Dr. T. asks:
I am relatively new to implants but I have done a lot of surgery and extractions. My protocol is not to prescribe an antibiotic unless there are clear indications that one is needed. This protocol has worked well for me and looking at my colleagues in my area, my patients generally do just as well without me prescribing nearly as many antibiotics as my colleagues. With regard to implants, I cannot find any controlled studies that suggest whether or not healthy patients should or should not receive antibiotics following socket grafting or implant placement. Does anyone have any suggestions? I do not want to prescribe antibiotics unnecessarily.
Antibiotics Following Implant Placement or Socket Grafting?
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According to one recent study one in 20 implants will be lost if antibiotics are not prescribed. In other words 19 people have to take AB so that 20th person’s surgery is successful.
I personally like Dr.Misch protocol : search “Dental Implant Summaries” website for Prophylactic antibiotic regimens in oral implantology.
I always give preop AB.
Diddo – I follow Misch’s protocol, too. The decadron is a big help, too.
I routinely premedicate with ABX for the surgery, mostly with amoxil. Obviously, the first 5 days can be critical where any bugs can start to undo what you just did. It just makes sense to me. Additionally, I place Clindamycin in my socket grafts. Some clinicians use tetracycline. I dont. I know no studies of any problems with this, but I have found Clindamycin to be a great ABX. I also use dose packs, which is a minimal steroid dose but helps control the initial inflammatory phase. My 2 cents. Bill
Dr. Woods:
How much clindamycin do you mix with your graft material?
When preparing a graft mixture, we routinely sprinkle some tetracycline granules into the mix, after being assured the patient does not have an aleregic history.
The granules are most probably osseoconductive, and eventually get resorbed, but their presence is an insurance against possible infection at the time of surgery.
I have not seen anything in the literature that is contradictory to the presence of antibiotics in a particulate graft mixture.
Gerald Rudick dds Montreal
Some graft materials are bacterio-static (CaSo4) and some even scidal (Easygraft).
When mixing there may be an effect on the implant surface interface if grafting at the time of placement.
Placing tetracycline into a particulate graft may inhibit bone development.
Peter, did you mean adverse reaction of the antibiotics or Easygraft on the implant surface ?
Franklin T: Clindamycin injectable vials 300mg/2ml. I usually use about 1/3 of the vial to incorporate a 0.5cc allograft. I prefer Lifenet mineralized graft or puros, but Puros is more expensive. Latetly I have been flushing the socket with the remaining clindo after curretting for RAP and removing any pathology if its there. I havent seen anything untoward in the literature from doing it this way and I have to believe it has merit. I have become accustomed to using it for anything that even hints of infection. For an I & D, I irrigate the pt with sterile saline and then irrigate using Clindamycin. 1 2ml vial is sufficient. The usse it for the oral ABX as well. Hope this helps. Bill
i am no expert on this subject but i think tetracycline due to its acidic ph is a bad idea. go with flagyl liuid (iv)
Hi Astronaft, the anti biotic mixture , the sythetic graft materials mentioned are bacteriostatic thus not an issue , I generally hear of mixing Tetracycline in graft material when Xenografts are used as infection can be devastating.
Regards Peter
Does anyone have any negative info concerning Clindamycin? I have not seen any but am open to hearing all sides. So far, every time I have reentered, there has been a pink “viable” graft. Not to say that it could not heppen and that there is a toxicity issue in some cases. I just havet seen it. Thanks for all of the info about antibiotics. There seems to be an ongoing debate about their use, and certainly the jury isnt out yet. Bill
I have had NO problems with clindamycin. In theory tetracycline can promote granulation rxn and inhibit osteogenesis. Clinically, I have not seen this!
Clindaycycin has it’s severe adverse effects of super- infection in gut by Clostidium difficile causes diarrhea- a classical problem of Clindamycin. But one should note that Clindamycin may prolong the Neuromascular blocking agents, and, to avoid the possible cross-resistance, it should not be used along with Macrlodes and Chloramphenicol. There is no known local reaction with implant components is not reported so far.
Chitta Choudhury PhD, FFDRCS
Mix tetracycline with the material, it will be used as AB and aids in healing process by preventing tissue break down of the collagen.
The ammount of antibioyic mixed with a bone graft would mostlikely not be a factor to cause any issue in the gut etc.