Efficacy of chemical approaches for implant surface decontamination in conjunction with sub-marginal instrumentation, in the non-surgical treatment of peri-implantitis: A systematic review.

AIM: To answer the following PICOS question: In adult patients with peri-implantitis, what is the efficacy of sub-marginal instrumentation combined with chemical surface decontamination in comparison with sub-marginal instrumentation with or without placebo, in terms of changes in probing depth (PD) and/or bleeding on probing, as reported in prospective randomized controlled trials, non-randomized controlled trials, or prospective cohort studies, with a minimum of 6-month "follow-up". MATERIALS AND METHODS: A systematic literature search was performed in PubMed, Web of Science, Embase, Scopus, Ovid Medline, and The Cochrane Library of the Cochrane Collaboration (CENTRAL) for articles published until March 2022. Data addressing the primary and secondary outcomes were extracted. RESULTS: The search gave 2033 results of which 3 fulfilled the inclusion criteria. Two studies investigated the use of anti-microbial photodynamic therapy as adjunct to sub-marginal instrumentation and the third study assessed the adjunctive use of a desiccant material. A meta-analysis was not deemed meaningful because of the large heterogeneity among the studies. All three studies showed favourable results in terms of PD reduction for chemical surface decontamination over control approaches, but were inconsistent or showed no differences for the other outcome variables. CONCLUSIONS: Adjunctive chemical approaches for implant surface decontamination may offer an advantage over sub-marginal instrumentation alone, in terms of improved PD.

An in vitro evaluation of 2 methods for retrieving fractured abutment screw fragments from the intaglio of 4 different implant systems.

STATEMENT OF PROBLEM: When an abutment screw fractures, there is no standardized technique for retrieving it from the intaglio of the dental implant. PURPOSE: The purpose of this in vitro study was to assess the relative efficacy of a commercially available screw fragment retrieval kit with a range of standard dental instruments in regard to success and retrieval time. In addition, the effects of other variables on the success rate of screw fragment retrieval and the retrieval time required were also investigated. Finally, the integrity of the intaglio screw channel of the dental implant was also assessed following retrieval. MATERIAL AND METHODS: The abutment screws from 4 dental implant systems: Osseotite Certain, Ø4.1 mm (Zimmer Biomet); Osseotite External hexagonal connection micromini, Ø3.25 mm (Zimmer Biomet); Standard Plus Tissue Level, Ø4.8 mm (Institut Straumann AG); and Brånemark Mark III TiUnite, Ø4.1 mm (Nobel Biocare) had notches placed between the first and second coronal threads before being placed in their respective abutments, positioned in the dental implants (n=128), and tightened until the screws fractured. The dental implant specimens were placed in maxillary and mandibular casts at the lateral incisor and first molar sites on both sides. The casts were placed in mannequin heads on a dental chair and assigned to 2 experienced and 2 inexperienced operators who used 2 different retrieval kits to retrieve the screw fragments. Chisquared tests were used to determine the association between the success rate of screw fragment retrieval and the other factors recorded (α=.05), and a binary logistic regression was used to determine the association between the retrieval event and all of the independent variables. Regression models were developed to determine the factors effecting retrieval time. RESULTS: An overall success rate of 88.3% was achieved for screw fragment retrieval. No statistically significant difference (P=1) was found in the relative efficacy of the retrieval kits. Univariate analysis identified a statistically significant association (P<.01) in the success of abutment screw fragment retrieval between the Osseotite Certain and the Osseotite External hexagonal connection micromini implant systems. Gamma regression analysis identified significant differences between the time taken to retrieve the screw fragments and the type of dental implant (P<.001), (P<.01). The time taken to retrieve screw fragments in the maxillary arch was significantly longer than for the mandibular arch (P<.05). CONCLUSIONS: The commercially available screw fragment retrieval kit and the standard dental instruments were equally effective in retrieving the screw fragments. Less time was required to retrieve screw fragments in the mandibular arch than the maxillary arch. The level of experience of the operator had no effect on the ability to successfully retrieve fractured abutment screws.

What is the influence of implant surface characteristics and/or implant material on the incidence and progression of peri-implantitis? A systematic literature review.

OBJECTIVES: To answer the focused question, 'In animals or patients with dental implants, does implant surface characteristics and/or implant material have an effect on incidence and progression of peri-implantitis?' MATERIAL AND METHODS: Pre-clinical in vivo experiments on experimental peri-implantitis and clinical trials with any aim and design, and ≥5 years follow-up, where the effect of ≥2 different type of implant material and/or surface characteristics on peri-implantitis incidence or severity, and/or progression, implant survival or losses due to peri-implantitis, and/or marginal bone levels/loss was assessed. RESULTS: Meta-analyses based on data of pre-clinical experiments, using the ligature induced peri-implantitis model in the dog, indicated that after the spontaneous progression phase implants with a modified surface showed significantly greater radiographic bone loss (effect size 0.44 mm; 95%CI 0.10-0.79; p = .012; 8 publications) and area of infiltrated connective tissue (effect size 0.75 mm2 ; 95%CI 0.15-1.34; p = .014; 5 publications) compared to non-modified surfaces. However, in 9 out of the 18 included experiments, reported in 25 publications, no significant differences were shown among the different implant surface types assessed. Clinical and/or radiographic data from 7605 patients with 26,188 implants, reported in 31 publications (20 RCTs, 3 CTs, 4 prospective cohort, and 4 retrospective studies; 12 with follow-up ≥10 years), overall did not show significant differences in the incidence of peri-implantitis, when this was reported or could be inferred, among the various implant surfaces. In general, high survival rates (90-100%) up to 30 years and no clinically relevant differences in marginal bone loss/levels, merely compatible with crestal remodelling, were presented for the various implant types. CONCLUSION: Pre-clinical in vivo experiments indicate that surface characteristics of modified implants may have a significant negative impact on peri-implantitis progression, while clinical studies do not support the notion that there is a difference in peri-implantitis incidence among the various types of implant surfaces. No assumptions can be made regarding the possible impact of implant material on incidence and/or peri-implantitis progression due to limited information.

Aerosol generating procedures in trauma and orthopaedics in the era of the Covid-19 pandemic; What do we know?

PURPOSE: COVID-19 pandemic has created havoc all over the globe and spared no one regardless of status, gender, location and ethnicity. There were questions raised if trauma and orthopaedic (T&O) procedures actually generated aerosols? The need for a review of literature highlighting the nature and impact of aerosol generation within T&O surgery was noted. METHODS: A comprehensive online search was performed for all published articles in the English language, evaluating AGPs in T&O surgery and the relevant personal protection equipment used. RESULTS: The search strategy populated 43 studies. Six studies were identified as duplicates. The shortlisted 37 studies were screened and nine studies were included in the review. An additional four studies were included from the bibliography review. CONCLUSION: Most orthopaedic procedures are high-risk aerosol generating procedures (AGPs). Conventional surgical masks do not offer protection against high-risk AGPs. In the current era of COVID-19 pandemic, there is a significant risk to the transmission of infection to the theatre staff. For protection against airborne transmission, appropriate masks should be used. These need proper fitting and sizing to ensure full protection when used.

Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management.

PURPOSE: Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm. METHODS: Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade. RESULTS: A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively. CONCLUSION: The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

Periodontitis and airflow limitation in older Swedish individuals.

AIM: To investigate whether there was an association between periodontitis and airflow limitation in older Swedish individuals. MATERIALS AND METHODS: Study individuals were randomly selected from the Swedish civil registration database representing the ageing population in Karlskrona, Sweden. Clinical and radiographic examinations were performed, alongside which participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Standard spirometry was performed to identify subjects with airflow limitation. Periodontitis was defined based on radiographic periodontal bone loss. Analysis included multiple logistic regression with adjustment for various confounders. RESULTS: A total of 826 Caucasian dentate subjects were included in the analysis. The median age of participants was 73.2 (IQR 66-81) years, and 443 (54.6%) subjects were female. Eighty-six (10.4%) individuals presented with airflow limitation. The proportion of participants presenting with periodontitis in the airflow limitation group was 65.1% compared to 41.5% with normal respiratory function (p < .001). Multiple logistic regression analysis showed that periodontitis was independently associated with airflow limitation with an odds ratio of 2.31 (95% CI 1.27-4.22) p < .01. CONCLUSION: In this group of older dentate individuals, periodontitis was significantly associated with airflow limitation independent of other known risk factors.

The effect of a decontamination protocol on contaminated titanium dental implant surfaces with different surface topography in edentulous patients.

Objectives: To investigate if it is possible to achieve complete decontamination of dental implant surfaces with different surface characteristics.Materials and methods: Twelve implant pieces with an Osseotite® surface and 12 implant pieces with a Ti-Unite® surface were attached on to the complete lower dentures of six patients and were allowed to accumulate plaque for 30 days. When retrieved, the implant decontamination protocol used, involved both mechanical (PeriBrush™) and chemical (3% H2O2) decontamination. The number of colony forming units per millilitre was determined and the dominant micro-organisms in selected samples was identified by 16s rRNA gene amplicon sequencing. The effect of the titanium brush on the implant surface was examined by SEM.Results: Complete decontamination was achieved in five out of 24 implants (four Osseotite® and one Ti-Unite®). The mean CFU/ml detected after decontamination were 464.48 for Osseotite® and 729.09 for Ti-Unite® implants. On the surface of the implants in which complete decontamination was not achieved, all of the predominant bacteria identified were streptococci except for one which was identified as micrococcus. SEM images revealed that the surface features of the decontaminated implants were not significantly altered.Conclusions: Mechanical decontamination using a titanium brush supplemented with chemical treatment for one minute (3% H2O2) can achieve complete decontamination of implant surfaces in edentulous patients.

Treatment Planning for Periimplant Mucositis and Periimplantitis.

PURPOSE: A literature search was performed in a number of health care databases for articles published until January 2018. DISCUSSION: A number of anatomical factors, risk indicators, possible aesthetic complications, and financial implications have to be taken into consideration before treatment commences. When diagnosed early, periimplant mucositis is a problem that can be easily managed as long as the patient is motivated and maintains good levels of oral hygiene. Periimplantitis is more difficult to treat and results can be unpredictable. Nonsurgical therapy has limited effectiveness on the treatment of periimplantitis, but it should always precede a surgical intervention. Clinically predictable surgical outcomes seem to rely mainly on the configuration of the bone defect, the position of the affected implant, and the patient's ability to perform good oral hygiene. CONCLUSIONS: Thorough treatment planning of periimplant diseases is paramount for the success of the treatment that follows. Local and general factors as well as patients' expectations have to be considered before proceeding, but treatment planning should also allow for a degree of flexibility, which will accommodate the unknown parameters.

Treatment of pathologic peri-implant pockets.

Peri-implant and periodontal pockets share a number of anatomical features but also have distinct differences. These differences make peri-implant pockets more susceptible to trauma and infection than periodontal pockets. Inadequate maintenance can lead to infections (defined as peri-implant mucositis and peri-implantitis) within peri-implant pockets. These infections are recognized as inflammatory diseases, which ultimately lead to the loss of supporting bone. Diagnostic and treatment methods conventionally used in periodontics have been adopted to assess and treat these diseases. Controlling infection includes elimination of the biofilm from the implant surface and efficient mechanical debridement. However, the prosthetic supra-structure and implant surface characteristics can complicate treatment. Evidence shows that when appropriately managed, peri-implant mucositis is reversible. Nonsurgical therapy, with or without the use of antimicrobials, will occasionally resolve peri-implantitis, but for the majority of advanced lesions this approach is insufficient and surgery is indicated. The major objective of the surgical approach is to provide access and visualize the clinical situation. Hence, a more informed decision can be made regarding whether to use a resective or a regenerative surgical technique. Evidence shows that following successful decontamination, surgical treatment to regenerate the bone can be performed, and a number of regenerative techniques have been proposed. After treatment, regular maintenance and good oral hygiene are essential for a predictable outcome and long-term stability.

Manipulation under anaesthetic for frozen shoulder using Codman's paradox: a safe and early return of function.

PURPOSE: Although previously frozen shoulder was thought to resolve by two to three years, recent studies demonstrated the symptoms can remain for much longer. Manipulation under anaesthetic (MUA) has been shown to be successful in relieving pain and restoring function. Yet, concerns have been raised regarding its safety and the risks of complications. We utilise Codman's paradox to manipulate the shoulder, avoiding rotational torque on the humerus. The aim of our study was to asses shoulder function in the early post MUA period. METHODS: Two hundred twelve consecutive patients (224 shoulders) (mean age 52.4 years) underwent MUA using Codman's paradox for frozen shoulder as sole procedure between 2005 and 2013. All were evaluated clinically, preoperatively and postoperatively, at three weeks and three months, for Constant score (CS), pain, range of motion (ROM), patient satisfaction and subjective shoulder value (SSV). RESULTS: At three weeks and three months, a significant improvement was found in CS from 30.7 to 66 and 70 respectively. Forward elevation improved from 91° to 154° and 160 °, abduction from 69° to 150° and 156 °, internal rotation from 12° to 62° and 66 °, and external rotation from 10° to 46° and 50 °. Pain score improved from 4.4/15 to 9.6/15 and 10.4/15, SSV improved from 1.5/10 to 6.5/10 and 6.7/10. (p<0.001). CONCLUSION: Use of Codman's paradox provides a safe and efficient way to perform MUA for frozen shoulder. It results in dramatic early improvement in ROM, functional outcomes and high satisfaction, as early as three weeks post-operatively.

First Detailed Genetic Characterization of the Structural Organization of Type III Arginine Catabolic Mobile Elements Harbored by Staphylococcus epidermidis by Using Whole-Genome Sequencing.

The type III arginine catabolic mobile element (ACME) was detected in three Staphylococcus epidermidis oral isolates recovered from separate patients (one healthy, one healthy with dental implants, and one with periodontal disease) based on ACME-arc-operon- and ACME-opp3-operon-directed PCR. These isolates were subjected to whole-genome sequencing to characterize the precise structural organization of ACME III for the first time, which also revealed that all three isolates were the same sequence type, ST329.

Bilateral reverse total shoulder arthroplasty-functional outcome and activities of daily living.

BACKGROUND: Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years, providing good shoulder elevation, yet less predictable rotations. Good rotations are crucial for performance of activities of daily living (ADLs), including personal hygiene. Concerns remain regarding bilateral rTSA over lack of rotations bilaterally and resultant difficulties with ADLs. This study examined the outcome of patients with bilateral rTSA in restoration of function and ADLs. METHODS: Data were prospectively collected for 19 patients (15 women, 4 men; 38 shoulders), with a mean age of 74.5 years, who underwent staged bilateral rTSA between 2007 and 2013. Mean follow-up was 48.4 months (range, 24-75 months). Patients were evaluated clinically using the Constant score, patient's satisfaction, Subjective Shoulder Value, and the Activities of Daily Living External and Internal Rotations (ADLEIR) score. Video clips were also recorded for documentation at all visits. RESULTS: Mean duration between staged operations was 18.2 months (range, 3-46 months). The Constant score improved from 18.7 to 65.1 points (age- and sex-adjusted, 100.2). Elevation improved from 57.5° to 143°, internal rotation (IR) from 9° to 81° (30 shoulders could reach above the sacroiliac joint), and external rotation (ER) from 20° to 32° (35 shoulders had >20° ER in adduction, 31 shoulders had full ER in elevation). The Subjective Shoulder Value improved from 2.1 of 10 to 9.2 of 10. Mean ADLEIR score was 33 of 36 (P < .001 for all). Most patients resumed their leisure and sport activities (gardening, golf, swimming, bowling). CONCLUSION: Bilateral rTSA results in marked and predictable improvement in all movements, pain relief, and functional outcomes, with high patient satisfaction and high ADLEIR score. All patients were able to perform perineal hygiene after their rTSA. Most patients had no limitation in ADLs and their leisure activities.

Comparison of two different techniques used for the maintenance of peri-implant soft tissue health: a pilot randomized clinical trial.

OBJECTIVES: The aim of this pilot study was to compare the effectiveness of two different methods of debridement on maintaining and improving peri-implant soft tissue health over a period of 12 months. MATERIALS AND METHODS: Twenty adult patients (25 implants) were enrolled in a randomized, single-blinded, parallel group clinical trial. All implants included showed no signs of pathologic bone loss. Patients were scheduled to be reviewed every 3 months over a 12 months period. Nine patients (15 implants) were randomly allocated to a test group and treated with a low abrasive air polishing powder (Air-Flow® Perio, EMS) (AFP) and another nine (10 implants) to a control group and treated with titanium curettes (TC). Peri-implant crevicular fluid samples were analyzed to quantitatively measure the concentration of six interleukins (IL-6, IL-8, IL-1ß, TNF, IL-10 and IL-12). A multilevel analysis was used to test the comparison between the two treatments. The same analysis was used to study the relationship between clinical parameters and cytokines while controlling for confounding factors. RESULTS: There was no significant difference in bleeding on probing (BOP) between the two treatment methods (p = .35). Both debridement techniques resulted in a similar reduction of BOP (40.04% and 39.93%). IL-6 was the only cytokine of the six investigated that demonstrated a correlation with a clinical parameter (BOP) (p = .05). CONCLUSIONS: Both treatment methods were proven to be effective in reducing peri-implant inflammation and preventing further disease progression. Some cytokines may act as markers for peri-implant disease as the present study showed a significant relationship between IL-6 and BOP.

EFP Delphi study on the trends in Periodontology and Periodontics in Europe for the year 2025.

AIM: The aim was to assess the potential trends in Periodontology and Periodontics in Europe that might be anticipated by the year 2025, using the Delphi method. MATERIAL AND METHODS: The expert opinion of 120 experts was sought through the use of an open-ended questionnaire, developed by an advisory group, containing 40 questions concerning the various trends in periodontology. RESULTS: The experts (113 responders) expect a stabilization of the prevalence of periodontitis, both for the chronic as well as the aggressive cases, but an increase in implant-related diseases up to the year 2025. Concurrently, the importance of implants is seen to be increasing. They foresee an increased demand for postgraduate periodontology and implantology training. This is mirrored in an increase in publications for implant dentistry and increase in demand and need for training. Concerning the patients, better-informed individuals seeking more routine check-ups are expected. CONCLUSION: A continued need for specialized periodontists, but also well trained dental practitioners is foreseen for next decade in Europe. Apart from periodontology they will be increasingly exposed to and trained in implant dentistry.

Clinical approaches to treat peri-implant mucositis and peri-implantitis.

Therapies proposed for the treatment of peri-implant diseases are primarily based on the evidence available from treating periodontitis. The primary objective is elimination of the biofilm from the implant surface, and nonsurgical therapy is a commonly used treatment. A number of adjunctive therapies have been introduced to overcome accessibility problems or difficulties with decontamination of implant surfaces as a result of specific surface characteristics. It is now accepted that following successful decontamination, clinicians can attempt to regenerate the bone that was lost as a result of infection. The ultimate goal is re-osseointegration, and a number of regenerative techniques have been introduced. By reviewing the existing evidence, it seems that peri-implant mucositis is reversible when appropriately treated. Additionally, a combined therapy (mechanical therapy with local antimicrobials as adjuncts) can serve as an alternative to surgical intervention when treating peri-implantits in cases not suitable for surgery. Surgical therapy is an effective method for treating peri-implantitis, and various degrees of success of the use of regenerative procedures have been reported, regardless of whether or not radiographic evidence of defect fill has been achieved. Finally, no matter which therapy is employed, a prerequisite for the long-term stability of treatment results obtained is the ability of the patient to maintain good oral hygiene.

Risk indicators for peri-implant mucositis: a systematic literature review.

OBJECTIVES: To examine the existing evidence in identifying risk indicators in the aetiology of peri-implant mucositis. MATERIAL AND METHODS: A search was performed in PubMed, Web of Science (WOS) and The Cochrane Library databases for articles published until June 2014. RESULTS: This search gave 3135 results of which 15 studies fulfilled the inclusion criteria. The current review revealed that only a few studies provided data on risk indicators for the development of peri-implant mucositis. Based on the data available, there is evidence that plaque is a risk indicator for peri-implant mucositis. Smoking has also been identified as an independent risk indicator whereas the overall evidence for surface roughness, residual cement, the dimension of the keratinized tissue and time of implant in function is weak. There are limited data available to support systemic conditions as risk indicators for peri-implant mucositis. CONCLUSIONS: Plaque accumulation at implants will result in development of peri-implant mucositis. Smoking should also be considered as a risk indicator for the development of peri-implant mucositis.

Primary prevention of peri-implantitis: managing peri-implant mucositis.

AIMS: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. METHODS: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. RESULTS: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. CONCLUSIONS: Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.

The management of osteoradionecrosis of the jaws--a review.

PURPOSE: To review the conservative and surgical management options of osteoradionecrosis, in particular, highlighting the recent the use of anti-radiation fibrosis drugs (pentoxifylline, tocopherol and clodronate). MATERIAL AND METHODS: We performed a literature review. The management options were divided into two groups, conservative and surgical management. RESULTS: Over the years several treatment options have been proposed including; conservative management (antibiotics, analgesics, oral hygiene), ultrasound therapy, hyperbaric oxygen therapy, surgical resection with reconstruction and more recently the use of anti-radiation fibrosis drugs (pentoxifylline, tocopherol and clodronate). Early or low grade ORN can be managed conservatively using a combination of treatment options. In advanced or refractory cases of ORN (pathological fracture, orocutaneous fistula) surgical treatment, at present, remains the only treatment option available. A new understanding of the pathophysiology of ORN (radiation induced fibroatrophic process) has lead to the development of new therapeutic management regimes. CONCLUSION: In advanced or refractory cases of ORN surgical treatment, including microvascular reconstructive techniques for bone and soft tissue, remains the only option available.

An in vivo comparison of internal bacterial colonization in two dental implant systems: identification of a pathogenic reservoir.

OBJECTIVES: The aim of this study was to compare internal bacterial colonization in two implant systems, one screw root form (SRF) with an external hexagon connection and one plateau root form (PRF) with a Morse taper internal connection. MATERIALS AND METHODS: Thirty-two implants; 12 SRF and 20 PRF, were sampled in 15 patients. All implants had been in function for at least 6 months prior to sampling. The implant restoration was removed and 10 µl of sterile saline was introduced into the implant well via a sterile glass syringe. The saline was drawn back up and transferred to the laboratory for microbiological analysis. The number of aerobic and anaerobic colony forming units per millilitre was determined and the dominant micro-organism in each sample was identified by 16s rRNA gene amplicon sequencing. RESULTS: There was a significant difference between bleeding on probing around the SRF implants (3%) and the PRF implants (28%) (p = 0.0496). Bacterial colonization was identified at 11 SRF and 19 PRF implants. The numbers of anaerobic bacteria recovered from PRF implants was significantly higher than that from SRF implants (p = 0.0002). Streptococcus species and Enterococcus faecalis were found to dominate. CONCLUSIONS: This in vivo study demonstrated bacterial colonization in both types of implant systems, irrespective of the type of connection. Significantly greater anaerobic counts were found in the Morse taper internal connection implants.

The influence of prophylactic antibiotic administration on post-operative morbidity in dental implant surgery. A prospective double blind randomized controlled clinical trial.

OBJECTIVES: A prospective double-blind randomised controlled trial was conducted to test the effect of prophylactic antibiotics on post-operative morbidity and osseointegration of dental implants. MATERIALS AND METHODS: Fifty-five subjects scheduled for implant surgery were enrolled. The patients were randomly assigned to the antibiotic (test group) and placebo (control group). Twenty-seven patients (test group) received 3 g amoxicillin one hour pre-operatively, and 28 patients (control group) received placebo capsules 1 h pre-operatively. No post-operative antibiotics were prescribed. Pain diaries and interference with daily activities diaries were kept by the patients for 1 week post-operatively. Signs of post-operative morbidity (swelling, bruising, suppuration and wound dehiscence) were recorded by the principal investigators at day 2 and day 7 following the operation. Osseointegration was assessed at 2nd stage surgery or 3-4 months post-operatively. RESULTS: The results of this study suggest that the use of prophylactic pre-operative antibiotics may result in higher dental implant survival rates (100% vs. 82%). Five implant failures, one in each of five patients, were reported in the placebo group and none in the antibiotic group (P = 0.0515). No significant differences were found for most of the signs of post-operative morbidity 2 and 7 days post-operatively. Only bruising at 2 days following the operation appeared to be higher in the placebo group (P = 0.0511). Post-operative pain (P = 0.01) and interference with daily activities (P = 0.01) appeared to be significantly lower for the antibiotic group after 7 days. Those patients with implant failure reported higher pain (based on the VAS scores) after 2 days (P = 0.003) and after 7 days (P = 0.0005), higher pain (based on the amount of analgesics used) after 7 days (P = 0.001) and higher interference with daily activities (based on the VAS scores) after 2 days (P = 0.005). CONCLUSIONS: The use of for dental implant surgery may be justified, as it appears to improve implant survival in the short term and also results in less post-operative pain and interference with daily activities. From the results of this study, it appears that prophylactic antibiotics may also be beneficial both in terms of implant survival, especially when the surgical procedure is prolonged due to its difficulty, high number of implants placed or operator's inexperience.