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Immediate Implants Placed into Infected Sockets
LETTER TO THE EDITOR J Oral Maxillofac Surg 66:2415, 2008
IMMEDIATE IMPLANTS PLACED INTO INFECTED SOCKETS To the Editor:—We are grateful for the comments of Dr Goldberg1 regarding our report on implants in infected sites.2 This is a controversial issue, and we welcome the debate on the points raised by this report. The decision to publish it in the Journal of Maxillofacial Surgery and to target its readership intended to stir up such discussion. Indeed, insertion of an implant into infected tissues should raise a few brows, but we must point out that we clearly stated that the sites were debrided, namely, were treated surgically for complete removal of the contaminated tissue. We wish to reemphasize that the protocol described in the report had been reviewed and recommended by several surgeons with extensive expertise in implantology and guided-bone regeneration. The report described insertion of implants in infected sites in both frontal and posterior maxillary and mandibular regions. Nonetheless, the advantages of using this protocol are much greater in the anterior regions, as detailed in the report. Admittedly, the examples we have discussed from the field of spinal surgery3,4 are for a more severe medical condition, but this technique was applied there despite the arguable existence of alternative approaches. Furthermore, not only did these examples support our surgical decision, but also suggested that the likelihood of success of such implants in the jaws is higher than in the vertebrae, realizing that circulation around the oral structures is superior to that of the spine. As for the antibiotic regimen, the protocol clearly stated that antibiotics were administered for 10 days, as is common in intraoral bone grafting, and not for 14 days. The use and dosage of antibiotic prophylaxis and treatment in implantology is currently under scrutiny,5,6 and therefore, we are aware that cautious and weighed use of antibiotics is required. The
alternative to our procedure might have involved 2 additional surgical procedures beyond the extraction of the involved teeth— bone augmentation, and at the later time, insertion of the implants. These additional procedures would, most likely, have required extra antibiotic therapy. Thus, our protocol actually reduced the use of antibiotics and minimized the consequential associated risks. We hope that future randomized clinical trials of this procedure will be conducted with the collaboration of experts in microbiology and infectious diseases. NARDY CASAP, DMD, MD Hadassah, Jerusalem, Israel
References 1. Goldberg MH: Immediate implants placed into infected sockets. J Oral Maxillofac Surg 66:1081, 2008 2. Casap N, Zeltser C, Wexler A, et al: Immediate placement of dental implants into debrided infected dentoalveolar sockets. J Oral Maxillofacial Surg 65:384, 2007 3. Hee HT, Majd ME, Holt RT, et al: Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15:149, 2002 4. Liljenqvist U, Lerner T, Bullmann V, et al: Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12:606, 2003 5. Esposito M, Coulthard P, Oliver R, et al: Antibiotics to prevent complications following dental implant treatment. Cochrane Database Syst Rev 3:CE004512, 2003 6. Schwartz AB, Larson EL: Antibiotic prophylaxis and postoperative complications after tooth extraction and implant placement: A review of the literature. J Dent 35:881, 2007
doi:10.1016/j.joms.2008.07.025
Letters to the Editor are considered for publication (subject to editing and abridgment), provided they are submitted in 1 of 2 ways. If typewritten, they must be submitted in duplicate, signed by all authors, double-spaced, and should not exceed 40 typewritten lines of manuscript text (excluding references). You may also e-mail your Letters to the Editor to [email protected]. The same length limits apply. Letters should not duplicate similar material being submitted or published elsewhere. Letters responding to a recent Journal article must be received within 6 weeks of the article’s publication. Receipt of letters is not acknowledged and there is no guarantee that your letter will be published. We cannot provide prepublication proofs. Submitting the letter constitutes your permission for its publication in any current or subsequent issue or edition of the Journal, in any form or media, now known or hereafter developed.
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IMMEDIATE IMPLANTS PLACED INTO INFECTED SOCKETS To the Editor:—We are grateful for the comments of Dr Goldberg1 regarding our report on implants in infected sites.2 This is a controversial issue, and we welcome the debate on the points raised by this report. The decision to publish it in the Journal of Maxillofacial Surgery and to target its readership intended to stir up such discussion. Indeed, insertion of an implant into infected tissues should raise a few brows, but we must point out that we clearly stated that the sites were debrided, namely, were treated surgically for complete removal of the contaminated tissue. We wish to reemphasize that the protocol described in the report had been reviewed and recommended by several surgeons with extensive expertise in implantology and guided-bone regeneration. The report described insertion of implants in infected sites in both frontal and posterior maxillary and mandibular regions. Nonetheless, the advantages of using this protocol are much greater in the anterior regions, as detailed in the report. Admittedly, the examples we have discussed from the field of spinal surgery3,4 are for a more severe medical condition, but this technique was applied there despite the arguable existence of alternative approaches. Furthermore, not only did these examples support our surgical decision, but also suggested that the likelihood of success of such implants in the jaws is higher than in the vertebrae, realizing that circulation around the oral structures is superior to that of the spine. As for the antibiotic regimen, the protocol clearly stated that antibiotics were administered for 10 days, as is common in intraoral bone grafting, and not for 14 days. The use and dosage of antibiotic prophylaxis and treatment in implantology is currently under scrutiny,5,6 and therefore, we are aware that cautious and weighed use of antibiotics is required. The
alternative to our procedure might have involved 2 additional surgical procedures beyond the extraction of the involved teeth— bone augmentation, and at the later time, insertion of the implants. These additional procedures would, most likely, have required extra antibiotic therapy. Thus, our protocol actually reduced the use of antibiotics and minimized the consequential associated risks. We hope that future randomized clinical trials of this procedure will be conducted with the collaboration of experts in microbiology and infectious diseases. NARDY CASAP, DMD, MD Hadassah, Jerusalem, Israel
References 1. Goldberg MH: Immediate implants placed into infected sockets. J Oral Maxillofac Surg 66:1081, 2008 2. Casap N, Zeltser C, Wexler A, et al: Immediate placement of dental implants into debrided infected dentoalveolar sockets. J Oral Maxillofacial Surg 65:384, 2007 3. Hee HT, Majd ME, Holt RT, et al: Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15:149, 2002 4. Liljenqvist U, Lerner T, Bullmann V, et al: Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12:606, 2003 5. Esposito M, Coulthard P, Oliver R, et al: Antibiotics to prevent complications following dental implant treatment. Cochrane Database Syst Rev 3:CE004512, 2003 6. Schwartz AB, Larson EL: Antibiotic prophylaxis and postoperative complications after tooth extraction and implant placement: A review of the literature. J Dent 35:881, 2007
doi:10.1016/j.joms.2008.07.025
Letters to the Editor are considered for publication (subject to editing and abridgment), provided they are submitted in 1 of 2 ways. If typewritten, they must be submitted in duplicate, signed by all authors, double-spaced, and should not exceed 40 typewritten lines of manuscript text (excluding references). You may also e-mail your Letters to the Editor to [email protected]. The same length limits apply. Letters should not duplicate similar material being submitted or published elsewhere. Letters responding to a recent Journal article must be received within 6 weeks of the article’s publication. Receipt of letters is not acknowledged and there is no guarantee that your letter will be published. We cannot provide prepublication proofs. Submitting the letter constitutes your permission for its publication in any current or subsequent issue or edition of the Journal, in any form or media, now known or hereafter developed.
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