Proton Pump Inhibitors and the Risk of Osseointegrated Dental Implant Failure: A Cohort Study.

Proton pump inhibitors (PPIs) have a negative impact on bone accrual. Because osseointegration is influenced by bone metabolism, this study investigates the association between PPIs and the risk of osseointegrated implant failure. This retrospective cohort study included a total of 1,773 osseointegrated dental implants in 799 patients (133 implants in 58 PPIs users and 1,640 in 741 non-users) who were treated at the East Coast Oral Surgery Clinic in Moncton, Canada, from January 2007 to September 2015. Kaplan-Meier estimator was used to describe the hazard function of dental implant failure by PPIs usage. Multilevel mixed effects parametric survival analyses were used to test the association between PPIs exposure and risk of implant failure adjusting for potential confounders. The failure rates were 6.8% for people using PPIs compared to 3.2% for non-users. Subjects using PPIs had a higher risk of dental implant failure (HR = 2.73; 95% CI = 1.10-6.78) compared to those who did not use the drugs. The findings suggest that treatment with PPIs may be associated with an increased risk of osseointegrated dental implant failure.

Antihypertensive Medications and the Survival Rate of Osseointegrated Dental Implants: A Cohort Study.

PURPOSE: Antihypertensive drugs in general are beneficial for bone formation and remodeling, and are associated with lower risk of bone fractures. As osseointegration is influenced by bone metabolism, this study aimed to investigate the association between antihypertensive drugs and the survival rate of osseointegrated implants. MATERIALS AND METHODS: This retrospective cohort study included a total of 1,499 dental implants in 728 patients (327 implants in 142 antihypertensive-drugs-users and 1,172 in 586 nonusers). Multilevel mixed effects parametric survival analyses were used to test the association between antihypertensive drugs use and implant failure adjusting for potential confounders. RESULTS: Only 0.6% of the implants failed in patients using antihypertensive drugs while 4.1% failed in nonusers. A higher survival rate of dental implants was observed among users of antihypertensive drugs [HR (95% CI): 0.12 (0.03-0.49)] compared to nonusers. CONCLUSIONS: Our findings suggest that treatment with antihypertensive drugs may be associated with an increased survival rate of osseointegrated implants. To our knowledge, this could be the first study showing that the systemic use of a medication could be associated with higher survival rate of dental implants.

Plaque Accumulation Beneath Maxillary All-on-4™ Implant-Supported Prostheses.

BACKGROUND: Maxillary prostheses supported by four implants, following the All-on-4(™) principles, have become an accepted effective treatment for totally edentulous patients. Maintaining the hygiene of such fixed implant-supported prostheses is challenging. PURPOSE: The purpose of this clinical study was to evaluate the distribution of plaque on the fitting surface of All-on-4 fixed prostheses in order to find new strategies for maintaining their hygiene. MATERIALS AND METHODS: Twenty All-on-4 maxillary fixed prostheses collected from 20 patients, 6 months after delivery, were stained with methylene blue to disclose plaque accumulation at the fitting surfaces of the prostheses. Digital photographs of the fitting surfaces of the prostheses were recorded and processed. The distribution of accumulated plaque was evaluated statistically. RESULTS: The average percentage of area covered with plaque was 28 ± 8% of the total area of the fitting surface of the prostheses. The fitting surfaces of the prostheses had three times more plaque on the palatal area (52.5 ± 7.33%) than on the buccal area (17.3 ± 7.33%, p < .05). The interimplant proximal areas of the fitting surface covered with plaque were high when the distance between implants was short (r = -0.326, p = .014). CONCLUSION: These findings suggest that the hygiene of the All-on-4 prostheses could be improved by maximizing the distances between the inserted implants in the jaw, minimizing the prostheses' palatal extension and guiding patients to optimize their oral hygiene practices targeting the palatal area of their prostheses.

Extraction of impacted mandibular third molars: postoperative complications and their risk factors.

OBJECTIVE: The purpose of this prospective study was to evaluate the incidence of various complications, including alveolitis, infection and paresthesia of the inferior alveolar nerve, in association with removal of impacted mandibular third molars. The relation between these 3 complications and several clinical variables (age, sex, degree of impaction, surgical difficulty and use of oral contraceptives) was also examined. MATERIALS AND METHODS: Data were collected prospectively for all patients who underwent extraction of an impacted third molar in a single private dental practice over a 12-month period. A variety of data were collected for each patient, including age, sex, medical status at the time of the procedure and type of procedure performed. Patients were contacted at 2 days and 4 weeks after surgery to establish the occurrence of complications, and those with complications were treated; those with paresthesia were followed for at least 24 months. RESULTS: A total of 550 impacted mandibular third molars were extracted from 327 patients (136 males and 191 females). The complication rate was 6.9%, consisting of 20 cases of alveolitis, 12 cases of infection and 6 cases of paresthesia of the inferior alveolar nerve. Of the 6 neurosensory deficits, 3 resolved and 3 were permanent. The risk factors associated with permanent neurosensory deficit were female sex, Pell and Gregory IC or IIC classification of impaction, and age greater than 24 years. The risk of postoperative alveolitis and infection was also greater among women. There was no significant relation between the use of oral contraceptives and alveolitis. CONCLUSIONS: Surgical removal of impacted mandibular third molars should be carried out well before the age of 24 years, especially for female patients. Older patients are at greater risk of postoperative complications and permanent sequelae. A surgeon's lack of experience could also be a major factor in the development of postoperative complications.

Antiplatelet drugs : is there a surgical risk?

Acetylsalicylic acid has long been the only nonsteroidal anti-inflammatory drug recommended for the treatment and prevention of thromboembolic diseases. More recently, new compounds have been used in patients with vascular diseases. However, these drugs are often associated with longer bleeding times and greater operative risk. In most surgical specialties, the question always arises as to whether antiplatelet therapy should be stopped before elective surgery. If so, for how long? If not, what are the risks? This article reviews the various antiplatelet drugs in use today, focusing on their mode of action, their effects on platelet function and the associated operative risks. It also proposes an algorithm for decision making in this setting, based on the literature and an understanding of the mechanisms of action of this class of drugs.