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Fundamentals of Esthetic Implant Dentistry
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Figure 12.25A, B, C. Different clinical situations for incision line opening.
enteric gram-negative rods) around implants failing because of infection. The clinical signs of inflammation, bleeding, and purulence, in addition to increased mobility, periimplant radiolucency, and probing depths greater than 6 mm, are associated with failing implants. Removal of the irritating cause is of prime importance. The clinician should select the proper antibiotics type and dosage to overcome the condition. (See Figure 12.26.) A study by Powell et al. (2005) evaluated a sample comprised of 395 patients, including 1,053 fully documented surgical procedures. Surgical techniques included several periodontal, implantology, grafting clinical procedures. Infection was defined as increasing and progressive swelling with the presence of suppuration. The impact of various treatment variables was examined, including postsurgical antibacterial rinses, systemic antibiotics, and dressings. Results were analyzed using Fisher’s exact test and Pearson’s chi-square test. Of the 1,053 surgical procedures evaluated, there were 22 infections for an overall prevalence of 2.09%. Patients who received antibiotics as part of the surgical protocol (pre- and/ or postsurgically) developed 8 infections in 281 procedures (2.85%) compared to 14 infections in 772 procedures (1.81%) in which antibiotics were not used. Procedures in which chlorhexidine was used during postsurgical care had a lower infection rate (17 infections in 900 procedures, 1.89%) compared to procedures in which chlorhexidine was not used (5 infections in 153 procedures, 3.27%). Surprisingly, the use of a postsurgical dressing demonstrated a slightly higher rate of infection (8 infections in 300 procedures, 2.67%) than nonuse of a dressing (14 infections in 753 procedures, 1.86%).
Figure 12.26. Soft tissue inflammation due to the intrusion of local irritating factor.
Despite these trends, no statistically significant relationship was found between postsurgical infection and any of the treatment variables examined, including the use of preoperative antibiotics. The study stated that although preoperative antibiotics are commonly used when performing certain regenerative and implant surgical procedures, data from this and other studies suggest that there may be no benefit in using antibiotics for the sole purpose of preventing postsurgical infections. Further large-scale, controlled clinical studies are warranted to determine the role of preoperative antibiotics in the prevention of periodontal postsurgical infections. In general, purulent areas respond to home irrigation devices. In the event of abscess formation, amoxicillin with clavulanate potassium (Augmentin,