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Issue: 02/2010 - B. L. J. Schmidt - K. A. Grötz
In which bisphosphonate patients am I allowed to place implants? A systematic review

Bisphosphonates (BP) result in a positive tissue balance in bone, largely due to the antiresorptive effects at the osteoclast level, but are associated with osteonecrosis of the jaws (ONJ), which is hard to treat. There have been several attempts to improve medical care for patients receiving bis-phosphonates through enhanced communication between physicians prescribing bisphosphonates and dentists. The aim is to minimize the risk of developing BP-ONJ. In this contentious field, implantation is of special importance; in the last 20 years, many (alleged) contraindications for implants have been put into perspective, but BP-ONJ may be a new one. The literature-based evidence reflects the limited current knowledge of the real risk of implant-related ONJ or implant loss due to BP-ONJ. Against the background of existing experiences, an algorithm for indications can be developed. Three criteria are of high clinical importance: (1) the individual’s BP-ONJ risk (which can be evaluated with the ASO control slip), (2) the increase or decrease in risk due to an implantation and (3) the necessity of augmentative procedures. This allows a methodical, understandable decision for each patient, regarding the suitability of implant-borne prosthetic rehabilitation.

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Issue: 03/2010 - N. Reichenbach - K.–L. Ackermann
Microbiological and genetical diagnostics for advanced risk profiles

Oral biofilms are deposits in the mouth in which various organisms are embedded in a matrix of extracellular polymer substances where they live together synergistically. Disturbances of the “oral” ecosystem are accompanied by proliferation primarily of bacteria that are intolerant or not readily tolerant of oxygen, which can lead to periodontitis or – in the case of implants – periimplantitis. In addition to conventional diagnostic methods, microbiological diagnostics are an important element in the assessment of the disease and in therapeutic decision-making when adjuvant systemic antibiotics are indicated alongside standard therapy. For identification of the causative microorganisms, we now have at our disposal molecular biological techniques as reliable diagnostic methods for the detection of periodontal pathogens. In the majority of cases, bacteria are detected at the DNA level. A key role is played by the genetic component of the clinical picture, which suggests that evaluation of interleukin polymorphism would be a good approach. Findings from recent studies on the detection of active matrix metalloproteinase-8 (aMMP-8) suggest that it is possible to identify – in the sense of expanded PA diagnostics – whether a tissue is biologically healthy or if collagenolytic tissue breakdown is actively occurring.

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Issue: 01/2010 - K. Stein - B. Al-Nawas
Indication of a preoperative antibiotic prophylaxis
for insertion of dental implants – A systematic review

The aim of this study was to review the available literature on the question of whether preoperative antibiotic prophylaxis during implant placement reduces the risk of implant failure in patients without general medical risk factors.

The literature search was done using the medical databases Pubmed, Medpilot and the Cochrane Library. A hand-search was performed in dental journals. The studies were selected using a systematic quality evaluation and a meta-analysis.

Eight studies fulfilled the inclusion criteria: neither of the two studies of evidence level I showed a significant difference in the early implant failure rate between the test and the control groups. The studies of evidence level II also showed only a minor positive effect of antibiotic prophylaxis. We performed an aggregation of the data of the prospective clinical studies with control groups, which naturally must be interpreted with appropriate caution as there was marked heterogeneity between the four studies. There, a statistically significant difference between the intervention and control groups was apparent, with antibiotic prophylaxis having a clearly positive effect on the early implant failure rate with a number needed to treat of 56.

Based on the present available evidence of “moderate quality”, a “weak recommendation” can be given for antibiotic prophylaxis with a penicillin during implant placement.

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