Non-impacted tooth extractions and antibiotic treatment: A RCT study.

OBJECTIVES: A controlled, single-blind, randomized clinical trial was performed to evaluate usefulness of antibiotics in preventing pain and complications after tooth extractions and benefits of probiotics in reducing gastro-intestinal symptoms associated with antibiotic therapy. MATERIALS AND METHODS: A total of 159 patients were enrolled in this trial. After tooth extractions, patients were allocated to one of the groups: group 1 received postoperatively amoxicillin + clavulanic acid; group 2 received the same antibiotic therapy with an adjunctive probiotic treatment; and group 3 received neither antibiotics nor probiotics. Follow-up visits were planned at 7, 14, and 21 days after tooth extractions (T1, T2, and T3), and parameters assessed were pain, presence of abscess, edema, fever, alveolitis, trismus, pain, difficulty in daily routine activities, and gastro-intestinal symptoms. RESULTS: The number of patients reporting pain at T1 was significantly higher in the control group when compared to group 2 (p = .016), while no difference for pain intensity was observed between groups. No surgical site infection was observed in any of the groups. Intestinal symptoms seemed to be tackled by probiotic administration. CONCLUSIONS: Pain was the most important symptom in the control group. Antibiotics were not necessary after non-impacted tooth extractions, and probiotics can reduce gastro-intestinal symptoms associated with antibiotics.

Early volumetric changes after vertical augmentation of the atrophic posterior mandible with interpositional block graft versus onlay bone graft: A retrospective radiological study.

PURPOSE: The aim of this study was to evaluate volumetric and clinical outcomes of atrophic posterior mandibles treated with inlay or onlay bone grafting techniques. MATERIALS AND METHODS: In posterior mandibles, alveolar ridges were treated either with interpositional equine cancellous bone block (inlay group) or with onlay autogenous bone block (onlay group). Bone volumes at baseline and at 4 months after surgery were measured by computed tomography. RESULTS: A total of 20 subjects were enrolled in the present study: 10 in the inlay group and 10 in the onlay group. After surgery, atrophic posterior mandibles showed a mean vertical augmentation height of 6.0 mm in the inlay group and 7.4 mm in the onlay group. No significant differences were recorded between the two groups regarding volume loss of the grafted bone or decrease in vertical bone height of the augmented site (29% and 1.9 mm for the onlay group, and 35% and 1.7 mm for the inlay group) during healing. Two complications (1 wound dehiscence and 1 mandibular fracture) occurred postoperatively in the inlay group; on the other hand, the onlay group had three complications (wound dehiscence). A total of 80 dental implants were placed in augmented areas: 46 in the inlay group with a peri-implant marginal bone loss of 0.8 mm, and 34 in the onlay group with a peri-implant marginal bone loss of 1.3 mm (p = 0.0006). CONCLUSIONS: Inlay xenogeneic grafts showed volumetric bone remodeling similar to that recorded for onlay autogenous bone. The success of the autogenous onlay blocks (82.4%) appeared to be lower than that registered for the inlay group (93.8%), but the difference was not significant.

The effectiveness of systemic antibiotic prophylaxis in preventing local complications after tooth extraction. A systematic review.

PURPOSE: To assess the beneficial or harmful effects of systemic prophylactic antibiotics at extraction of teeth, apart from third molars, vs no antibiotic or placebo administration. Furthermore, if antibiotics are beneficial, to determine which type, dosage, duration and timing of administration is the most effective. MATERIALS AND METHODS: The Cochrane Oral Health Group's Trials Register (to 30 January 2016) and MEDLINE (1 January 1950 to 30 January 2016) were searched. There were no language or date restrictions placed on the searches of the electronic databases. Randomised controlled trials (RCTs) of parallel group design, with a follow-up of at least 2 weeks, comparing the administration of various prophylactic antibiotic regimens vs no antibiotics to people undergoing extraction of teeth, not including third molars, were included. Outcome measures were postoperative complications/adverse events, post-operative pain and swelling. Screening of eligible studies, assessment of the risk of bias of the trials and data extraction were conducted in triplicate by three independent review authors. Results were to be expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes, with 95% confidence intervals (CIs). Heterogeneity, including both clinical and methodological factors, was to be investigated. RESULTS: No relevant RCT was identified. CONCLUSIONS: There is no RCT to determine if the antibiotic therapy is needed at extraction of teeth, excluding third molars. Properly designed and conducted RCTs are needed to understand the role of the antibiotic therapy for tooth extraction. Conflict-of-interest statement: This systematic review was self-funded and the authors have no conflict of interests to declare.

Surgical techniques used in the rehabilitation of partially edentulous patients with atrophic posterior mandibles: A systematic review and meta-analysis of randomized controlled clinical trials.

PURPOSE: Given the lack of general consensus in the literature regarding the best method to rehabilitate partially edentulous patients with extended atrophic edentulous sites in the posterior zone of the mandible, and with a residual ridge height less than 8 mm (with or without bone augmentation procedures), the aim of this systematic review was to analyze all the relevant randomized clinical trials (RCT), and, by means of a meta-analysis of the collected data, draw some conclusions regarding the best available treatments for the rehabilitation of posterior edentulism in partially dentate mandible. MATERIALS AND METHODS: An electronic search was conducted in the MEDLINE and Cochrane Oral Health Group databases for studies published between January 2000 and September 2015 with the use of relevant keywords and hand-searching. All identified publications were screened by the authors according to the Cochrane Data Collection Form for Intervention Reviews. Collected outcomes such as biological complications, vertical ridge changes, implant and prosthetic failure were studied by subgroups analyses. RESULTS: An initial search yielded 81 potential articles, of which 12 studies were chosen for inclusion. Short implants seemed to be effective in limiting incidence of the biological complications (RR: 2.822; 95% CI: 1.809-4.403; p < 0.0001) and degree of ridge height reduction (difference in means of 0.052 mm; 95% CI: 0.026-0.079 mm; p < 0.0001) when compared with long implants placed in augmented bone. Implants placed in augmented areas with the use of onlay block grafts seemed to behave worse than implants placed in the augmented sites regardless of the augmentation procedures. However, this difference did not reach statistical significance. CONCLUSION: Findings from subgroup analyses revealed that (1) short implants placed in the posterior atrophic areas of partially edentulous mandibles were associated with superior outcomes compared with long implants in augmented bone, such as lower rate of biological complications and of peri-implant bone loss; whereas (2), there was no evidence that onlay augmentation was inferior to any of the other augmentation techniques employed.

Clinical and Histological changes after ridge preservation with two xenografts: preliminary results from a multicentre randomized controlled clinical trial.

OBJECTIVES: To evaluate and compare clinical and histological changes after ridge preservation procedures with those of spontaneous healing. MATERIALS AND METHODS: Ninety patients were enrolled in the present randomized controlled clinical trial and underwent single-tooth extraction in the premolar/molar areas. Thirty sites were grafted with collagenated cortico-cancellous (coll), 30 sites with cortical (cort) porcine bone and 30 sites underwent natural healing. Primary (vertical and horizontal bone changes after 3 months) and secondary outcomes (histomorphometric after 3 months) were evaluated at implant placement. RESULTS: The vertical bone changes at the grafted sockets were significantly (p < 0.0001) lower (0.30 mm for cort group and 0.57 mm for coll group) when compared to non-grafted sockets (2.10 mm for nat group). Moreover, the width reduction of the coll (0.93 mm) and cort (1.33 mm) groups was significantly lower (p < 0.0001) than the non-grafted group (3.60 mm). The analysis of subgroups attested that when premolar and molar sites were compared, the buccal bone loss appeared to be dependent both on tooth position and grafting material employed. CONCLUSION: The ridge preservation procedures had significantly better outcomes when compared to natural healing. The biomaterials did not differ for maintenance of bone width; even though, the bone height seemed to be better preserved with the cortical porcine bone.

Bleeding Rate After Tooth Extraction in Patients Under Oral Anticoagulant Therapy.

OBJECTIVES: The aim of this single-cohort prospective study was to evaluate the risk of adverse outcomes after tooth extraction in patients suffering from cardiovascular disorders and under oral anticoagulant therapy with an international normalized ratio within the value of 3.0. METHODS: Two hundred ninety-three patients (mean age of 58.7 years) were enrolled and 560 tooth extractions were performed. Fresh extraction sockets were treated with collagen tablets and sutures. The risk of increased bleeding rate was evaluated for type of drug therapy (acenocoumarol or warfarin), type of cardiovascular diseases, and number of tooth extractions. Level of significance was set at 0.05. RESULTS: The overall bleeding event rate was 6.8%. Among patients who had bleeding events, 4 suffered from valvular disorders, whereas 11 suffered from arrhythmias (8) or cardiomyopathies (3). The remaining 5 patients had a history of cardiomyopathy and arrhythmia.The bleeding events in patients who had more than 2 tooth extractions were significantly higher than those observed in patients who had only 1 tooth extraction (P <0.05). CONCLUSION: Patients who received more than 2 tooth extractions, who were under treatment with acenocoumarol, and who suffered from multiple cardiovascular diseases were at high risk for bleeding events.

The Effect of Insertion Torque on the Clinical Outcome of Single Implants: A Randomized Clinical Trial.

BACKGROUND: The insertion torque value has been extensively used as an indicator for implant primary stability, which is considered a determining parameter for the implants success. PURPOSE: The primary goal of the present randomized clinical trial was to evaluate and compare the clinical outcome for implants placed with high insertion torque (between 50 Ncm and 100 Ncm) and regular insertion torque (within 50 Ncm) in healed ridges. MATERIALS AND METHODS: Partially edentulous patients, missing one or more mandibular or maxillary teeth, having an adequate amount of bone, requiring implant placement, were randomized to receive Blossom CT implants with regular insertion torque (<50 Ncm) or CT implants with high insertion torque (≥50 Ncm). Implants were left to heal submerged for 3 months. Implants were restored with individualized abutments and cemented metal-ceramic crowns. Acquired measurements were: insertion torque values (IT), thickness of buccal bone plate after implant osteotomy preparation (BBT), marginal bone level (MBL), and facial soft tissue level (FST). All patients were followed 12 months after implant placement. RESULTS: One hundred sixteen implants were placed in one hundred sixteen patients and enrolled for the study. Fifty-eight implants were randomly allocated in regular-IT and high-IT groups with a mean insertion torque ranging from 20 Ncm to 50 Ncm and from 50 Ncm to 100 Ncm, respectively. Three implants failed, and another five implants showed at the 12-month evaluation a marginal bone loss (ΔMBL) greater than 1.5 mm, being considered unsuccessful. CONCLUSIONS: The findings suggested that implants inserted with high-IT (≥50 Ncm) in healed bone ridges showed more peri-implant bone remodeling and buccal soft tissue recession than implants inserted with a regular-IT (<50 Ncm). Moreover, sites with a thick buccal bone wall (≥1 mm) - after implant osteotomy site preparation - seemed to be less prone to buccal soft tissue recession after 12 months than sites with a thin buccal bone wall (<1 mm).