amoxicillin-potassium-clavulanate-combination and Peri-Implantitis

Peri-implantitis leads to gradual peri-implant bone loss. Severe and extreme cases lead to complete implant failure and imply lost implants have to be removed. The aim of the present report is to present a case where an extreme peri-implantitis, causing complete peri-implant bone loss, was managed successfully.. A patient already rehabilitated with a prosthesis supported by two implants at positions 3.4 and 3.6 presented with severe peri-implantitis affecting both implants. Initial probing depths were 11 and 9 mm respectively. Implant at position 3.4 showed a bone-implant gap ≥3 mm all around it, but was kept firmly in place by the prosthesis, still supported by the other implant. The patient refused to have her prosthesis removed. In an attempt to save it anyway, after debridement, sandblasting and decontamination of both implant surfaces an enzyme-deantigenic collagenic bone substitute was grafted. Controls followed at 1, 3, 5 and 12 months after surgery.. Radiographic exams showed radio-opacity at the grafted sites to gradually increase over time. Postoperative probing depth gain, 7 and 6 mm respectively at position 3.4 and 3.6 remained unchanged at all follow-up controls. After 12 months the patient is asymptomatic and the failed implant can be considered restored.. The way we managed this extreme peri-implantitis case has allowed to give clinical success even if, to comply to the patient's will, the best clinical, evidence-based treatment, was not performed. The implant that was otherwise lost was successfully recovered. As an hypothesis, a new osseointegration process could have occurred between the implant and the newly formed bone.

Topics: Aged, 80 and over; Alveolar Bone Loss; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bone Regeneration; Bone Transplantation; Chlorhexidine; Debridement; Dental Restoration Failure; Female; Humans; Mouthwashes; Osseointegration; Peri-Implantitis; Periodontal Pocket; Radiography; Surgical Flaps

Although the risk of developing osteonecrosis of the jaw for oral implants in patients using oral bisphosphonates (BPs) is low, the devastating complications still require caution. We document a case of severe periimplant infection that developed after the patient had used oral BPs for 3 years. Exposed bone and osteonecrosis persisted for more than 2 months after 1 infected implant was explanted by a dentist unaware that the patient was taking BPs. After oral BPs had been stopped, another involved implant was explanted, sequestra were removed, a primary closure was sutured, and the antibiotic was changed; then the wound was finally under control. The explanted implant with attached bone was processed for undecalcified ground sections, and specimens from the bony lesion were sent to pathology for examination. Osteonecrosis, severe inflammatory osteolysis, and heavy bacterial colonization were found. Patients at risk must be alerted about the potential risks of implant failure and developing BP-related osteonecrosis of the jaw.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bisphosphonate-Associated Osteonecrosis of the Jaw; Dental Implants; Dental Restoration Failure; Device Removal; Fusobacterium Infections; Humans; Male; Peri-Implantitis; Prosthesis-Related Infections; Streptococcal Infections; Viridans Streptococci

Although polymicrobial infections, such as peri-implantitis or periodontitis, were postulated in the literature to be caused by synergistic effects of bacteria, these effects remain unclear looking at antibiotic susceptibility. The aim of this study is to compare the antibiotic susceptibilities of pure cultures and definite cocultures.. Laboratory strains of Aggregatibacter actinomycetemcomitans (Aa) (previously Actinobacillus actinomycetemcomitans), Capnocytophaga ochracea (Co), and Parvimonas micra (Pm) (previously Peptostreptococcus micros) were cultivated under anaerobic conditions, and their susceptibilities to 10 antibiotics (benzylpenicillin G, ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, minocycline, metronidazole, linezolid, azithromycin, and moxifloxacin) were tested using the Epsilometertest. Cocultures, each consisting of two or three bacteria, were treated analogously.. All four cocultures showed lower susceptibilities to azithromycin and minocycline than to pure cultures. The coculture Aa-Co showed a lower susceptibility to moxifloxacin as did the coculture Aa-Pm to benzylpenicillin G; the coculture Co-Pm showed a lower susceptibility to amoxicillin, amoxicillin/clavulanic acid, metronidazole, and benzylpenicillin G. However, the coculture Co-Pm showed a higher susceptibility to ampicillin, linezolid and moxifloxacin as did Aa-Pm and Aa-Co-Pm to linezolid.. In addition to established in vitro assays, it was demonstrated that antimicrobial cocultures caused antibiotic susceptibilities that differed from those of pure cultures. Bacterial cocultures frequently showed lowered susceptibilities to antibiotics.

Topics: Acetamides; Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Aza Compounds; Azithromycin; Capnocytophaga; Coculture Techniques; Coinfection; Drug Resistance, Bacterial; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Linezolid; Metronidazole; Microbial Interactions; Minocycline; Moxifloxacin; Oxazolidinones; Penicillin G; Peptostreptococcus; Peri-Implantitis; Periodontitis; Quinolines; Sulbactam