed antibiotic. On average, 10,724 mg of antibiotics were prescribed per implant surgery. This average was significantly (p<0.001) higher than 2,000 mg. Overall, amoxicillin doses were significantly higher than 2,000 mg (9,700 mg, p<0.001). All prescribed amoxicillin regimens independently contained more than 2,000 mg, including those comprising only preoperative amoxicillin (2,175 mg, p = 0.006). Exclusive preoperative antibiotic regimens were the only subgroup with prescription dosages below this threshold (p = 0.091). Significant variations in antibiotic prescriptions were found among different countries and antibiotic regimens (p<0.001). In conclusion, the average dose of antibiotics prescribed per oral implant surgery was larger than the evidence-based recommended dose in healthy patients and straightforward conditions. In addition, variations in the average antibiotic dosages were found among different countries and prescription regimens.

Antibiotic prophylaxis prescribing habits in oral implant surgery in the Netherlands: a cross-sectional survey.

BACKGROUND: There seems to be no consensus on the prescription of prophylactic antibiotics in oral implant surgery. The Dutch Association of Oral Implantology (NVOI) guidelines do not include a clear policy on prophylactic antibiotic prescriptions for oral implant surgery among healthy patients. The purpose of the study was to determine whether antibiotic prophylaxis is commonly prescribed in the Netherlands by general dentists, maxillofacial surgeons and oral implantologists in conjunction with oral implant surgery among healthy patients and to assess the type and amount of prophylactic antibiotic prescribed. METHODS: This observational cross-sectional study is based on a web survey. A questionnaire developed in the United States of America was translated and slightly adjusted for use in the Netherlands. It contained predominantly close-ended questions relating to demographics, qualifications, antibiotic type, prescription duration and dosage. An email including an introduction to the study and an individual link to the questionnaire was sent in February 2018 to a sample of 600 general dental practitioners and all 302 specialized dentists (oral implantologists, periodontists and maxillofacial surgeons) recognized by the NVOI. Overall, 902 questionnaires were anonymously sent. Finally, 874 potential participants were reached. Collected data were analyzed through descriptive statistics. RESULTS: In total, 218 (24.9%) participants responded to the questionnaire, including 45 females (20.8%) and 171 males (79.2%). Overall, 151 (69.9%) regularly placed oral implants. Of them, 79 (52.7%) prescribe antibiotics only in specific situations, 66 (43.7%) regularly, and 5 (3.3%) did not prescribe antibiotics at all. Overall, 83 participants who prescribe antibiotics did so both pre- and postoperatively (57.2%), 47 only preoperatively (32.4%) and 12 exclusively postoperatively (8.3%). A single dose of 2000 mg of amoxicillin orally one hour prior to surgery was the most prescribed preoperative regimen. The most frequently prescribed postoperative regimen was 500 mg of amoxicillin three times daily for five days after surgery. On average, participants prescribe a total of 7018 mg of antibiotics before, during or after oral implant surgery. CONCLUSIONS: Antibiotic prophylaxis in conjunction with oral implant surgery is prescribed in the Netherlands on a large scale, and recommendations based on the last published evidence are frequently not followed.

Antibiotic prophylaxis habits in oral implant surgery among dentists in Italy: a cross-sectional survey.

BACKGROUND: The prescription of prophylactic antibiotics in conjunction with oral implant surgery remains inconsistent among different populations of dentists. The main objective of this study was to assess the current antibiotic prescribing habits of dentist in conjunction with oral implant surgery in Italy. The secondary objective was to assess the nature and amount (mg) of antibiotics prescriptions in order to evaluate whether any consensus has been reached and if the current recommendations are complied. METHODS: Observational cross-sectional study based on a web-survey reported according to the STROBE guidelines. A questionnaire was sent via email to each registered member of the Italian Academy of Osseointegration (n = 400). The email included a link to the anonym web questionnaire developed on www.encuestafacil.com. It contained close-ended and some open-ended questions concerning demographics, antibiotic type, prescription duration and dosage. Collected data were analyzed using STATA® 14 software. RESULTS: 160 participants responded the survey (response rate = 40%). Approximately 84% routinely prescribed prophylactic antibiotics in conjunction with oral implant surgery, 15.6% prescribed antibiotics in certain situations and only 1 did not prescribe antibiotics at all. Overall, 116 respondents prescribed both pre- and postoperative antibiotics, 29 prescribed antibiotics only preoperatively and 14 prescribed antibiotics exclusively after surgery. Italian dentists prescribed an average amount of 10,331 mg antibiotics before, during or after oral implant surgery. Approximately, only 17% (n = 27) of the participants who prescribed antibiotics before oral implant surgery complied with the recommendations proposed by the latest publications (no more than 3 g of preoperative amoxicillin before oral implant surgery). CONCLUSIONS: Dentists in Italy on a large scale prescribe antibiotic prophylaxis in conjunction with oral implant surgery among healthy patients. A high range of prophylactic regimens is prescribed and they are not adhering to the new science-based specifications. Guidelines focused on the indications for prophylactic antibiotics among healthy patients are required to prevent bacterial resistance, side effects and costs caused by overtreatment and the irrational use of antibiotics.

Antibiotic prophylaxis habits in dental implant surgery among dentists in Spain. A cross-sectional survey

BACKGROUND: The use of antibiotics to prevent dental implant failures and postoperative infections remains a controversial issue. The objectives of this study were to assess the current antibiotic prescribing patterns and antibiotic prescribing frequency of dentists in Biscay (Spain) in conjunction with routine dental implant surgery among healthy patients and to determine whether any consensus has been reached by such practitioners and last published evidence was being followed. MATERIAL AND METHODS: Observational cross-sectional study: electronic survey. This study was reported according to the STROBE guidelines. This anonymous questionnaire contained open-ended and close-ended questions. An email was sent 26 October 2017 to all the registered members of the Biscay dentists' College (n=989). The collected data were analyzed using STATA(R) 14 software, and 95% confidence intervals (CI) were used to assess the frequency of prescription for each antibiotic regimen. RESULTS: The survey was responded to by a total of 233 participants (response rate=23.56%). Overall, 210 participants finished the survey completely, and 23 surveys were answered partially. The questionnaire was responded to by 122 females (58.1%) and 88 males (41.9%). Of the participants, 88% (n=207) always routinely prescribed prophylactic antibiotics in conjunction with dental implant surgery (95% CI: 84.79-92.88%). Approximately 9% (n=22) prescribed antibiotics sometimes (95% CI: 5.68-13.19%), and only 4 dentists (1.72%) never prescribed antibiotics (95% CI: 0.04-3.38%). Overall, 179 of 233 respondents prescribed both pre- and postoperative antibiotics (78.85%, 95% CI: 72.96-83.97%), 13 prescribed antibiotics only preoperatively (5.73%, 95% CI: 3.08-9.59%), and 35 prescribed antibiotics exclusively after routine dental implant surgery (15.42%, 95% CI: 10.98-20.78%). CONCLUSIONS: Most of the dentists working in Biscay routinely prescribe prophylactic antibiotics in conjunction with dental implant surgery among healthy patients. A large range of prophylactic regimens are prescribed and the most recently published evidence is not being followed

Which antibiotic regimen prevents implant failure or infection after dental implant surgery? A systematic review and meta-analysis.

OBJECTIVE: To assess which antibiotic regimen prevents dental implant failures or postoperative infections following dental implant placement. MATERIALS AND METHODS: Systematic review and meta-analysis. DATA SOURCES: Pubmed, Cochrane, Science Direct, and EMBASE via OVID were searched up to August 2017. Only randomized controlled clinical trials (RCT) using antibiotics were included. Outcome measures were set on dental implant failures or postoperative infection incidence after dental implant surgery. Three reviewers independently undertook risk of bias assessment and data extraction. Stratified meta-analyses of binary data using fixed-effects models were performed using Stata 14.0. The risk ratio (RR) and 95% confidence interval (CI) were estimated. RESULTS: Nine articles were included corresponding to 15 RCTs. All RCTs tested only oral amoxicillin. Implant-failure analysis: overall RR = 0.53 (P = .005, 95% CI: 0.34-0.82) and overall NNT = 55 (95% CI, 33-167). Single-dose oral amoxicillin preoperatively (SDOAP) is beneficial (RR = 0.50, CI: 0.29-0.86. P = .012), when compared to postoperative oral amoxicillin (POA): RR = 0.60, CI: 0.28-1.30. P = .197. Postoperative-infection analysis: overall RR = 0.76 (P = 0.250, 95% CI: 0.47-1.22). Neither SDOAP (RR = 0.82, CI = 0.46-1.45, P = .488) nor POA (RR = 0.64, CI = 0.27-1.51, P = .309) are beneficial. I2 = 0.0%, chi-squared tests P ≈ 1. CONCLUSION: Only SDOAP is effective and efficacious at preventing implant failures, but it was not significant for postoperative infections following dental implant surgeries.

Does Chlorhexidine Prevent Alveolar Osteitis After Third Molar Extractions? Systematic Review and Meta-Analysis.

PURPOSE: The prevention of alveolar osteitis (AO) in dental extractions remains a controversial issue. Chlorhexidine is one of the most widely studied antiseptics for the prevention of AO. The purpose of this systematic review and meta-analysis was to assess the efficacy and effectiveness of chlorhexidine in the prevention of AO after third molar extractions. MATERIALS AND METHODS: The authors searched databases and the references of each article retrieved up to December 2015. Clinical randomized controlled trials (RCTs) using only chlorhexidine were included. The predictor variable was whether chlorhexidine was used in any formulation, concentration, or regimen. The outcome measurement was the incidence of postoperative AO. The authors also recorded variables describing the characteristics of the included studies. Statistical analysis was performed using STATA 12.0. Meta-analysis of binary data was conducted using a fixed-effects model. Risk ratios and 95% confidence intervals (CIs) were estimated. Forest, l'Abbé, and funnel plots were constructed. RESULTS: Twenty-three studies published from 1979 to 2015, corresponding to 18 trials (16 parallel-group and 2 split-mouth RCTs), that reported on 2,824 third molar extractions (1,458 in experimental group and 1,366 in control group) were included. The overall relative risk (RR) was 0.53 (95% CI, 0.45-0.62; P < .0001). There was no evidence of heterogeneity (I2 = 9.3%; P = .336 by χ2 test). The number needed to treat was 8 (95% CI, 7-11). There were no relevant differences between chlorhexidine rinse (RR = 0.58; 95% CI, 0.47-0.71) and gel (RR = 0.47; 95% CI, 0.37-0.60). Chlorhexidine did not cause a larger proportion of adverse reactions than placebo. CONCLUSION: The use of chlorhexidine, in any formulation, concentration, or regimen, is efficacious and effective in preventing AO in patients who have undergone third molar extraction. Chlorhexidine gel was found to be moderately more efficacious than the rinse formulation.