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.

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

Does chlorhexidine reduce bacteremia following tooth extraction? A systematic review and meta-analysis.

BACKGROUND AND AIMS: Scientific evidence is not clear regarding the use of antimicrobial mouth rinse before dental extraction to reduce bacteremia. We tested the null hypothesis that there would be no difference in the incidence of bacteremia following dental extractions in patients treated with or without chlorhexidine. MATERIAL AND METHODS: We conducted a meta-analysis following the recommendations proposed by PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The data sources Pubmed, Cochrane, Web of Science, Science Direct, Scopus, and Ovid MD were searched until April 30, 2017. (chlorhexidine) AND (bacteremia OR bacteraemia) AND (extraction OR removal) were used as key words in a free-text search. Published meeting abstracts were searched. The references of each article were reviewed. We only included randomized controlled clinical trials. There were no restrictions regarding language or date of publication. The outcome measure was the incidence of the bacteremia measured within the first ten minutes post-extraction. Two reviewers independently undertook the risk of bias assessment and data extraction. A fixed-effects inverse variance weighted meta-analysis was conducted. RESULTS: Out of 18 studies, eight eligible trials with 523 participants were selected, 267 in the experimental group and 256 in the control group: risk ratio = 0.882 (95% confidence interval 0.799 to 0.975; p = 0.014), heterogeneity I2 = 13.07%, and p = 0.33. The number needed to treat was 16 (95% CI 7-Infinity). CONCLUSIONS: Approximately 12% of bacteremia cases can be prevented if a population is exposed to chlorhexidine. CRD42016046586.

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.

Immediate temporary restoration of single-tooth implants: Prospective clinical study

Purpose: The goal of this study is to ass ess the survival, marginal bone loss and complications around sing le-toothimplants on which immediate provisionalization was carried out.Patients and Methods: 78 implants were placed in 57 patients:56 after extraction and 22 in healed sockets. Immediatelyafter surgery provisional crowns were delivered without contacts in both centric and excursive jaw movements.The final crowns were inserted between 3 to 6 months later. During the study there were 3 x-rays takenper patient. The marginal bone loss was measured and complications were recorded. The statistical analys is of thedata was carried out with the STATA 10® software.Results: The mean duration of the study was 92 weeks. Survival rate was 98.7% (1 failure out of 78 implants). Themean mesial bone loss was 0.2±0.4 mm and the mean distal bone loss was 0.2±0.4 mm. No statistically significantdiff erences were found between immediate or delayed implants. 67 implants sh owed a bone loss less than 1 mm,and 36 did not sh ow any bone loss at all.The main complications were the uncementing of the crowns (11 crowns ), the presence of cement remnants (10crowns ) and the development of apical lesions around implants (6 implants).Conclusion: With the limitations of this study, it can be concluded by saying that immediate restoration withsing le-tooth implants and provisional crowns may be cons idered as a predictable technique (AU)

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Immediate temporary restoration of single-tooth implants: Prospective clinical study.

PURPOSE: The goal of this study is to assess the survival, marginal bone loss and complications around single-tooth implants on which immediate provisionalization was carried out. PATIENTS AND METHODS: 78 implants were placed in 57 patients: 56 after extraction and 22 in healed sockets. Immediately after surgery provisional crows were delivered without contacts in both centric and excursive jaw movements. The final crowns were inserted between 3 to 6 months later. During the study there were 3 x-rays taken per patient. The marginal bone loss was measured and complications were recorded. The statistical analysis of the data was carried out with the STATA 10® software. RESULTS: The mean duration of the study was 92 weeks. Survival rate was 98.7% (1 failure out of 78 implants). The mean mesial bone loss was 0.2 ± 0.4 mm and the mean distal bone loss was 0.2 ± 0.4 mm. No statistically significant differences were found between immediate or delayed implants. 67 implants showed a bone loss less than 1 mm, and 36 did not show any bone loss at all. The main complications were the uncementing of the crowns (11 crowns), the presence of cement remnants (10 crowns) and the development of apical lesions around implants (6 implants). CONCLUSION: With the limitations of this study, it can be concluded by saying that immediate restoration with single-tooth implants and provisional crowns may be considered as a predictable technique.

[Heavy metals (Pb, Cd, Cr and Hg) in the general adult population near an urban waste treatment plant in Biscay, Spain, in 2006]. / Metales pesados (Pb, Cd, Cr y Hg) en población general adulta próxima a una planta de tratamiento de residuos urbanos de Bizkaia.

BACKGROUND: The possible emissions from a municipal urban solid waste treatment plant (MUSWTP) include heavy metals. The purpose of this study is to ascertain the levels of heavy metals in the blood and urine of the general population of Biscay. METHODS: The level of Pb was measured in 95 blood samples (BPb) and Cd, Cr and Hg in 93 urine samples (UCd, UCr, UHg) taken from adults in the general population of Biscay, Basque Country, in 2006. The samples were obtained in two areas with high traffic density in the metropolitan area of Bilbao close to an MUSWTP which had just commenced operation, a third area in downtown Bilbao with heavy traffic and at a distance from the area of influence of possible emissions from the MUSWTP, and a fourth area at a distance from the plant and with low traffic density. The objective was to select a minimum of 20 participants from each area, with an equal number of male and female subjects, and with half the subjects aged between 20 and 44 years and the other half between 45 and 69. A chi-squared test was used to study the association between categorical variables, Students t-test was used as a comparison of means test, and ANOVA was used for variables with two or more categories. A multiple linear regression model was used to adjust for confounding factors. RESULTS: The mean concentrations were: BPb: 2.68 microg/100ml; UCd: 0.54 microg/g creatinine; UCr: 0.51 microg/g creatinine; UHg: 0.65 microg/g creatinine. CONCLUSION: No significant differences were observed between the areas. The single-factor and multifactor analyses showed that the BPb levels increased with age and were associated with the consumption of local horticultural products and with employment in the metallurgy sector. The UCd levels also increased with age, and higher levels were observed in the upper social classes as well as in women and smokers. The UCr levels were higher in areas at a distance from the MUSWTP and in the upper classes, and UHg levels were higher in women than in men.

Metales pesados (Pb, Cd, Cr y Hg) en población general adulta próxima a una planta de tratamiento de residuos urbanos de Bizkaia / Heavy metals (Pb, Cd, Cr and Hg) in the general adult population near an urban waste treatment plant in Biscay, Spain, in 2006

Fundamento: Entre las posibles emisiones de una planta de valorización energética de residuos sólidos urbanos (PVERSU) se encuentran los metales pesados. el objetivo del estudio es conocer los niveles en sangre y orina de metales pesados en población general de Bizkaia. Métodos: En 2006 se midió la exposición a Pb en 95 muestras de sangre y Cd, Cr y Hg en 93 muestras de orina de adultos de la población general de Bizkaia, País Vasco, obtenidas de dos áreas con alta densidad de tráfico del área metropolitana de Bilbao en la cercanía de una PVERSU que iniciaba su actividad, una tercera correspondiente a una zona urbana de Bilbao con tráfico denso y alejada del área de influencia de las posibles emisiones de la PVERSU y la cuarta alejada de la planta y con baja densidad de tráfico. De cada área se estableció como objetivo elegir a un mínimo 20 participantes, la mitad de cada sexo y, a su vez, la mitad de 20 a 44 años y la mitad de 45 a 69. Se utilizó la prueba de la c2 para estudiar la asociación entre variables categóricas. Como prueba de comparación de medias se utilizó la t de Student y la ANOVA para variables con dos o más categorías, respectivamente. Para ajustar factores de confusión se utilizó un modelo de regresión lineal múltiple. Resultados: Las concentraciones medias fueron PbS: 2,68 µg/100ml, CdU 0,54 µg/g creatinina, CrU: 0,51 µg/g creatinina, y HgU: 0,65 µg/g creatinina. Conclusión: No se observaron diferencias entre las zonas. El análisis unifactorial y multifactorial mostró que los niveles de PbS se incrementaban con la edad y estaban asociados con el consumo de productos locales de huerta y con el trabajo en la metalurgia. La edad eleva los niveles de CdU y se observa en clases sociales altas niveles más elevados, así como en mujeres y en personas fumadoras. Los niveles de CrU eran más elevados en zonas alejadas a la PVERSU y en las clases altas. Los niveles de HgU fueron más elevados en mujeres que en hombres (AU)

Background: The possible emissions from a municipal urban solid waste treatment plant (MUSWTP) include heavy metals. The purpose of this study is to ascertain the levels of heavy metals in the blood and urine of the general population of Biscay. Methods: The level of Pb was measured in 95 blood samples (BPb) and Cd, Cr and Hg in 93 urine samples (UCd, UCr, UHg) taken from adults in the general population of Biscay, Basque Country, in 2006. The samples were obtained in two areas with high traffic density in the metropolitan area of Bilbao close to an MUSWTP which had just commenced operation, a third area in downtown Bilbao with heavy traffic and at a distance from the area of influence of possible emissions from the MUSWTP, and a fourth area at a distance from the plant and with low traffic density. The objective was to select a minimum of 20 participants from each area, with an equal number of male and female subjects, and with half the subjects aged between 20 and 44 years and the other half between 45 and 69. A chi-squared test was used to study the association between categorical variables, Student’s t-test was used as a comparison of means test, and ANOVA was used for variables with two or more categories. A multiple linear regression model was used to adjust for confounding factors. Results: The mean concentrations were: BPb: 2.68 µg/100ml; UCd: 0.54 µg/g creatinine; UCr: 0.51 µg/g creatinine; UHg: 0.65 µg/g creatinine. Conclusion: No significant differences were observed between the areas. The single-factor and multifactor analyses showed that the BPb levels increased with age and were associated with the consumption of local horticultural products and with employment in the metallurgy sector. The UCd levels also increased with age, and higher levels were observed in the upper social classes as well as in women and smokers. The UCr levels were higher in areas at a distance from the MUSWTP and in the upper classes, and UHg levels were higher in women than in men (AU)