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Ask UsDr. S. asks:
Has anyone had experience or read anything about coating tetracycline on dental implants at the time of placement? I have tried this and feel integration is quicker and superior.
I have been using tetracycline in my composite bone grafts with great success over the last few years. I
now understand that in Europe they are coating gortex membranes with success
and at the last AO conference it was stated that sinus grafts have less
infection with tetracycline added to the graft. Any thoughts?
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11 Responses to “ Coating Tetracycline on Implants? ”
How are you determining that your implant integration is quicker and superior and your composites grafts do better…compared to what…any science? All of what you suggest is antecdotal.
Dear Dr. S:
Tetracycline has been used in implants since before I started that means more than 15 years. Its acidity is the key to a faster osseointegration … it helps osteoblasts to turn into osteoclasts so bone remodeling is faster and helps in the diferentiation to osteoblasts so new bone is formed faster.
I have too used tetracycline for years in my grafts with great success.
Many times we irrigate the osteotomy site with a tetra solution before placing the implant… no cientific data but empiricly I would say it works.
Cheers
As a periodontist I’ve long impregnated allograft materials for 3-walled pockets, as well as sinus graft allo- and xeno- materials. Success rate seems markedly improved, albeit emperical. However, I’m skeptical that salting the walls of an osteotomy will be kind to the bone-implant interface. The acidity of the tetracycline is my concern
most of us have seen improvements in implant grafting using tetracycine, so why not the implants? Has anyone even investigated this option, the science is there regarding the inductive effect of tetracycine as well as the colliginase and inflammatory inhibiting effects of this remarkable antibiotic.
tetracycine is on of the hidden secrets of surgery of the oral cavity. we all assume that antibodies will take care of things but this is not always the case. case success can be greatly improved and should be improved using agents such as tetracycline. especially when prothetic devices such as implants are imbedded into living tissue such as bone. It makes sense from a logical and imperical standpoint but if we wait for the “real science” to prove it we’ll be waiting for thirty years for data just like we were all waiting for scientific evidence that smoking causes cancer. why not rely on observation and clinical examination.
What form of tetracycline does one use? How is it prepared?
Thanks!
It is my understanding that tetracycline has the unfortunate ability to denature HA and should therefore not be considered for use around HA coated implants and/or grafts containing HA. I wish I could remember the studies that I obtained this information from; if I come across them shortly, I will post them.
I hope that this is helpful to you.
Some of the pioneering work work from Dr. Roland Meffert at the University of Texas regarding ailing implants is that tetracycline interferes with the Ca-P bond in bone and is containdicated in attempting to reintegrate the HA covered implant. While the acidity of tetracycline hydochloride mimics the cellular change of pH in the inflammatory response, it may actually DELAY the initial bone response. However, the antimicrobial effect may be beneficial in extraction/immediate placement cases. If you want the same response without the baggage of delayed bone healing, try low level laser (diode) therapy post implant placement. There is ample peer-reviewed orthopeadic literature to support what we are doing with lasers in oral implantology to speed up osseointegration.
there is logic in the fact that if tetracycline is good for bone generation and healing that it should be good for bone to generate around the implant interface as long as it is titanium. Ha interface may be a consern but HA implants are on their way out. Maybe the coorporate mogals at nobel should be paying attention to this blog….
On the contrary, HA coatings are still superior in their ability to increase the rate of type I human collagen synthesis and thus the rate of osseointegration. It is the PLASMA SPRAYED coatings that will be phased out in favor of thin film ion beam impregnation of surfaces - all of the benefits of HA without the old baggage.
In the sinus, the problem is essentially anaerobs. Therefore, cyclines are not the best AB. Metronidazole is the answer.
That has been widely studied and publshed already in Europe. Choukroun & Al, 2001, 2004.
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