Lots of research you have there on MATERIALS. Might be time to take a detour and research PERIODONTAL PATHOGENS.
IMO, the MISSING LINK, as far as infections to ANY material goes, is that infections arise from PERIODONTAL PATHOGENS (found in the mouth, between the teeth or close to gums) that can get released into the BLOOD STREAM when a CUT is made INSIDE the mouth to place the implants. These pathogens just love to find their way to any place in the body where there is an implant.
To cut down on the probability of periodontal pathogens ruining an implant surgery, (or any surgery where cuts are made inside the mouth) get a full CLEANING (deep scaling under gum line if needed) MANY months before implants and another cleaning a few months or so before the surgery and in between be very concious that the teeth and gums are very clean and healthy.
Don't get a cleaning too close to the time of the implant surgery though.
Prep with a lot of mouth baths like salt water rinses, hydrogen peroxide, dilute iodine solutions and any other home remedies you can find that are good for 'periodontitis' or 'gingivitis' since it is those 2 conditions that pretty much have the same/similar pathogens associated with the dental and gum conditions they cause.
You can even search out dental practices that do a periodontal pathogen ASSAY. Doesn't hurt to have prophylactic anti-biotics before hand either.
@Kavan: Excellent point and great information which can only further help others prevent complications when dealing with implantable materials. I dropped an applaud on you for + karma
Extending upon what kavan has said, I did indeed decide to detour and came across some beneficial information/resources relating to periodontal pathogens. The following should help inform individuals in preventative planning as well as treatment/therapy of periodontal pathogens which is paramount when considering implants.
Periodontal PathogensPeriodontal pathogens are bacteria that have been shown to significantly contribute to periodontitis.
Although approximately
700 bacterial species have been identified in the oral cavity and nearly 300 species have been cultured and found to contribute to the biofilm (once your implant becomes immersed in biofilm it's over i.e. removal) of the periodontal pocket, there is a much smaller number of species that have been shown to be more closely related to the initial incidence and continued persistence of periodontitis, including:
• Aggregatibacter actinomycetemcomitans
• Porphyromonas gingivalis
• Tannerella forsythia (formerly Bacteroides forsythus)
• Treponema denticola
• Fusobacterium nucleatum
• Prevotella intermedia
• Prevotella nigrescens
• Eikenella corrodens
• Eubacterium nodatum
• Parvimonas micra (formerly Peptostreptococcus micros or Micromonas micros)
• Streptococcus intermedius
• Campylobacter rectus
• Capnocytophaga sp.
Periodontal disease is an inflammatory disease of the supporting tissues of the teeth, which is caused by specific microorganisms or groups of microorganisms living in a biofilm, on and around the teeth. Microorganisms initiate an immune response, and in some cases the result is progressive destruction of gingival tissues, the periodontal ligament and alveolar bone
(Au revoir to your implants) ORAL SYSTEMIC LINK (affecting your implants)
One hundred million Americans are infected with periodontal disease. It is recognized to increase risk for diabetes, heart disease, stroke and other systemic diseases.3 One out of every two American adults over age 30 has gum disease, according to the Center for Disease Control and Prevention (CDC). The findings, published in the Journal of Dental Research, estimate that 47.2 percent, or 64.7 million American adults, have some form of periodontal disease.
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SCurrent scientific evidence links periodontal disease to a myriad of health problems, such as pneumonia, chronic respiratory disease, heart disease, pre-term and low-birth weight babies. One study published in Cardiovascular (1999) reported that among Canadians aged 36 to 69, individuals with severe gum disease have a three to seven times higher risk of fatal heart disease. Researchers also found that those with poor oral health may be up to three times more likely to have a stroke.
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SPrevention & Risk Assessment Bacterial DNA is the key to finding out if the patient is at risk from a microbial burden and human DNA is the key to understanding if the patient is genetically predisposed to an exaggerated response to inflammation.
OralDNA® Labs is a specialty diagnostics company that offers saliva screening by three DNA-polymerase chain-reaction (DNA-PCR) tests based on bacteria, genetics and viral load.
• The first is a bacterial test,
MyPerioPath®, which is used to detect periodontal disease, specifically pathogenic bacteria. This helps guide therapy based on causative agents and not on subjective observation. Additionally, the results of the test will identify tissue invasive bacteria and suggest adjunct oral and locally applied antibiotic protocols if needed. After therapy is completed, a follow-up sample will help monitor the efficacy of treatment and determine if additional measures are required.
Very comprehensive,
check out a test result sample: https://www.oraldna.com/pdf/MyPerioPath_ReportNew.pdf• The second test is based on the individual’s genetic response to inflammation.
MyPerioID® is a genetic susceptibility test which needs to be performed only once in a patient’s lifetime. The Interleukin-6 (IL-6) gene variance in a patient’s DNA is an indication of a predisposition for over-expression of inflammatory mediators. Over-expression of inflammatory mediators can increase the risk for attachment loss or periodontal disease activity. This test result will either be positive or negative. Knowing this information will help determine genetic risk prior to extensive therapy and can help guide therapeutic decisions. Knowing their genetic susceptibility can also help patients understand the severity of their disease and why they might struggle in controlling it. This is additionally helpful for patients with therapy resistant periodontitis or aggressive infections where host modulation therapy is needed.
Test result sample: https://www.oraldna.com/pdf/OralDNALabs-MyPerioID-IL1-report.pdfIn summary, both MyPerioPath® and MyPerioID® enable early identification of risk, and therefore, an opportunity to further personalize care. Without personalized therapy, the patient may continue to experience unresolved infection after therapy and the further spiral of periodontal breakdown.
Here is the link to the kits if anyone is interested:
https://www.oraldna.com/periodontal-testing.htmlTreatmentAn outline of the total mouth disinfection protocol is as follows:1. Occlusal analysis to identify and remove any fremitus in chewing.
2. Attack the bacteria in the pockets mechanically using scaling and root planing.
3. Attack the bacteria in the pockets chemically by irrigating with CariFree Treatment Rinse (Oral BioTech,
www.carifree.com), iodine or chlorhexidine.
4. Deposition of a locally applied time-release antibiotic, Arestin® (OraPharma, Inc.,
www.orapharma.com) in all pockets equal to or greater than 5mm.
5. Attack the bacteria in the bloodstream with the antibiotic regimen suggested on the OralDNA report.
6. Attack the bacteria in the rest of the oral cavity with CariFree Treatment Rinse, ProFresh (ProFresh International Corp.,
www.profresh.com) or other chlorine dioxide rinse to control microbial load. The rinse protocol is to swish for one minute, twice daily.
7. Prescribe home care adjuncts such as a mechanical toothbrush, Waterpik® (Water Pik, Inc.,
www.waterpik.com) or Hydroflosser (Shazzam Tsunami™, Bling Dental Products,
www.blingdentalproducts.com) and interproximal aids, etc., for enhanced bacteria load control.
8. Maintain two-month re-evaluation appointments until stability (zero bleeding on periodontal chart) has been achieved.
Here is the specific total mouth disinfection protocol followed:• Full mouth mechanical debridement with ultrasonic scaling and root planning followed by hand scaling.
• Full mouth in office irrigation with CariFree Treatment Rinse.
• Locally applied Arestin antibiotic placement in all pockets 5mm and above.
• Systemic antibiotic as suggested from the OralDNA report – Amoxicillin 500 mg tid for eight days in combination with Metronidazole 500 mg bid for eight days.
• Oral hygiene instructions were reviewed with specific instructions on the use of an electric toothbrush and an oral irrigator.
• CariFree Treatment Rinse was initiated for one minute twice daily for two months to control biofilm on the tongue, cheeks, and areas not supported by the teeth.
• A tight two-month re-evaluation schedule was planned until zero bleeding was established.
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