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Erschienen in: Clinical Oral Investigations 9/2013

01.12.2013 | Original Article

Computer-assisted flapless implant placement reduces the incidence of surgery-related bacteremia

verfasst von: Volkan Arısan, Nilüfer Bölükbaşı, Lütfiye Öksüz

Erschienen in: Clinical Oral Investigations | Ausgabe 9/2013

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Abstract

Objective

Bacteremia—the access of bacterium to the bloodstream—may yield life-threatening complications. The aim of this study was to compare the incidence, duration, and type of bacterium leading to bacteremia with relation to conventional and computer-assisted flapless implant surgery.

Material and methods

A total of 377 implants were placed in 68 edentulous jaws using the conventional (conventional group) or a computer-assisted stereolithographic (SLA) template-guided surgery technique (flapless group). Bacteremia was monitored from pre- and postoperative blood samples.

Results

The duration of the surgical intervention was significantly shorter in the flapless group (p = 0.3510). Baseline samples were sterile. Following the 15th minute after the placement of the last implant, bacteria were present in 62 and 12 % of the patients in the conventional and flapless groups, respectively (p < 0.0001; relative risk: 3.05). The differences in the incidence of the bacteremia detected at the baseline and 15 min after the last implant placement were statistically significant in the conventional group (p = 0.0001). However, no such statistical significance was present in the flapless group. Staphylocccus epidermidis, Bifidobacterium spp., Streptococcus viridans, Corynebacterium spp., and Streptococcus sanguinis were the isolated bacterium.

Conclusions

Irrespective of the utilized technique, bacteremia may occur upon the placement of four to eight implants to an edentulous jaw. The probability of bacteremia for the patients operated with the conventional technique is, however, 3.05 greater than those operated with the flapless technique.

Clinical relevance

Flapless implant placement reduces the incidence of surgery-related bacteremia and, therefore, may be beneficial to patients at risk.
Literatur
2.
Zurück zum Zitat Bhanji S, Williams B, Sheller B, Elwood T, Mancl L (2002) Transient bacteremia induced by toothbrushing a comparison of the Sonicare toothbrush with a conventional toothbrush. Pediatr Dent 24(4):295–299PubMed Bhanji S, Williams B, Sheller B, Elwood T, Mancl L (2002) Transient bacteremia induced by toothbrushing a comparison of the Sonicare toothbrush with a conventional toothbrush. Pediatr Dent 24(4):295–299PubMed
4.
Zurück zum Zitat Heimdahl A, Hall G, Hedberg M, Sandberg H, Soder PO, Tuner K, Nord CE (1990) Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures. J Clin Microbiol 28(10):2205–2209PubMed Heimdahl A, Hall G, Hedberg M, Sandberg H, Soder PO, Tuner K, Nord CE (1990) Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures. J Clin Microbiol 28(10):2205–2209PubMed
5.
Zurück zum Zitat Rajasuo A, Perkki K, Nyfors S, Jousimies-Somer H, Meurman JH (2004) Bacteremia following surgical dental extraction with an emphasis on anaerobic strains. J Dent Res 83(2):170–174PubMedCrossRef Rajasuo A, Perkki K, Nyfors S, Jousimies-Somer H, Meurman JH (2004) Bacteremia following surgical dental extraction with an emphasis on anaerobic strains. J Dent Res 83(2):170–174PubMedCrossRef
7.
Zurück zum Zitat Bolukbasi N, Ozdemir T, Oksuz L, Gurler N (2012) Bacteremia following dental implant surgery: preliminary results. Med Oral Patol Oral Cir Bucal 17(1):e69–e75PubMedCrossRef Bolukbasi N, Ozdemir T, Oksuz L, Gurler N (2012) Bacteremia following dental implant surgery: preliminary results. Med Oral Patol Oral Cir Bucal 17(1):e69–e75PubMedCrossRef
8.
Zurück zum Zitat Janket SJ, Baird AE, Chuang SK, Jones JA (2003) Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95(5):559–569. doi:10.1067/moe.2003.107 PubMedCrossRef Janket SJ, Baird AE, Chuang SK, Jones JA (2003) Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95(5):559–569. doi:10.​1067/​moe.​2003.​107 PubMedCrossRef
9.
Zurück zum Zitat Gould FK, Elliott TS, Foweraker J, Fulford M, Perry JD, Roberts GJ, Sandoe JA, Watkin RW, Working Party of the British Society for Antimicrobial C (2006) Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 57(6):1035–1042. doi:10.1093/jac/dkl121 PubMedCrossRef Gould FK, Elliott TS, Foweraker J, Fulford M, Perry JD, Roberts GJ, Sandoe JA, Watkin RW, Working Party of the British Society for Antimicrobial C (2006) Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 57(6):1035–1042. doi:10.​1093/​jac/​dkl121 PubMedCrossRef
10.
Zurück zum Zitat Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (2008) Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 139(Suppl):3S–24SPubMed Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (2008) Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 139(Suppl):3S–24SPubMed
11.
Zurück zum Zitat Durack DT, Kaplan EL, Bisno AL (1983) Apparent failures of endocarditis prophylaxis. Analysis of 52 cases submitted to a national registry. JAMA 250(17):2318–2322PubMedCrossRef Durack DT, Kaplan EL, Bisno AL (1983) Apparent failures of endocarditis prophylaxis. Analysis of 52 cases submitted to a national registry. JAMA 250(17):2318–2322PubMedCrossRef
12.
Zurück zum Zitat Hall G, Hedstrom SA, Heimdahl A, Nord CE (1993) Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis 17(2):188–194PubMedCrossRef Hall G, Hedstrom SA, Heimdahl A, Nord CE (1993) Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis 17(2):188–194PubMedCrossRef
13.
Zurück zum Zitat van der Meer JT, Thompson J, Valkenburg HA, Michel MF (1992) Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis. Arch Intern Med 152(9):1869–1873PubMedCrossRef van der Meer JT, Thompson J, Valkenburg HA, Michel MF (1992) Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis. Arch Intern Med 152(9):1869–1873PubMedCrossRef
14.
Zurück zum Zitat Farbod F, Kanaan H, Farbod J (2009) Infective endocarditis and antibiotic prophylaxis prior to dental/oral procedures: latest revision to the guidelines by the American Heart Association published April 2007. Int J Oral Maxillofac Surg 38(6):626–631. doi:10.1016/j.ijom.2009.03.717 PubMedCrossRef Farbod F, Kanaan H, Farbod J (2009) Infective endocarditis and antibiotic prophylaxis prior to dental/oral procedures: latest revision to the guidelines by the American Heart Association published April 2007. Int J Oral Maxillofac Surg 38(6):626–631. doi:10.​1016/​j.​ijom.​2009.​03.​717 PubMedCrossRef
15.
Zurück zum Zitat Cousido MC, Tomás Carmona I, García-Caballero L, Limeres J, Alvarez M, Diz P (2010) In vivo substantivity of 0.12 % and 0.2 % chlorhexidine mouthrinses on salivary bacteria. Clin Oral Investig 14(4):397–402PubMedCrossRef Cousido MC, Tomás Carmona I, García-Caballero L, Limeres J, Alvarez M, Diz P (2010) In vivo substantivity of 0.12 % and 0.2 % chlorhexidine mouthrinses on salivary bacteria. Clin Oral Investig 14(4):397–402PubMedCrossRef
18.
Zurück zum Zitat Branemark P, Zarb G (1985) Tissue-integrated prosthesis: osseointegration in clinical dentistry. In: Branemark PI (ed) Tissue-integrated prosthesis: osseointegration in clinical dentistry. Quintessence, Chicago, pp 241–282 Branemark P, Zarb G (1985) Tissue-integrated prosthesis: osseointegration in clinical dentistry. In: Branemark PI (ed) Tissue-integrated prosthesis: osseointegration in clinical dentistry. Quintessence, Chicago, pp 241–282
19.
Zurück zum Zitat Arisan V, Karabuda CZ, Ozdemir T (2010) Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res 21(9):980–988. doi:10.1111/j.1600-0501.2010.01957.x PubMed Arisan V, Karabuda CZ, Ozdemir T (2010) Implant surgery using bone- and mucosa-supported stereolithographic guides in totally edentulous jaws: surgical and post-operative outcomes of computer-aided vs. standard techniques. Clin Oral Implants Res 21(9):980–988. doi:10.​1111/​j.​1600-0501.​2010.​01957.​x PubMed
20.
Zurück zum Zitat Fortin T, Bosson JL, Isidori M, Blanchet E (2006) Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants 21(2):298–304PubMed Fortin T, Bosson JL, Isidori M, Blanchet E (2006) Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants 21(2):298–304PubMed
21.
Zurück zum Zitat Cutress TW, Ainamo J, Sardo-Infirri J (1987) The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 37(4):222–233PubMed Cutress TW, Ainamo J, Sardo-Infirri J (1987) The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 37(4):222–233PubMed
22.
Zurück zum Zitat Arisan V, Karabuda ZC, Piskin B, Ozdemir T (2012) Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-aided implant placement. Part II: reliability of mucosa-supported stereolithographic guides. Clin Implant Dent Relat Res. doi:10.1111/j.1708-8208.2011.00435.x Arisan V, Karabuda ZC, Piskin B, Ozdemir T (2012) Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-aided implant placement. Part II: reliability of mucosa-supported stereolithographic guides. Clin Implant Dent Relat Res. doi:10.​1111/​j.​1708-8208.​2011.​00435.​x
23.
Zurück zum Zitat Arisan V (2011) Conventional—and cone beam—CT-derived stereolithographic surgical guides in the planning and placement of dental implants. In: Saba L (ed) Computed tomography—special applications. Intech, Crotia, pp 195–216 Arisan V (2011) Conventional—and cone beam—CT-derived stereolithographic surgical guides in the planning and placement of dental implants. In: Saba L (ed) Computed tomography—special applications. Intech, Crotia, pp 195–216
26.
Zurück zum Zitat Takai S, Kuriyama T, Yanagisawa M, Nakagawa K, Karasawa T (2005) Incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99(3):292–298. doi:10.1016/j.tripleo.2004.10.022 PubMedCrossRef Takai S, Kuriyama T, Yanagisawa M, Nakagawa K, Karasawa T (2005) Incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99(3):292–298. doi:10.​1016/​j.​tripleo.​2004.​10.​022 PubMedCrossRef
27.
Zurück zum Zitat Otten JE, Pelz K, Christmann G (1987) Anaerobic bacteremia following tooth extraction and removal of osteosynthesis plates. J Oral Maxillofac Surg 45(6):477–480PubMedCrossRef Otten JE, Pelz K, Christmann G (1987) Anaerobic bacteremia following tooth extraction and removal of osteosynthesis plates. J Oral Maxillofac Surg 45(6):477–480PubMedCrossRef
30.
Zurück zum Zitat Lucas VS, Lytra V, Hassan T, Tatham H, Wilson M, Roberts GJ (2002) Comparison of lysis filtration and an automated blood culture system (BACTEC) for detection, quantification, and identification of odontogenic bacteremia in children. J Clin Microbiol 40(9):3416–3420PubMed Lucas VS, Lytra V, Hassan T, Tatham H, Wilson M, Roberts GJ (2002) Comparison of lysis filtration and an automated blood culture system (BACTEC) for detection, quantification, and identification of odontogenic bacteremia in children. J Clin Microbiol 40(9):3416–3420PubMed
31.
Zurück zum Zitat Hogg GM, McKenna JP, Ong G (2008) Rapid detection of methicillin-susceptible and methicillin-resistant Staphylococcus aureus directly from positive BacT/Alert blood culture bottles using real-time polymerase chain reaction: evaluation and comparison of 4 DNA extraction methods. Diagn Microbiol Infect Dis 61(4):446–452. doi:10.1016/j.diagmicrobio.2008.03.012 PubMedCrossRef Hogg GM, McKenna JP, Ong G (2008) Rapid detection of methicillin-susceptible and methicillin-resistant Staphylococcus aureus directly from positive BacT/Alert blood culture bottles using real-time polymerase chain reaction: evaluation and comparison of 4 DNA extraction methods. Diagn Microbiol Infect Dis 61(4):446–452. doi:10.​1016/​j.​diagmicrobio.​2008.​03.​012 PubMedCrossRef
32.
Zurück zum Zitat Lockhart PB, Durack DT (1999) Oral microflora as a cause of endocarditis and other distant site infections. Infect Dis Clin North Am 13(4):833–850, viPubMedCrossRef Lockhart PB, Durack DT (1999) Oral microflora as a cause of endocarditis and other distant site infections. Infect Dis Clin North Am 13(4):833–850, viPubMedCrossRef
33.
Zurück zum Zitat Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS, Investigators ICE (2005) Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 293(24):3012–3021. doi:10.1001/jama.293.24.3012 PubMedCrossRef Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS, Investigators ICE (2005) Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 293(24):3012–3021. doi:10.​1001/​jama.​293.​24.​3012 PubMedCrossRef
34.
Zurück zum Zitat Percival RS, Challacombe SJ, Marsh PD (1991) Age-related microbiological changes in the salivary and plaque microflora of healthy adults. J Med Microbiol 35(1):5–11PubMedCrossRef Percival RS, Challacombe SJ, Marsh PD (1991) Age-related microbiological changes in the salivary and plaque microflora of healthy adults. J Med Microbiol 35(1):5–11PubMedCrossRef
35.
Zurück zum Zitat Wade W, Kononen E (2012) Propionibacterium, Lactobacillus, Actinomyces, and other non-spore-forming anaerobic gram-positive rods. In: Murray, Baron, Jorgensen, Landry, Pfaller (eds) Manual of clinical microbiology, vol 1, 10th edn. ASM, Washington DC, pp 872–888 Wade W, Kononen E (2012) Propionibacterium, Lactobacillus, Actinomyces, and other non-spore-forming anaerobic gram-positive rods. In: Murray, Baron, Jorgensen, Landry, Pfaller (eds) Manual of clinical microbiology, vol 1, 10th edn. ASM, Washington DC, pp 872–888
36.
Zurück zum Zitat Funke G, Kathryna A (2012) Coryneform gram-positive rods. In: Carroll K, Funke G (eds) Manual of clinical microbiology, vol 1. ASM, Washington DC., pp 485–499 Funke G, Kathryna A (2012) Coryneform gram-positive rods. In: Carroll K, Funke G (eds) Manual of clinical microbiology, vol 1. ASM, Washington DC., pp 485–499
37.
Zurück zum Zitat Netzer RO, Zollinger E, Seiler C, Cerny A (2000) Infective endocarditis: clinical spectrum, presentation and outcome. An analysis of 212 cases 1980–1995. Heart 84(1):25–30PubMedCrossRef Netzer RO, Zollinger E, Seiler C, Cerny A (2000) Infective endocarditis: clinical spectrum, presentation and outcome. An analysis of 212 cases 1980–1995. Heart 84(1):25–30PubMedCrossRef
38.
Zurück zum Zitat Monsenego P (2000) Presence of microorganisms on the fitting denture complete surface: study ‘in vivo’. J Oral Rehabil 27(8):708–713PubMedCrossRef Monsenego P (2000) Presence of microorganisms on the fitting denture complete surface: study ‘in vivo’. J Oral Rehabil 27(8):708–713PubMedCrossRef
39.
Zurück zum Zitat Marsh PD, Percival RS, Challacombe SJ (1992) The influence of denture-wearing and age on the oral microflora. J Dent Res 71(7):1374–1381PubMedCrossRef Marsh PD, Percival RS, Challacombe SJ (1992) The influence of denture-wearing and age on the oral microflora. J Dent Res 71(7):1374–1381PubMedCrossRef
40.
Zurück zum Zitat Roberts GJ, Watts R, Longhurst P, Gardner P (1998) Bacteremia of dental origin and antimicrobial sensitivity following oral surgical procedures in children. Pediatr Dent 20(1):28–36PubMed Roberts GJ, Watts R, Longhurst P, Gardner P (1998) Bacteremia of dental origin and antimicrobial sensitivity following oral surgical procedures in children. Pediatr Dent 20(1):28–36PubMed
42.
Zurück zum Zitat Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638. doi:10.1086/313753 PubMedCrossRef Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638. doi:10.​1086/​313753 PubMedCrossRef
43.
Zurück zum Zitat Tomás I, Cousido MC, García-Caballero L, Rubido S, Limeres J, Diz P (2010) Substantivity of a single chlorhexidine mouthwash on salivary flora: influence of intrinsic and extrinsic factors. J Dent 38(7):541–546PubMedCrossRef Tomás I, Cousido MC, García-Caballero L, Rubido S, Limeres J, Diz P (2010) Substantivity of a single chlorhexidine mouthwash on salivary flora: influence of intrinsic and extrinsic factors. J Dent 38(7):541–546PubMedCrossRef
44.
Zurück zum Zitat Groppo FC, Castro FM, Pacheco AB, Motta RH, Filho TR, Ramacciato JC, Florio FM, Meechan JG (2005) Antimicrobial resistance of Staphylococcus aureus and oral streptococci strains from high-risk endocarditis patients. Gen Dent 53(6):410–413PubMed Groppo FC, Castro FM, Pacheco AB, Motta RH, Filho TR, Ramacciato JC, Florio FM, Meechan JG (2005) Antimicrobial resistance of Staphylococcus aureus and oral streptococci strains from high-risk endocarditis patients. Gen Dent 53(6):410–413PubMed
45.
Zurück zum Zitat Motulsky H (1995) Designing clinical studies. In: Motulsky H (ed) Intuitive biostatistics. Oxford University Press, New York, pp 183–191 Motulsky H (1995) Designing clinical studies. In: Motulsky H (ed) Intuitive biostatistics. Oxford University Press, New York, pp 183–191
Metadaten
Titel
Computer-assisted flapless implant placement reduces the incidence of surgery-related bacteremia
verfasst von
Volkan Arısan
Nilüfer Bölükbaşı
Lütfiye Öksüz
Publikationsdatum
01.12.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Oral Investigations / Ausgabe 9/2013
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-012-0886-y

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