Survival rates and bone loss after immediate loading of implants in fresh extraction sockets (single gaps). A clinical prospective study with 4 year follow-up.

BACKGROUND: The aim of this prospective study was to report the outcome of treatment with implants inserted after tooth extraction and immediately loaded. MATERIAL AND METHODS: Fifty-six patients with single tooth loss were treated with 116 IPX Galimplant® implants with internal connections and a sandblasted, acid-etched surface. All implants were placed after tooth extraction using a flapless approach without bone regeneration, and they were then immediately loaded with cemented acrylic prostheses. After a period of three months, definitive cemented ceramic prostheses were placed. Patients were examined throughout a total of 4 years of follow-up. Marginal bone loss and survival rates were evaluated using digital periapical radiographs, taking into account clinical variables such as age, gender, smoking, history of periodontitis, etiology of extraction, placement site, diameter, and implant length. The Mann-Whitney U and Kruskal-Wallis non-parametric tests were used to compare differences between subgroups created based on the different clinical variables identified. RESULTS: Clinical results indicate an implant survival and success rate of 97.4%. Three implants were lost. Of the 116 immediate acrylic single crowns initially placed, 113 were replaced with definitive ceramic crowns after 3 months. A total of 77.8% of implants were inserted in the maxilla, while 22.2% were inserted in the mandible. No further complications were reported after the follow-up period (4 years). The mean marginal bone loss was 0.67 mm ± 0.40 mm. No differences were found among the subgroups of study patients. CONCLUSIONS: This study indicates that dental implants that are inserted after tooth extraction and immediately loaded may constitute a successful and predictable alternative implant treatment.

Dental caries status of patients with schizophrenia in Seville, Spain: a case-control study.

BACKGROUND: The aim of this study was to assess the dental status (DMFT) in patients with schizophrenia compared with a control group. MATERIAL: In this case-control study, 50 patients with schizophrenia attended in the Psychiatric Unit at the Virgen Macarena University Hospital of Seville were compared with 50 people (without systemic diseases and not taking psychotropic drugs) in a control group attended in the School of Dentistry of Seville. Decayed, missing and filled teeth (DMFT) were assessed according to the World Health Organization WHO criteria. RESULTS: Patients with schizophrenia showed a decayed teeth (DT) score of 7.26 ± 5.69 compared with 6.50 ± 4.37 for patients the control group. These differences were significant and suggest that dental caries are most prevalent in patients with schizophrenia. People who smoked showed significantly higher DT scores in both groups. Among patients with schizophrenia, smokers scored 9.34 ± 5.42 compared with 4.38 ± 4.82 for non-smokers. Among the healthy controls, smokers scored 6.88 ± 4.85 compared with 6.12 ± 3.85 for non-smokers (p < 0.05). Patients with schizophrenia showed a missing teeth (MT) score of 9.10 ± 8.56 compared with 5.38 ± 5.14 in control patients. MT scores increased significantly with age and with smoking in both groups of patients (p < 0.05). Patients with schizophrenia showed a filled teeth (FT) score of 1.38 ± 2.70 compared with 2.34 ± 3.48 in control patients. FT differences in gender and smoking habits between patients with schizophrenia and healthy control subjects were statistically significant (p < 0.05). This data, along with the DT scores, suggests that patients with schizophrenia have extensive untreated dental disease. CONCLUSIONS: Patients with schizophrenia constitute a high risk population for dental health. This group showed a greater prevalence of decayed and missing teeth and more extensive treatment needs.

Relevant aspects in the surface properties in titanium dental implants for the cellular viability.

Roughness and topographical features are the most relevant of the surface properties for a dental implant for its osseointegration. For that reason, we studied the four surfaces more used in titanium dental implants: machined, sandblasted, acid etching and sandblasted plus acid etching. The roughness and wettability (contact angle and surface free energy) was studied by means 3D-interferometric microscope and sessile drop method. Normal human gingival fibroblasts (HGF) were obtained from small oral mucosa biopsies and were used for cell cultures. To analyze cell integrity, we first quantified the total amount of DNA and LDH released from dead cells to the culture medium. Then, LIVE/DEAD assay was used as a combined method assessing cell integrity and metabolism. All experiments were carried out on each cell type cultured on each Ti material for 24h, 48h and 72h. To evaluate the in vivo cell adhesion capability of each Ti surface, the four types of discs were grafted subcutaneously in 5 Wistar rats. Sandblasted surfaces were significantly rougher than acid etching and machined. Wettability and surface free energy decrease when the roughness increases in sand blasted samples. This fact favors the protein adsorption. The DNA released by cells cultured on the four Ti surfaces did not differ from that of positive control cells (p>0.05). The number of cells per area was significantly lower (p<0.05) in the sand-blasted surface than in the machined and surface for both cell types (7±2 cells for HGF and 10±5 cells for SAOS-2). The surface of the machined-type discs grafted in vivo had a very small area occupied by cells and/or connective tissue (3.5%), whereas 36.6% of the sandblasted plus acid etching surface, 75.9% of sandblasted discs and 59.6% of acid etching discs was covered with cells and connective tissue. Cells cultured on rougher surfaces tended to exhibit attributes of more differentiated osteoblasts than cells cultured on smoother surfaces. These surface properties justify that the sandblasted implants is able to significantly increase bone contact and bone growth with very good osseointegration results in vivo.

Pattern of antibiotic prescription in the management of endodontic infections amongst Spanish oral surgeons.

AIM: To identify antibiotic prescription practices in the treatment of endodontic infections amongst Spanish oral surgeons. METHODOLOGY: Members of the Spanish Oral Surgery Society (SECIB) were surveyed on antibiotic prescription on six different pulpal and periapical diagnoses. A total of 200 questionnaires were delivered with 127 returned (64%). RESULTS: The average duration of antibiotic therapy was 7.0 +/- 1.0 days. Ninety five percent of respondents selected amoxicillin as the first choice antibiotic in patients with no medical allergies, alone (34%) or associated to clavulanate (61%). The first drug of choice for patients with an allergy to penicillins was clindamycin 300 mg (65%), followed by azithromycin (15%) and metronidazole-spiramycin (13%). For cases of irreversible pulpitis, 86% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis and no swelling, 71% prescribed antibiotics. Almost 60% of respondents prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract; in this clinical situation, odontologists prescribed more frequently antibiotics compared to stomatologists (P = 0.0080; odds ratio = 8.0; C. I. 95% = 1.7-37.1). CONCLUSIONS: The majority of the members of the SECIB were selecting the appropriate antibiotic for use in endodontic infections, but there are still many who are prescribing antibiotics inappropriately. The use of antibiotics for minor infections, or in some cases in patients without infections, could be a major contributor to the world problem of antimicrobial resistance.