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® 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.

Autologous dental pulp mesenchymal stem cells for inferior third molar post-extraction socket healing: A split-mouth randomised clinical trial.

BACKGROUND: Since the discovery of adult mesenchymal stem cells extensive research has been conducted to determine their mechanisms of differentiation and effectiveness in cell therapy and regenerative medicine. MATERIAL AND METHODS: To assess the efficacy of autologous dental pulp mesenchymal stem cells delivered in a collagen matrix for post-extraction socket healing, a single-centre, double-blind, randomised, split-mouth, controlled clinical trial was performed. Both impacted mandibular third molars were extracted from 32 patients. Dental pulp was collected and dissociated; the resulting cell suspension, obtained by centrifugation, was incorporated into a resorbable collagen matrix and implanted in 32 experimental post-extraction sockets. Collagen matrices alone were implanted in 32 contralateral, control post-extraction sockets. Two neuroradiologists independently assessed the extent of bone repair at 6 months after the extractions. Computed tomography (CT, Philips Brilliance) and an advanced display platform (IntelliSpace Portal) was used to record extraction socket density, expressed as Hounsfield units (HU) and height (mm) of the distal interdental bone septum of the second molar. Measurements at 6 months post-extraction were compared with measurements obtained immediately after extraction. Data were analysed with the statistical program STATA 14. RESULTS: Two patients dropped out of the study. The final sample consisted of 22 women and 8 men (mean age, 23 years; range: 18-30 years). Clinical, radiological, and surgical characteristics of impacted third molars of the control and experimental groups were homogeneous. Measurements obtained by the two neuroradiologists showed agreement. No significant differences were found in the extent of bone repair during analyses of density (p=0.4203 neuroradiologist 1; p=0.2525 neuroradiologist 2) or interdental septum height (p=0.2280 neuroradiologist 1; p=0.4784 neuroradiologist 2). CONCLUSIONS: In our clinical trial, we were unable to demonstrate that autologous dental pulp mesenchymal stem cells reduce socket bone resorption after inferior third molar extraction.

Radiologic variables of clinical significance in the extraction of impacted mandibular third molars.

OBJECTIVE: To determine which radiologic variables have a clinical significance in the extraction of impacted mandibular third molars. STUDY DESIGN: A prospective study was carried out on 100 consecutive extractions of unilateral impacted mandibular third molars (60 women and 40 men, mean age: 26.27 +/- 10.63 years). Fourteen radiologic variables were ordinally evaluated, establishing their relation to the surgical intervention time. The Kruskal-Wallis test, a multivariant analysis of the principal components, the Pearson correlation coefficient, and logistical regression tests were carried out. RESULTS: Seven variables (occlusal plane, relation to the second molar, depth, follicle, periodontal ligament width, ramus of the mandible, and angulation) demonstrated a statistically significant relation to the surgical intervention time (Kruskal-Wallis tests, p < 0.007). Two associated variables, depth and periodontal ligament width, showed the most powerful and simple relation to the surgical intervention time (r2 multiple = 0.307, p < 0.001). CONCLUSION: The model we propose is a tool that may help the general practitioner to establish competence in an extraction of the impacted mandibular third molar by measuring the association of two radiologic variables: depth and periodontal ligament width.

Sentinel node biopsy in relation to survival in floor of the mouth carcinoma.

Promising results have been obtained with sentinel node biopsy (SNB) in early oral carcinoma, but the floor of the mouth remains a site at risk of misdiagnosis. A retrospective and prospective study was designed to test the safety of SNB by comparing survival among patients with early stage carcinoma of the floor of the mouth (FOM) undergoing SNB, to a control group managed traditionally by a combination of clinical observation and elective neck dissection (END). A total of 63 patients with early stage carcinoma of the FOM were treated between 1991 and 2005. In the control group, 26 patients were managed with END and nine by close observation. In the test group, 28 patients were managed prospectively with SNB. Regional recurrence occurred in 23% (8/35) of control patients and 25% (7/28) of test patients. Approximately 25% of patients were successfully treated by salvage surgery. Disease-specific survival was 65.5% for control patients and 85% for SNB patients; the difference was not statistically significant. The use of SNB in the management of cancers of the FOM did not adversely affect survival and prevented 69.5% of patients undergoing unnecessary neck dissections, while clinical progress was better in the SNB group than in controls.