The patient undergoing implant therapy. Summary and consensus statements. The 4th EAO Consensus Conference 2015

Patterns of antibiotic prescription in implant dentistry and antibiotic resistance awareness among European dentists: A questionnaire-based study

OBJECTIVES

Antimicrobial resistance is an alarming global public health concern, threatening the effective treatment of common infections. This phenomenon is driven by the improper prescription of antibiotics. This study aimed to elucidate the patterns of antibiotic prescription in implant dentistry among European dentists and their awareness of antibiotic resistance.

MATERIALS AND METHODS

An anonymous online validated questionnaire was distributed via e-mail to 6431 recipients through the European Association for Osseointegration. It comprised of 17 structured questions investigating demographic variables, working environment, clinical experience, attitude towards antibiotic prescription in particular in relation to implant dentistry and COVID-19 pandemic, and awareness of antibiotic resistance. Data were collected from April to May 2023.

RESULTS

281 dentists from 33 European countries completed the survey. Almost 80% affirmed to routinely prescribe antibiotics as prophylaxis as well as after dental implant placement, especially in medically compromised patients or in cases of bone grafting. Amoxicillin, alone (61%) or in combination with clavulanic acid (56%), was the most common antibiotic of choice. Awareness of penicillin resistance among respondents was high. For peri-implantitis treatment, more than half reported the use of systemic antibiotics. The large majority (95%) did not prescribe more antibiotics since the beginning of COVID-19 pandemic. Less than 40% declared to follow national guidelines for antibiotic prescription.

CONCLUSION

This survey revealed a high prescription rate of antibiotics in implant dentistry, despite the awareness about antibiotic resistance among the respondents. The development and adherence to European guidelines has been identified as a potential strategy for improving antimicrobial stewardship.

Influence of Titanium Surface Residual Stresses on Osteoblastic Response and Bacteria Colonization

Grit basting is the most common process applied to titanium dental implants to give them a roughness that favors bone colonization. There are numerous studies on the influence of roughness on osseointegration, but the influence of the compressive residual stress associated with this treatment on biological behavior has not been determined. For this purpose, four types of surfaces have been studied using 60 titanium discs: smooth, smooth with residual stress, rough without stress, and rough with residual stress. Roughness was studied by optic interferometry; wettability and surface energy (polar and dispersive components) by contact angle equipment using three solvents; and residual stresses by Bragg-Bentano X-ray diffraction. The adhesion and alkaline phosphatase (ALP) levels on the different surfaces were studied using Saos-2 osteoblastic cultures. The bacterial strains Streptococcus sanguinis and Lactobacillus salivarius were cultured on different surfaces, determining the adhesion. The results showed that residual stresses lead to increased hydrophilicity on the surfaces, as well as an increase in surface energy, especially on the polar component. From the culture results, higher adhesion and higher ALP levels were observed in the discs with residual stresses when compared between smooth and roughened discs. It was also found that roughness was the property that mostly influenced osteoblasts' response. Bacteria colonize rough surfaces better than smooth surfaces, but no changes are observed due to residual surface tension.

Prescription of antibiotic prophylaxis in implant placement among Portuguese dentists: A web survey

OBJECTIVES

This study aims to assess whether antibiotic prophylaxis for dental implant placement is commonly used by dentists in Portugal.

MATERIALS AND METHODS

This cross-sectional survey study was based on a web survey with 22 questions divided into 5 parts. The 1st part focused on demographic details, work experience, and academic expertise, whereas the 2nd and 3rd parts were about the pre- and postoperative antibiotic prescriptions. The 4th and 5th parts focused on dentists' motivation for using/avoiding antibiotic prophylaxis and the use of a protocol, respectively. Data interpretation included descriptive analysis and statistical inference via cross-tabling with chi-square adjusted standardised for residual effects.

RESULTS

Of the 204 valid surveys, at least one was received from every large Portuguese city which ensured the national coverage of the survey. Most respondents are not specialist dentists (72%). Sixty-four percent of the respondents always use antibiotic prophylaxis, while 29% adopt it only when grafting materials are employed. Most respondents use both pre- and postoperative regimens (55%). Amoxicillin 875 mg + clavulanic acid 125 mg is the most prescribed antibiotic (57%). Finally, the risk reduction of postoperative infection is the most frequent justification for the use of antibiotic prophylaxis (60%).

CONCLUSIONS

The results highlight that most of the respondents do not follow the consensual international guidelines for prophylactic antibiotherapy in dental implant placement surgeries. This finding should serve as a rationale to increase the dissemination of those guidelines.

Indications for Antibiotic Prophylaxis for Dentoalveolar Procedures

Antibiotic prophylaxis is the use of antibiotics perioperatively to prevent infections at the surgical site or distant locations. The decision to provide prophylaxis must balance risks of antibiotic resistance, adverse drug reactions, and increased health care costs with the benefit of decreasing infection. This determination has been studied extensively in patients with specific cardiac conditions and prosthetic joints. Prophylactic antibiotics in healthy patients have been shown to reduce the frequency of alveolar osteitis and decrease the failure rates of dental implants.

A systematic review on removal of osseointegrated implants: un update

BACKGROUND

Today dental implants represent an effective therapy in case of partial or total edentulism, with an excellent success rate. Despite the results obtained, there may be biological or mechanical complications during the therapy, which lead to the loss of the implant. This systematic review aims to evaluate the current state of the art in the literature on techniques used for the removal of dental implants. Various aspects will be analyzed, such as the success of the technique, any complications, and the advantages and disadvantages of their use.

METHODS

Two reviewers conducted a literature analysis (PubMed, Embase, Web of Science) of the last 20 years (2003-2023). The main criterion analyzed was the success of the technique, while secondary outcomes such as complications and risks of the technique were also analyzed. 258 articles were identified in the various search databases. 42 eligible articles were subsequently identified after an article screening. Only 18 full texts were subsequently included in the review.

RESULTS

A total of 18 articles were selected and 1142 implants and 595 patients were included. The main techniques used were the Counter-Torque Ratchet Technique (CTRT), Piezoelectric bone surgery (PBS), trephine drills, carbide burs, Erbium, Chromium, Yttrium, Scandium, Gallium, Garnett (Er:Cr:YSGG) laser and carbon dioxide (CO2) laser. Combined uses of techniques have been identified such as: PBS and trephine burs or carbide burs, trephine burs with the use of a 3d-printed guide, CTRT and trephine burs. The technique with the highest success rate, less morbidity for the patient, and less removal of bone appears to be the CTRT.

CONCLUSIONS

The use of conservative techniques, especially CTRT, in bone removal is useful to allow for immediate implant placement in the removal area. However, further studies with a high sample size are needed to be performed on all techniques, particularly new randomized controlled trials (RCTs) that allow for the analysis of the success of alternative techniques such as Laser and Piezosurgery, which appear to be very promising.

Comparison of Prophylactic Effects between Localized Biomimetic Minocycline and Systematic Amoxicillin on Implants Placed Immediately in Infected Sockets

This study evaluated the prophylactic effect of localized biomimetic minocycline and systemic amoxicillin on immediate implant placement at infected extraction sites. Twelve mongrels with six implants each were randomly assigned to five groups: uninfected negative control (Group N); infected with oral complex bacteria (Group P); infected and treated with amoxicillin one hour before implant placement (Group A); infected and treated with minocycline during implant placement (Group B); and infected and treated with amoxicillin one hour before implant placement and with minocycline during implant placement (Group C). Radiographic bone level, gingival index (GI), probing depth (PD), papillary bleeding index (PBI), and removal torque (RT) were recorded. There was no significant difference between Groups A, B, and C for bone loss. Group A showed the highest RT, the lowest PBI, and significantly lower GI and PD values than Group P. Group B exhibited significantly higher RT value than Group N and significantly smaller PD value than Group P at 6 w postoperatively. Localized minocycline could improve implant success by reducing bone loss and increasing RT and systemic amoxicillin could maintain the stability of the peri-implant soft tissue. However, combined use of these two antibiotics did not augment the prophylactic effect.

Do Antimicrobial Photodynamic Therapy and Low-Level Laser Therapy Influence Oral Health-Related Quality of Life After Molar Extraction?

PURPOSE

Most individuals experience significant deterioration in their oral health-related quality of life (OHRQoL) in the first few days after tooth extraction. This study aimed to evaluate the impact of antimicrobial photodynamic therapy (aPDT) and low-level laser therapy (LLLT) protocols on OHRQoL after extraction of lower molars.

METHODS

The investigators designed a double-blind, randomized controlled clinical trial study. Patients with indications for lower molar extraction were included in the study and randomized into four groups: control group, antimicrobial photodynamic therapy group, LLLT group (LLLT.G), and aPDT and LLLT group (aPDT + LLLT.G).The Oral Health Impact Profile (OHIP-14) questionnaire was used through an interview with the participants before the extraction (T0 - baseline) and on the 7th (T1) and 30th (T2) days after extraction. Other variables were age, sex, ethnicity, decayed-missing-filled teeth (DMFT) and tooth types. Appropriate univariate and bivariate statistics were computed, and statistical significance was set at a value P < .05.

RESULTS

The sample was composed of 40 patients with a mean age of 41.25 ± 13.97 and 25 (62.5%) were women. The mean OHIP-14 scores were significantly different in the intervals at T0 versus T1 and T0 versus T2 for all domains (P < .001), demonstrating a positive impact on the OHRQoL. The total scores indicated a significant improvement in the OHRQoL in the aPDT (7.10, standard deviation 4.18, P = .043), LLLT (6.40, SD 5.87, P = .025), and aPDT + LLLT (5.30, SD 3.59, P = .012) groups compared to that in the control group (12.90, SD 6.64) at T1. Patients undergoing extraction of lower mandibular molars with aPDT + LLLT had the lowest mean OHIP-14 total score at T1 (5.30) and T2 (0.70).

CONCLUSION

The aPDT and LLLT protocols had a positive impact on the participants' OHRQoL. These procedures can be applied in everyday surgical practice.

Corrosion Resistance and Titanium Ion Release of Hybrid Dental Implants

One of the strategies for the fight against peri-implantitis is the fabrication of titanium dental implants with the part close to the neck without roughness. It is well known that roughness favors osseointegration but hinders the formation of biofilm. Implants with this type of structure are called hybrid dental implants, which sacrifice better coronal osseointegration for a smooth surface that hinders bacterial colonization. In this contribution, we have studied the corrosion resistance and the release of titanium ions to the medium of smooth (L), hybrid (H), and rough (R) dental implants. All implants were identical in design. Roughness was determined with an optical interferometer and residual stresses were determined for each surface by X-ray diffraction using the Bragg-Bentano technique. Corrosion studies were carried out with a Voltalab PGZ301 potentiostat, using Hank's solution as an electrolyte at a temperature of 37 °C. Open-circuit potentials (Eocp), corrosion potential (Ecorr), and current density (icorr) were determined. Implant surfaces were observed by JEOL 5410 scanning electron microscopy. Finally, for each of the different dental implants, the release of ions into Hank's solution at 37 °C at 1, 7, 14, and 30 days of immersion was determined by ICP-MS. The results, as expected, show a higher roughness of R with respect to L and compressive residual stresses of -201.2 MPa and -20.2 MPa, respectively. These differences in residual stresses create a potential difference in the H implant corresponding to Eocp of -186.4 mV higher than for the L and R of -200.9 and -192.2 mV, respectively. The corrosion potentials and current intensity are also higher for the H implants (-223 mV and 0.069 μA/mm²) with respect to the L (-280 mV and 0.014 μA/mm² and R (-273 mV and 0.019 μA/mm²). Scanning electron microscopy revealed pitting in the interface zone of the H implants and no pitting in the L and R dental implants. The titanium ion release values to the medium are higher in the R implants due to their higher specific surface area compared to the H and L implants. The maximum values obtained are low, not exceeding 6 ppb in 30 days.

Prolonged Inhibition of Streptococcus mutans Growth and Biofilm Formation by Sustained Release of Chlorhexidine from Varnish Coated Dental Abutments: An in Vitro Study

Background

It has been confirmed that bacterial biofilm covering dental implants is the main microbial source causing preimplant infectious and inflammatory diseases. The purpose of this study was to evaluate the antibacterial/antibiofilm effect of chlorhexidine, incorporated into a sustained-release varnish of chlorhexidine (SRV-CHX) coating, on dental abutments.

Materials and Methods

Three kinds of dental abutments were used: a high-performance semi-crystalline engineering thermoplastic polyetheretherketone (PEAK) healing abutment, a titanium healing abutment, and a titanium permanent abutment. These abutments were coated with SRV-CHX or SRV-placebo and exposed daily to fresh cultures of Streptococcus mutans. The effect of SRV-CHX on S. mutans growth on agar plates was studied by measuring the zone of inhibition (ZOI) around each tested abutment every day for a period of 36 days. Biofilm formation on the SRV-CHX/placebo-coated abutments was detected using confocal laser scanning microscopy (CLSM) and high-resolution scanning electron microscopy (HR-SEM), energy dispersive X-ray analysis (EDX), and monitored by crystal violet (CV) staining.

Results

SRV-CHX-coated abutments 2 and 3 were able to inhibit S. mutans growth for 34 days, while abutment 1 inhibited growth for 32 days. Abutment-associated biofilm formation was notably inhibited by SRV-CHX coating after 13 days of incubation with S. mutans. Finally, the biofilm formed around SRV-CHX-coated abutments was completely inhibited up to 12 days of abutment exposure to S. mutans.

Conclusion

Coating of dental abutments with SRV-CHX demonstrated long-term effective inhibition of S. mutans growth and biofilm formation on the abutment surface.

Horizontal augmentation techniques in the mandible: a systematic review

Purpose

Placement of dental implants has evolved to be an advantageous treatment option for rehabilitation of the fully or partially edentulous mandible. In case of extensive horizontal bone resorption, the bone volume needs to be augmented prior to or during implant placement in order to obtain dental rehabilitation and maximize implant survival and success.

Methods

Our aim was to systematically review the available data on lateral augmentation techniques in the horizontally compromised mandible considering all grafting protocols using xenogeneic, synthetic, or allogeneic material. A computerized and manual literature search was performed for clinical studies (published January 1995 to March 2021).

Results

Eight studies ultimately met the inclusion criteria comprising a total of 276 procedures of xenogeneic, allogeneic, or autogenous bone graft applications in horizontal ridge defects. Particulate materials as well as bone blocks were used as grafts with a mean follow-up of 26.0 months across all included studies. Outcome measures, approaches and materials varied from study to study. A gain of horizontal bone width of the mandible with a mean of 4.8 mm was observed in seven of eight studies. All but one study, reported low bone graft failure rates of 4.4% in average.

Conclusions

Only limited data are available on the impact of different horizontal augmentation strategies in the mandible. The results show outcomes for xenogeneic as well as autologous bone materials for horizontal ridge augmentation of the lower jaw. The use of allogeneic bone-block grafts in combination with resorbable barrier membranes must be re-evaluated. Randomized controlled clinical trials are largely missing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-022-00421-7.

Effect of antibiotic prophylaxis in dental implant surgery: A multicenter placebo‐controlled double‐blinded randomized clinical trial

Background

Purpose

Materials and Methods

Results

Conclusion

Preventive Antibiotic Therapy in the Placement of Immediate Implants: A Systematic Review

Immediate implants present a high risk of early failure. To avoid this, preventive antibiotics (PAs) are prescribed; however, their inappropriate administration leads to antimicrobial resistance. The present study aims to clarify whether the prescription of PAs reduces the rate of early failure of immediate implants and to establish guidelines to avoid the overprescription of these drugs. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS and OpenGrey was carried out. The criteria described in the PRISMA^® statement were used. The search was temporarily restricted from 2010 to 2021. The risk of bias was analysed using the SIGN Methodological Assessment Checklist for Systematic Reviews and Meta-Analyses and the JBI Prevalence Critical Appraisal Tool. After searching, eight studies were included that met the established criteria. With the limitations of this study, it can be stated that antibiotic prescription in immediate implants reduces the early failure rate. Preoperative administration of 2–3 g amoxicillin one hour before surgery followed by 500 mg/8 h for five to seven days is recommended. It is considered prudent to avoid the use of clindamycin in favour of azithromycin, clarithromycin or metronidazole in penicillin allergy patients until further studies are conducted.

What is the evidence on the added value of implant-supported overdentures? A review

Background

Implant‐supported overdentures (IODs) have been reported to increase patients' oral health‐related quality of life (OHRQoL) in comparison with conventional dentures (CDs); however, the conclusiveness of evidence on the clinical effectiveness and value for money of IODs versus CDs remains unclear.

Purpose

To review how the added value of IODs is demonstrated in the literature.

Materials and methods

MEDLINE, EMBASE, and the Cochrane Database were searched for randomized control trials, controlled clinical trials, and prospective cohort studies containing evaluations of the economic and health benefits and costs of IODs. Information about the clinical effectiveness, such as magnitude of bite forces or chewing efficacy, OHRQoL, costs, and cost‐effectiveness of IODs, was extracted.

Results

A total of 17 articles were included, reporting 15 economic evaluations: 11 cost‐utility analyses (CUAs), 2 of which were combined with a cost‐effectiveness analysis (CEA), and 2 cost–benefit analyses (CBAs). Seven CUAs used the Oral Health Impact Profile (OHIP) questionnaire while four used satisfaction questionnaires to assess the OHRQoL. One study applied quality‐adjusted prosthesis years (QAPYs) for this purpose. The CBAs expressed both the beneficial outcome and the costs of the IOD in monetary terms. The included studies employed a large variety of economic evaluation methods, which limited cross‐study comparability.

Conclusions

On the basis of existing economic evaluations, IODs have frequently been suggested to be a cost‐efficient treatment alternative to CDs; however, the comparability between the various economic evaluation studies was limited due to the different outcome measures used. In addition, it remains unclear whether the additional health benefits of IODs outweigh the higher costs. This is largely dependent on the decision maker's valuation of oral health outcomes. Future research is encouraged to further elucidate patient willingness to pay for IODs and the societal return on investing in IODs more generally.

Microsurgical endodontic treatment of the upper molar teeth and their relationship with the maxillary sinus: a retrospective multicentric clinical study

PURPOSE

To assess the clinical and radiographic success rate of microsurgical endodontic treatment of upper molar teeth in relationship with the maxillary sinus, with 12 months follow-up.

METHODS

Patients treated with microsurgical endodontic treatment of upper molar teeth in the period between 2017 and 2019 were recruited from two dental clinics according to specific selection criteria. The outcomes were determined based on clinical and radiographic results taken three, six and 12 months post-operatively, compared with those taken immediately before and after surgery. Clinical and radiographic outcomes were recorded. The distance between the most apical part of the root and of the lesion to the maxillary sinus was measured on CBCT images before the surgery. Patient-related outcomes were recorded.

RESULTS

Out of 35 patients evaluated, 21 were selected according with the selection criteria for a total of 27 roots and 29 canals treated. After 12 months, 18 patients showed a complete healing whereas three demonstrated incomplete healing. Consequently, the success rate in this study was 85.7% after one year. In 28.5% (6 patients) there was a perforation of the Schneiderian membrane that didn't seem to affect the outcome. All patients kept the molar one year later. The pain level decreased significantly over the time during the first week after surgery.

CONCLUSION

Microsurgical Endodontic treatment of the upper molar teeth should be considered a valid and predictable treatment option even in case of Schneiderian membrane perforation. Future clinical studies with a larger sample size are needed to compare the results obtained.

Preventive Antibiotic Prescribing Habits among Professionals Dedicated to Oral Implantology: An Observational Study

The prescription of preventive antibiotics (PA) in oral implantology is a controversial issue. The study aimed to determine the prescribing habits of PA in professionals dedicated to oral implantology in various treatments in healthy and at-risk patients. This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. An electronic survey consisting of 4 blocks of questions was sent to members of the Spanish Society of Implants. The data were analyzed using descriptive analysis. A total of 303 participants (20.8%) responded to the questionnaire. One percent never prescribed PA, 55.4% prescribed them always, and 43.6% prescribed them sometimes. Ninety-six percent administered them preoperatively, while 92.4% administered them postoperatively. The most commonly used antibiotic is amoxicillin followed by amoxicillin with clavulanic acid (875/125 mg). Clindamycin is the most commonly administered antibiotic in patients with allergies. Professionals dedicated to oral implantology frequently prescribe PA in both healthy and at-risk patients, especially perioperatively. Immediate implant placement, sinus lifts, bone regeneration, and multiple implant placement are the treatments in which PA are most commonly prescribed, as well as in patients with heart valve prostheses or a history of bacterial endocarditis and immunodeficiency.

Crestal bone loss associated with different implant surfaces in the posterior mandible in patients with a history of periodontitis. A retrospective study

OBJECTIVE

To retrospectively assess the interproximal bone loss (CBL) in external hexagon implants (EHI), with different surface micro-topography, placed in the posterior mandible in patients with a history of periodontitis undergoing supportive periodontal care.

MATERIAL AND METHODS

268 consecutive patients received 755 EHI implants in the mandibular molar region between 2007 and 2015 with the following surface characteristics: 72 turned, 145 hybrids (double acid-etched/turned), and 538 anodized. CBL was yearly evaluated by analysing calibrated digital periapical radiographs, with a follow-up of 1-6 years. Data on implant survival were also calculated.

RESULTS

At 6 years (53 patients), the mean CBL was 1.34/1.42 mm at patient/implant level, respectively (range: 0-5.2 mm). Significantly higher CBL was detected in anodized implants than in turned and hybrid implants (1.92/1.46/1.02 mm) (p < .01). The maximum CBL values were found in 2 anodized implants at 4 years (6.3 and 8.1 mm). CBL ≥2 mm was detected in 18% of implants at 3 years and 35% at 6 (p < 2.2 × 10^-16 ), this prevalence being 2.6 times higher in the anodized than in the hybrid and turned group (40%/15.6%, p < .0094). At 6 years, 25 anodized implants presented CBL ≥3 mm (18%). 6 anodized implants (5 patients) were removed between 4 and 5 years.

CONCLUSION

A significant higher CBL was observed in anodized, compared to hybrid and turned implants, when placed in the mandibular molar region of periodontal patients, with a follow-up of 1 to 6 years.

Antibiotic prophylaxis during dental implant placement in the UK

Background Antimicrobial resistance is a growing concern globally. It has previously been demonstrated that antibiotic prescribing for dental implants within the UK is varied with an apparent lack of guidance. This study aimed to establish current use of antibiotic prophylaxis during dental implant placements in the UK.Method An anonymous validated online questionnaire was distributed to members of the BAOS, BSSPD, BSP, ADI and ITI. Data were then collated and analysed.Results Two hundred and twenty-nine responses were received during April-July 2018. Fifty-five percent of dentists routinely prescribed antibiotics during implant placements. One-third did sometimes, but not routinely. Thirteen percent never prescribed. Reported protocols contained 61 different drug/dose combinations given over 124 different regimens. Those who prescribed routinely had significantly higher levels of training/qualification (P = 0.008), placed more implants (P = 0.014) and undertook more complex placements (P = 0.002) than non-prescribers. Seventy-three percent believed antibiotics decrease post-operative infection. One in ten felt they gave no benefit. Half believed they decrease implant failure. Over 90% would like national guidelines.Conclusion Significant variance in practice is clear. Almost half of practitioners did not routinely prescribe. Those who did were significantly more experienced, highly trained and did more complex placements. There was a difference between practitioners' perceived benefits of antibiotic prophylaxis and the evidence in the literature. There was a great desire for clearer guidance.

Efficacy of preoperative antibiotics in prevention of dental implant failure: a Meta-analysis of randomized controlled trials

BACKGROUND

Dental implants are commonly used for replacement of missing teeth. Despite the published data highlighting the high success rate of dental implants, failures do occur. Some of these failures are believed to be a result of bacterial contamination at the site of implant insertion. Various antibiotic regimens have already been suggested to prevent failure due to infection.

OBJECTIVE

This meta-analysis aims to examine the efficacy of preoperative antibiotics in prevention of dental implant failure secondary to infections.

METHODOLOGY

An exhaustive search was conducted on electronic database including PubMed Medline, Google Scholar, Scopus, and Cochrane on July 15, 2019. All the randomized controlled trials (RCT) comparing preoperative antibiotics with no antibiotics/placebo in dental implants were included in the study. The primary outcome for assessment was implant failure. A random effect meta-analysis was conducted for risk ratios of dichotomous data.

RESULTS

A total 8544 abstracts were screened following which 16 full text articles were reviewed and 5 RCTs were included in the analysis. Meta-analysis results indicated that the preoperative antibiotics resulted in statistically significantly lower number of implant failures.

CONCLUSION

Preoperative antibiotics effectively reduce the implant failure rate. However, it is recommended to conduct large-scale RCT to determine the efficacy of preoperative antibiotics in dental implants.

Antibiotic prescribing habits of the clinicians dealing with dental implant surgery in Turkey: a questionnaire study

PURPOSE

Although various prophylactic and/or postoperative systemic antibiotic regimens have been suggested to minimize failure after dental implant placement and postoperative infection, the role of antibiotics in implant dentistry is still controversial. The purposes of this questionnaire study were to determine the current antibiotic prescribing habits of clinicians in conjunction with dental implant placement and to understand whether any consensus has been reached among implant surgery performing clinicians.

METHODS

An electronic questionnaire was sent by electronic mail to all members of the Turkish Dental Society. The questions were related to whether antibiotics were routinely prescribed either pre- or/and postoperatively during routine dental implant placement. The respondents were also asked to specify their workplace and education. The results were analyzed using SPSS software. Descriptive and chi-square analyses were used to compare categorical data; Kruskal-Wallis test was used to compare the quantitative data by category.

RESULTS

A total of 429 members responded to the questionnaire. The clinicians having more experience had a greater tendency to prescribe preoperative antibiotics (p < 0.001), but there was no statistically significant difference between the postoperative antibiotic prescription choice of the clinician according to the clinicians' experience (p > 0.05). A total of 175 of the clinicians preferred to prescribe preoperative antibiotics when there was systemic comorbidity; 99 of the clinicians preferred to prescribe antibiotics before every implant surgery. The aminopenicillins were the most commonly prescribed antibiotics by the clinicians. A total of 38.58% of the respondents (n = 130) who were prescribing preoperative antibiotics, 2000 mg aminopenicillin was given 1 h before the surgical procedure. Dentists and solo private practitioners were prescribing more preoperative antibiotics (p < 0,05).

CONCLUSIONS

There was no consensus among clinicians regarding the use of antibiotics in association with routine dental implant placement. Aminopenicillins were the most commonly prescribed antibiotics for both pre- and postoperatively. Furthermore, most of the antibiotic regimens being used are not in accordance with the current published data.

Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review

Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients' risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients.

Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants

BACKGROUND

There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available.

AIM

This randomised clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13).

METHODS

Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a "bottom-up" costing estimation method.

RESULTS

Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost-effectiveness ratios suggested that the overdentures retained by one or two implants were more cost-effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one-way sensitivity analysis.

CONCLUSION

This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost-effective than the fixed implant treatment for the edentulous mandible.

The Long-Term Effect of Smoking on 10 Years' Survival and Success of Dental Implants: A Prospective Analysis of 453 Implants in a Non-University Setting

Background: The purpose of this study was to compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and non-smokers. Material and Methods: All patients referred for implant treatment between November 2004 and 2007 were scrutinized. All implants were placed by the same surgeon (B.C.). The single inclusion criterion was a follow-up time of at least 10 years. Implant survival, health, and bone loss were evaluated by an external calibrated examiner (S.W.) during recall visits. Radiographs taken at recall visits were compared with the post-surgical ones. Implant success was based on two arbitrarily chosen success criteria for bone loss (≤1 mm and ≤2 mm bone loss after 10 years). Implant survival in smokers and non-smokers was compared using the log-rank test. Both non-parametric tests and fixed model analysis were used to assess bone loss in both groups. Results: A total of 453 implants in 121 patients were included for survival analysis, and 397 implants in 121 patients were included for peri-implant bone-loss analysis. After a mean follow-up time of 11.38 years (SD 0.78; range 10.00–13.65), 33 implants out of 453 initially placed had failed in 21 patients, giving an overall survival rate of 92.7% and 82.6% on the implant and patient level, respectively. Cumulative 10 years’ survival rate was 81% on the patient level and 91% on the implant level. The hazard of implant loss in the maxilla was 5.64 times higher in smokers compared to non-smokers (p = 0.003). The hazard of implant loss for implants of non-smokers was 2.92 times higher in the mandible compared to the maxilla (p = 0.01). The overall mean bone loss was 0.97 mm (SD 1.79, range 0–17) at the implant level and 0.90 mm (SD 1.39, range 0–7.85) at the patient level. Smokers lost significantly more bone compared to non-smokers in the maxilla (p = 0.024) but not in the mandible. Only the maxilla showed a significant difference in the probability of implant success between smokers and non-smokers (≤1 mm criterion p = 0.003, ≤2 mm criterion p = 0.007). Taking jaw into account, implants in smokers experienced a 2.6 higher risk of developing peri-implantitis compared to non-smokers (p = 0.053). Conclusion: Dental implants with a fluoride-modified surface provided a high 10 years’ survival with limited bone loss. Smokers were, however, more prone to peri-implant bone loss and experienced a higher rate of implant failure, especially in the upper jaw. The overall bone loss over time was significantly higher in smoking patients, which might be suggestive for a higher peri-implantitis risk. Hence, smoking cessation should be advised and maintained after implant placement from the perspective of peri-implant disease prevention.

Which is the best antibiotic prophylaxis protocol to prevent early implant failures?

Selection criteria The inclusion criteria of this systematic review were patients undergoing dental implant placement. Only randomised clinical trials (RCTs) that compared placebo, no antibiotic and/or any type of antibiotics, administered pre-operatively, intra-operatively, post-operatively or combinations of these, at any dose and for any duration were considered eligible. Included RCTs were required to have a follow up period of at least three months with at least 20 patients per treatment arm. No restrictions on date of publication or language were applied.Key study factor Four electronic databases (MEDLINE, SCOPUS, CENTRAL and Web of Knowledge) in addition to six related journals (Journal of Clinical Periodontology, Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, Journal of Periodontology, European Journal of Oral Implantology, International Journal of Oral & Maxillofacial Implants) were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through hand-searching of reference lists, and through grey literature databases. Two independent reviewers screened the titles and abstracts . Data extraction and risk of bias assessment was performed simultaneously by two reviewers independently and in duplicate using the Cochrane tool for risk of bias assessment. A Network Meta-analysis (NMA) was conducted by integrating direct and indirect comparisons and the probability that each protocol was optimal was estimated. Subgroup and sensitivity analyses were planned to test the effect of risk of bias and of different variables on the results, but were not conducted due to the limited number of included studies.Main outcome measure Outcomes analysed were adverse events and early implant failures, defined as removal of mobile or stable implants with progressive marginal bone loss or infection in the first year after placement.Main results A total of 2248 RCTs were identified after removing duplicates, nine of which were finally included. Different protocols of antibiotic prophylaxis were compared with a total number of 1,693 participants. Seven of the included trials compared the use of one or more protocols of antibiotic prophylaxis with no prophylaxis or prophylaxis with a placebo, and two trials compared the use of different protocols, without the use of a no prophylaxis/placebo group. Amoxicillin was the only type used in all studies. Doses and timing varied among studies, although most of them used a single dose taken just before the implant placement. For the investigated outcomes, two trials were considered at low risk of bias and seven at high risk of bias.All protocols were more effective in reducing implant failures compared to placebo/no antibiotic (mean OR 0.08 to 0.45). Meta-analysis of direct comparison was only possible for the four trials comparing 2 g amoxicillin one hour preoperatively (B) to no antibiotic or placebo (A), indicating B as more effective (pulled OR = 0.40; 95% CI: 0.19-0.88; heterogeneity chi-squared 1.40, P = 0.706). These results were consistent with NMA effect estimates (mean OR = 0.45; 95% CI: 0.0210.93). A single dose of 3 g of amoxicillin administered one hour pre-operatively (C) was statistically more effective in reducing implant failures if compared to no prophylaxis/placebo (OR = 0.41, 95% CI = 0.180.91) and was considered as the most effective protocol. The single dose of 2 g of amoxicillin administered one hour pre-operatively was less effective than protocol C. Adverse events could not be studied in a meta-analysis due to an insufficient number of trials reporting it.Conlusions Implant patients are likely to benefit from antibiotis being administered one hour preoperatively in a dose of 3 g orally. The use of post-operative antibiotics does not seem, however, to be justified.

Antibiotic prophylaxis at dental implant placement: Which is the best protocol? A systematic review and network meta-analysis

AIM

This systematic review of randomized controlled trials (RCTs) aims to answer to the following question: "In patients undergoing dental implant placement, which is the best antibiotic prophylaxis protocol to prevent early failures?"

MATERIALS AND METHODS

The MEDLINE, SCOPUS, CENTRAL and Web of Knowledge electronic databases were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through (i) handsearching on both relevant journals and reference lists, and (ii) searching in databases for grey literature. A network meta-analysis (NMA) was conducted, and the probability that each protocol is the "Best" was estimated.

RESULTS

Nine RCTs were included, with a total of 1,693 participants. Due to the few events reported, it was not possible to conduct a NMA for adverse events, therefore it was conducted only for implant failures (IF). The protocol with the highest probability (32.5%) of being the "Best" one to prevent IF was the single dose of 3 g of amoxicillin administered 1 hr pre-operatively. Even if the single pre-operative dose of 2 g of amoxicillin is the most used, it achieved only a probability of 0.2% to be the "Best" one.

CONCLUSIONS

Basing on the available RCTs, the use of antibiotic prophylaxis is protective against early implant failures. Whenever an antibiotic prophylaxis is needed, there is still insufficient evidence to confidently recommend a specific dosage. The use of post-operative courses does not seem however to be justified by the available literature. Prospero registration number: CRD42015029708.

Differential Efficacy of Two Dental Implant Decontamination Techniques in Reducing Microbial Biofilm and Re-Growth onto Titanium Disks In Vitro

Dental implants are crucial therapeutic devices for successful substitution of missing teeth. Failure cases are mainly pathogen-associated events, allowing clinical progression toward peri-mucositis or peri-implantitis. The aim of this study was to compare the performance of two mechanical decontamination systems, Nickel-Titanium brush (Brush) and Air-Polishing system with 40 µm bicarbonate powder (BIC-40), by means of a novel bioluminescence-based model that measures microbial load in real time. Briefly, 30 disks were contaminated using the bioluminescent Pseudomonas aeruginosa strain (BLI-P. aeruginosa), treated with Brush (30 s rounds, for 90 s) or BIC-40 (30 s, at 5 mm distance) procedure, and then assessed for microbial load, particularly, biofilm removal and re-growth. Our results showed that Brush and BIC-40 treatment reduced microbial load of about 1 and more than 3 logs, respectively. Furthermore, microbial re-growth onto Brush-treated disks rapidly occurred, while BIC-40-treated disks were slowly recolonized, reaching levels of microbial load consistently below those observed with the controls. In conclusion, we provide evidence on the good performance of BIC-40 as titanium device-decontamination system, the clinical implication for such findings will be discussed.

Intentional Replantation of Teeth is a Viable and Cost-effective Alternative Treatment to Single-Tooth Implants

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

A Systematic Review of the Survival of Teeth Intentionally Replanted with a Modern Technique and Cost-effectiveness Compared with Single-tooth Implants. Mainkar A. J Endod 2017:43(12):1963-8.

SOURCE OF FUNDING

Information not available.

TYPE OF STUDY/DESIGN

Systematic review/meta-analysis.

Immediate loading vs. early/conventional loading of immediately placed implants in partially edentulous patients from the patients' perspective: A systematic review

OBJECTIVES

This systematic review aimed at answering the following PICO question: In patients receiving immediate (Type 1) implant placement, how does immediate compare to early or conventional loading in terms of Patient-Reported Outcome Measures (PROMs)?

MATERIAL AND METHODS

Following search strategy development, the OVID, PubMed, EMBASE, and Cochrane Database of Systematic Reviews databases were search for the relevant literature. All levels of evidence including randomized controlled trials, prospective and retrospective cohort studies, and case series of at least five patients were considered for possible inclusion. An additional manual search was performed by screening the reference lists of relevant studies and systematic reviews published up to May 2017. The intervention considered was the placement of immediate implant. Study selection and data extraction were performed independently by two reviewers.

RESULTS

The search yielded a list of 1,102 references, of which nine were included in this systematic review. The limited number of studies included and the heterogeneity of the data identified prevented the performance of a meta-analysis. Three studies, one of which was a randomized controlled trial, allowed the extraction of comparative data specific to the aim of the present systematic review. The remaining studies allowed only data extraction for one single treatment modality and were viewed as single cohort studies. Overall, irrespective of the PROMs chosen, patients' satisfaction was overall high with little difference between the two loading protocols. Moreover, studies indicated a positive impact on oral health-related quality of life following immediate implant placement and loading.

CONCLUSIONS

Within the limitations of the present systematic review, immediate implant placement and loading in single tooth edentulous space seems to be a well-accepted treatment modality from the patients' perspective and is worthy of consideration in clinical practice. However, the paucity of comparative data limits any definitive conclusions as to which loading protocol; immediate or early/conventional, should be given preference based on PROMs.

Experience with bruxism in the everyday oral implantology practice in the Netherlands: a qualitative study

Objective

To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice.

Materials and methods

Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach.

Results

Oral implant treatments in bruxing patients were a generally well-accepted practice. Complications were often expected, with most being of minor impact. Contradictive attitudes emerged on the topic of bruxism being an etiologic factor for peri-implant bone loss and loss of osseointegration. Views on the ideal treatment plan varied, though the importance of the superstructure’s occlusion and articulation features was repeatedly pointed at. Similarly, views on protective splints varied, regarding their necessity and material choice. Bruxism was diagnosed mainly by clinical examination, alongside with patient anamnesis and clinician’s intuition. There was little attention for awake bruxism.

Discussion

Bruxism was generally not considered a contraindication for implantological treatments by accredited oral implantologists. Views on the interaction between bruxism and bone loss/loss of osseointegration varied, as did views on the ideal treatment plan.

Conclusions

There is a need for better understanding of the extent to which, and under which circumstances, sleep and/or awake bruxism can be seen as causal factors for the occurrence of oral implant complications.

Anaerobic Bacteria in Implants and Homologous Teeth 2-14 Years after Implantation

OBJECTIVE

The objective of the study was to establish whether there is a difference in the presence of potentially pathogenic anaerobic microorganisms around the implant and the homologous tooth in implant-prosthetic patients who received individual information about maintaining their oral hygiene.

MATERIAL AND METHODS

The study included 30 subjects with dental implants and metal-ceramic crowns. A periodontal probe was used to record the approximal plaque index (API), the papilla bleeding index (PBI), the periodontal pocket probing depth (PD) and the gingival recession. The fluid around the implant and the gingival sulcus fluid around the homologous tooth on the opposite lateral side were sampled.

RESULTS

The results have shown a positive API and PBI on 30% of the implants and a negative one on 70% of the implants. The average mucosal retraction measured around the implants was 0.15 mm, and the average probing depth was 2.25 mm. The API and PBI were positive on 78.3% of the homologous teeth. The average gingival retraction measured was 1.06 mm, and the average probing depth was 1.85 mm. Anaerobic bacteria were found in 12 out of 30 subjects (40%). Anaerobic bacteria were isolated only on the implant in 7 subjects, only on the homologous tooth in 3 subjects and both on the implant and the homologous tooth in 2 subjects.

CONCLUSIONS

Anaerobic bacteria were more abundantly present on implants than on homologous teeth.

Ten-year follow-up of dental implants used for immediate loading in the edentulous mandible: A prospective clinical study

PURPOSE

The purpose of this study is to evaluate the 10-year outcome of 25 patients with immediate loading in the edentulous mandible.

MATERIAL AND METHODS

Twenty-five patients were consecutively treated with 5 immediately loaded fluoride-modified implants in the edentulous mandible. Implant survival and bone loss were evaluated by an external researcher comparing digital periapical radiographs taken during recall visits with baseline (at implant insertion). Statistical descriptive analysis and nonparametric tests were performed using SPSS v23, multilevel analysis was performed by means of R version 3.1.0. to identify risk factors for bone loss.

RESULTS

Twenty-one patients (8 males, 13 females, mean age 68.4, range 49-84) responded to the 10-year recall invitation. No implants were lost during follow-up, resulting in a 100% survival rate. After 10 years, bleeding on probing and plaque were present at 49.5% and 67.6% of the sites, respectively. The mean pocket probing depth was 3.77 mm (SD 0.73, range 3.0-6.83). Bone loss on implant level after 3, 12, 24, and 120 months was 0.16 mm (SD 0.33, range 0-1.75), 0.14 mm (SD 0.24, range 0-1.05), 0.17 mm (SD 0.27, range 0-1.5), and 0.49 mm (SD 1.08, range 0-7.8). Five implants were identified with or at risk for progressive bone loss. Forty-seven percent of the implants did not show any bone loss after 10 years in function and 87% lost less than 1 mm. Multilevel statistical analysis identified 2-year bone loss as a predictor for bone loss after 10 years of function.

CONCLUSION

Immediate loading of 5 fluoride-modified dental implants with a fixed prosthetic rehabilitation is a predictable and reliable treatment in the edentulous mandible, based on a 100% implant survival and limited peri-implant bone loss. Implants used for immediate loading in the edentulous mandible who are showing early bone loss may be at higher risk to develop peri-implantitis.

Roles of a new drug-delivery healing abutment in the prevention and treatment of peri-implant infections: a preliminary study

In this study we modified the common healing abutment into a specifically designed drug-delivery abutment (DDA), which is a hollow columnar system with drug-distribution holes in peripheral wall. The objective of this study was to investigate the possibility of the prevention and treatment of peri-implant diseases with this drug-delivery system. Minocycline hydrochloride was added to DDAs with different hole diameters, and then subjected to bacteria-inhibition tests in vitro with three oral bacterial strains, namely, Streptococcus mutans, Streptococcus sanguinis, and Porphyromonas gingivalis. The implants were placed into the mandible of beagle dogs. DDAs with or without minocycline and normal healing abutments were installed. One week after surgery, the plaques on all the abutments were analyzed by plaque stain. Following this, both abutments and adjacent teeth received oral hygiene to maintain a healing environment. Eleven weeks later, the ligature-induced experimental peri-implantitis model was set up for eight weeks. Periapical radiographs and clinical measurements were performed during the process. We found that inhibition zones were observed surrounding all the tested drug-delivery abutments in all three bacterial strains. One week after implant installation, oral plaque formed on the DDAs with minocycline was significantly less than that on normal abutments and DDAs without drugs. DDA with the minocycline group showed a relatively slower rate of deterioration of the mucosal inflammation and probing depth in the experimental peri-implant lesions. We suggest that this drug-delivery abutment could effectively deliver medications into peri-implant tissues to minimize plaque formation and relieve peri-implant inflammation in the experimental peri-implantitis model.

We modified a normal abutment into a drug delivery abutment and discussed its possible application in the prevention and treatment of peri-implant infections.

Knowledge, aptitudes, and preferences in implant dentistry teaching/training among undergraduate dental students at the University of Barcelona

Background

Oral implant rehabilitation should be considered a treatment option for any edentulous patient and Implant Dentistry is currently a discipline taught in the undergraduate formation. The level of knowledge acquired and how the students perceive the quality of training in Implant Dentistry could assess to know if it is necessary to improve the syllabus.

Material and Methods

A questionnaire was developed with 11 questions: Basic knowledge (7); Perception of training received (2); Ways in which students would receive training (2). To be responded anonymously and voluntarily for undergraduates students in the Faculty of Dentistry (University of Barcelona, Spain).

Results

One hundred and seven students, 76 third year (Group A) and 31 fourth year (Group B) answered the questionnaire. In Group A, 98.68% of students and in Group B 93.54% believed they were poorly informed; 100% of both groups would prefer to receive more training as part of the degree or as postgraduate training through modular courses imparted by experts (A: 71,05%, B: 70,96%) Training through postgraduate programs or training given by private businesses were the least desirable options (A: 42%, B: 64.51%). Questions about basic knowledge acquired received varying responses, which might indicate a certain level of confusion in this area.

Conclusions

The undergraduate syllabus must be revised to include sufficient content and training to allow the student to indicate implant-based treatments based on evidence. Students would prefer training to be included in the undergraduate syllabus.

Key words:Dental implants, dental students, dental education, dental syllabus, implant dentistry.

Biofilm Analysis of Retrieved Dental Implants after Different Peri-Implantitis Treatments

The aim of the current study was to analyse the planktonic growth of Streptococcus mutans on the surfaces of three implants retrieved after three different peri-implantitis treatments. Three implants from a male patient with high levels of bone loss were treated by mechanical debridement, chemical decontamination, and implantoplasty. After 4 months of follow-up, the implants were removed. The growth and biofilm formation were measured by spectrophotometry (OD630 nm) and scanning electron microscopy (SEM), after 48 hours of incubation. Results showed an average of Streptococcus mutans planktonic growth over the implants of 0.21 nm (mechanical debridement), 0.16 nm (chemical decontamination), and 0.15 nm (implantoplasty). Data were analysed by ANOVA and Tukey's test (p < 0.05 for chemical decontamination and implantoplasty). Implantoplasty and chemical decontamination showed the lowest levels of planktonic growth, indicating a possible influence of the modification procedures on the titanium surface on the initial biofilm attachment.

Survival rate of teeth with periodontally hopeless prognosis after therapies with intentional replantation and perioprosthetic procedures - a study of case series for 5-12 years

The purpose of the present study was to evaluate the longitudinal survival rate of the treatment of teeth affected with periodontally hopeless prognosis and secondary occlusal traumatism (SOT) using intentional replantation (IR) and periodontal prosthesis. We collected data from 17 individuals who received IR and participated in the study during 1995 to 2014. Of the 17 teeth affected by periodontally extreme conditions with deep angular bone defects, severe alveolar bone loss extending to or beyond the apex, and SOT, was recognized as having hopeless prognosis. Those teeth were treated sequentially using procedures that included basic periodontal therapy, therapeutic provisional prosthesis, IR, fixed dental prosthesis, crown and sleeve-coping telescopic dentures (CSCTDs), or fixed prosthesis and CSCTD combined. Longitudinal assessments of clinical parameters and radiographic bone change before and after IR were evaluated. Clinical results showed that the overall cumulative survival rate of assayed teeth after IR therapy (5-12 years) was 88.2%. The mean (±SD) estimated radiographic alveolar bone loss was 12.7 ± 2.1 mm (88.5% ± 13.3%) of the root length, initially, and estimated radiographic alveolar bone gain was 4.0 ± 2.2 mm ultimately, in 17 replanted teeth with SOT. Only one tooth (5.9%) exhibited root resorption. Ankylosis was not observed during the study. Periapical radiographs demonstrated that satisfactory periodontal healing of lamina dura and bone fills occurred in all replanted teeth with SOT. Generally, tooth mobility and SOT were significantly improved after therapy. Most treated teeth functioned well and remained stable clinically throughout the periods of study. The present study documented a promising outcome for autogenous IR and periprosthetic therapy of 17 periodontally hopeless teeth for 5-12 years. The present study revealed good bone gain and elimination of SOT and prominent occlusal function. We concluded that the application of IR, minocycline-HCL and periodontal prosthetic procedures later elevated the prognosis of these otherwise hopeless teeth with SOT, which are valuable options for retaining teeth with periodontally extreme situations.