Effects of Antibiotics on Bone and Soft-Tissue Healing Following Immediate Single-Tooth Implant Placement Into Sites With Apical Pathology
Overprescription of antibiotics can cause bacterial resistance problems, leading to life-threatening illnesses and public health crises. Clinicians often believe antibiotics can prevent dental implant failure and postoperative complications. In conjunction with implant surgery, antibiotics are therefore routinely prescribed for all cases. In this double-blind, randomized controlled trial, the effects of antibiotics on the clinical outcomes of immediate implant placement upon replacing a tooth with an apical pathology were examined to compare antibiotics (n = 10) and placebo (n = 10). In each subject, a tooth with a chronic apical lesion was extracted, thoroughly curetted, irrigated, and replaced with single implant with a screw-retained custom provisional abutment/crown. Postoperative pain/discomfort was measured at 1- and 4-week postsurgical follow-up visits using visual analog scales. Facial alveolar bone and soft-tissue changes were measured using pre- and postoperative cone-beam computerized tomography and impressions. We found survival rates of 100% (antibiotics) and 78% (control). However, there was no statistical difference in means for any clinical outcome (t tests with Bonferroni adjustment for multiple testing), except for midfacial soft-tissue changes: 0.43 mm (SD, 0.76) in the antibiotics group and 1.70 mm (SD, 1.06) in the placebo group (t15 = −2.89, P = .011). The average change of the midfacial alveolar plate was 0.62 mm (SD, 0.46) and 1.34 mm (SD, 0.91) for the antibiotic and placebo groups, respectively, which did not significantly differ statistically. No significant correlation (Spearman correlation) existed between the changes in facial alveolar bone and the facial gingival margin. Antibiotics appear to have little effect on immediate implant treatment outcomes.
Figure 1. Preoperative radiographs and immediate implant protocol. (a) A preoperative periapical radiograph of the tooth with a periapical lesion. (b) An example of cone-beam computerized tomography scans of the affected area. (c) Implant placement protocol showing the placement of an implant by engaging the palatal bone and the bone apical to the extraction socket. Figure 2. Clinical treatment protocol showing a series of an immediate implant surgery. (a) Preoperative view of the nonrestorable tooth. (b) The extraction socket after curettage and irrigation. (c) The implant drill in the extraction socket showing the angulation of the osteotomy site. (d) The implant in place. (e) Occlusal view of the implant fixture showing no contact to the facial bone.
Figure 3. Screw-retained custom provisional abutment/crown. (a) The provisional screw-retained abutment/crown showing the screw hole near the incisal edge of the crown. (b) The provisional abutment/crown after the screw hole was filled. (c) Postoperative periapical radiograph taken immediately after the implant placement. Figure 4. Definitive restoration. (a) The definitive prefabricated zirconia abutment in place. (b) The definitive cement-retained computer-aided design–computer-aided manufacturing lithium disilicate crown.
Figure 5. Preoperative measurement of facial alveolar bone. (a) Measurements at the reference site, tooth mesial to the implant site, in the sagittal plane (upper) and frontal plane (lower). (b) Measurements at the affected tooth site in the sagittal plane (upper) and frontal plane (lower). Figure 6. Postoperative measurement of facial alveolar bone. (a) Measurements at the reference site, tooth mesial to the implant site, in the sagittal plane (upper) and frontal plane (lower). (b) Measurements at the implant site in the sagittal plane (upper) and frontal plane (lower).
Figure 7. Measurements of facial soft tissue. The same 5 points of references were used including the top of the line angles of the adjacent teeth, the top of the interdental papillae, and the lowest part of the marginal gingiva. (a) Preoperative measurements. (b) Postoperative measurement. Figure 8. Postoperative pain/discomfort measured by visual analog scale. (a) At the 1-week postoperative visit. (b) At the 4-week postoperative visit. Figure 9. Correlation between facial bone and facial soft-tissue changes after immediate implant placement. Plot based on the Spearman rank correlation coefficient showing no significant correlation between hard- and soft-tissue changes.
Contributor Notes