1. ANTIMICROBIAL AGENTS FOR AVOIDING SURGICAL SITE INFECTION IN IMPLANT SURGERY Dr Alireza Talebian ResearchGate Score: 11.08 Dr Roghayeh Iranpoor

2.  File of this presentation is available at:  www.dr-Talebian.ir www.dr-Talebian.ir  https://www.researchgate.net/profile/Alireza_Talebian/contributions https://www.researchgate.net/profile/Alireza_Talebian/contributions

3. REFERENCE: 1- GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS — 2003. AVAILABLE AT: WWW.CDC.GOV 2- GUIDELINE FOR PREVENTION OF SURGICAL SITE INFECTION, 1999 AVAILABLE AT: WWW.CDC.GOV 3-USE OF ANTIBIOTICS IN DENTAL IMPLANT SURGERY: A DECISION BASED ON EVIDENCE FROM SYSTEMATIC REVIEW INTERNATIONAL JOURNAL OF ODONTOSTOMATOLOGY 9(1):137-147, 2015 A 4-BRITISH DENTAL JOURNAL VOLUME 217 NO. 4 AUG 22 2014 5- ASEPSIS DURING PERIODONTAL SURGERY INVOLVING ORAL IMPLANTS AND THE USEFULNESS OF PERI ‐ OPERATIVE ANTIBIOTICS: A PROSPECTIVE, RANDOMIZED, CONTROLLED CLINICAL TRIAL. M ABU ‐ TA'A, M QUIRYNEN, W TEUGHELS… - … PERIODONTOLOGY, 2008WWW.CDC.GOV

4.  Some reports have shown that antibiotic prophylaxis offers no advantage in preventing post- operative infections or affecting the outcomes of periodontal surgery involving gingivectomy (Pack & Haber 1983), mucogingival procedures (Checchi et al. 1992), osseous grafts (Pack & Haber 1983), or the insertion of endosseous implants (Gynther et al.1998).Ref No 5 p 2  The rate of infections following periodontal surgery, when no antibiotics were used, ranges from less than 1% (Pack & Haber 1983) to 4.4% (Checchi et al. 1992) for routine periodontal surgery and 4.5% when endosseous implants are installed (Gynther et al. 1998). Ref No 5 p 2  Several sources of infection during surgery in the oral cavity have been identified: instruments, the hands of surgeon and assistants, the air of the operatory room (OR), patients’ nostrils and saliva, and the peri-oral skin (van Steenberghe et al. 1997). Ref No 5 p 2  Nose Mesh during surgery

5. It has been reported that S. aureus carriers have a two- to nine-fold increased risk of development of surgical-site infections (Wenzel & Perl 1995) Ref No 5 p 2

6.  Presence of bacterial biofilms, overheating, and surgical trauma are considered the main reasons of early implant failure. Oral microbes Surgical Site Infection Implant Failure Antibiotics are effective in reducing Surgery Site Infection and therefore implant failure. But which type, dosage and duration is the most effective?

7. In medicine: According to a CDC document, any graft, prostheses, or implant can be infected with Staphylococcus strains and antimicrobial prophylaxis is indicated (Ref No 2 P 255). It is applicable for dental implants.

8. In 2015, In a systematic review (by Claudia Asenjo-Lobos; Jorge Jofre; Marcela Cortes & Manterola Carlos), from 164 articles reviewed, 11 fulfilled the selection criteria representing 9472 placed implants. Antibiotics regimens used are as follows: Pre-operative only: 2 grs Amoxicillin PO 1 hour before surgery 1 gr Penicillin V PO 1 hour before surgery or 600 mg Clindamycin PO 1 hour before surgery Pre-operative + postoperative: Slowly 1.000.000 unit (Pen G) IV or 600mg (Clynda) IV + 300 mg (Pen V) P.O. 4 times/day for 7 days or 150 mg (Clynda) P.O. 3 times/day for 7 days 2 g Pen V P.O. 2 times/day for 1 week postoperatively, the first dose being given1 hour preoperatively. 2 g Amox P.O. 1 hour preoperatively + postoperative doses of 500 mg 3 times/day for 5 days 2 g Amox P.O 1 hour preoperatively + 1 g 2 times/day for 7 days postoperatively 500 mg (Azithro/Clari) P.O. 1h preoperatively+500mg P.O.6h after+500mg P.O. 18h after Postoperative only: Amoxicillin/Clavulanic acid (Coamoxiclave) 625 mg P.O. 3 times/day for 5 days postoperatively. Amoxicillin 1 g P.O. 2 times/day postoperatively continued for 1 week.

11. Additionally, it should be considered that most dental implants are located in previously compromised sites with a certain degree of infection which could be a main risk for infection and risk of implant failure. (Nelson & Thomas, 2010)

13. In Claudia study, they found that follow-up periods in survived investigations varied from 7 to 180 days as indicated in the table bellow

14. Implant failures are as follows:

15. Antibiotic Adverse effects. Overall, antibiotics were well tolerated by patients. No participant presented hypersensitivity reactions. People using prophylaxis antibiotics had very low frequency of gastrointestinal effects.

16. Conclusion: Despite the study limitations, antibiotic prophylaxis seems to yield a favorable effect, particularly when used in regimens considering postoperative antibiotics.

19. Preprocedural Mouth Rinses 1)Antimicrobial mouth rinses used by patients before a dental procedure are intended to reduce the number of microorganisms (97%) the patient might release in the form of aerosols or spatter that subsequently can contaminate DHCP and equipment operatory surfaces. 2)In addition, preprocedural rinsing can decrease the number of microorganisms introduced in the patient’s bloodstream during invasive dental procedures Reference No 1 page 32 A 1 min pre-operative rinse of 0.2% CHX is recommended as this has been demonstrated to reduce the oral bacterial load by 97%.Three times daily mouth rinses of 0.2% CHX for 7 days (or until the sutures are removed) is also advised as an effective adjunct for post-implant placement wound care. Reference No 4 p 173 Therefore preprocedural mouth rinses (e.g. chlorhexidine) has synergistic effect on antibiotic therapy.