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PubMed1992

Long-standing plaque and gingivitis at implants and teeth in the dog.

The experiment was performed to evaluate the effects of long-standing plaque on the gingiva and peri-implant mucosa. 5 beagle dogs were used in the study. The mandibular right premolars were extracted. 3 months later, 3 titanium fixtures were installed and after another 3 months, abutment connection was performed. Plaque control, in the implant as well as the contralateral tooth regions, was maintained during a 4-month period prior to the start of the main experiment. On Day 0, the teeth and implant sections were examined with respect to plaque and gingivitis. The plaque control program was terminated. The animals were subsequently fed a diet which allowed gross plaque accumulation. After 90 days of undisturbed plaque formation, the dogs were re-examined and biopsies harvested from implants and contralateral teeth. On day 90, all teeth and implants had accumulated large amounts of plaque. The soft tissue at implants and teeth bled on gentle probing. The histological examination of the gingiva and the peri-implant mucosa revealed: (i) both tissues contained an inflammatory cell infiltrate; ICT, (ii) the apical extension of ICT was more pronounced in the peri-implant mucosa than in the gingiva and (iii) the composition of the 2 lesions had many features in common.

Animals↗
PubMed1992

Putative periodontal pathogens on titanium implants and teeth in experimental gingivitis and periodontitis in beagle dogs.

The microflora around titanium implants and teeth in 4 beagle dogs was analyzed in order to follow the longitudinal development from healthy conditions to experimental gingivitis and periodontitis. A 2-month plaque control program was performed to establish healthy conditions on titanium implants and control teeth (baseline, day 0). Subgingival bacterial samples and radiographs were obtained. The plaque control was ceased and all measurements were repeated on day 21 (gingivitis). A new period of plaque control was initiated to re-establish healthy conditions (day 49). A cotton ligature was placed subgingivally around the implants and the control teeth to induce tissue breakdown. The ligatures were removed on day 91. The study was completed with registrations on day 121 (periodontitis). No significant microbiological difference was found between titanium implants and teeth in healthy conditions and in gingivitis and periodontitis. The mean total viable count increased 10 times on implants as well as on teeth. Streptococci were dominating at baseline: 40.2% on implants and 60.6% on teeth and decreased in gingivitis to 11.7% and 5.4%. When periodontitis had developed, the proportion of streptococci was < 1%. At baseline few Porphyromonas gingivalis and Prevotella intermedia were detected. They increased at gingivitis to 37.4% and 21.0%; when periodontitis developed, they comprised about 25.0%. Microbial colonization and establishment on titanium implants with healthy gingiva, experimental gingivitis and periodontitis follow the same pattern as on teeth.

Animals↗
PubMed1992

Plaque-induced marginal tissue reactions of osseointegrated oral implants: a review of the literature.

An intimate contact between bone and titanium implants was first demonstrated in 1969, and since then the bone-implant interface of osseointegrated implants has been investigated extensively. However, investigations of the marginal tissues and the microflora associated with osseointegrated implants have almost exclusively been carried out over the last decade. This review covers the clinical, radiographic, histologic, and microbiologic studies of marginal tissues of osseointegrated oral implants. In general, successfully osseointegrated implants exhibit low amounts of plaque concomitant with the absence of marginal inflammation. However, plaque accumulation may cause inflammatory reactions around the implants, sometimes giving rise to mucosal hyperplasia. Apparently, keratinized mucosa is not a requisite for the maintenance of peri-implant health if oral hygiene is adequate, but the presence of peri-implant keratinized mucosa is generally advocated. Alveolar bone loss around successful implants is minimal, but significant focal loss may occur due to plaque-induced inflammation or perhaps repeatedly extensive implant load. The progression of plaque-induced alveolar bone loss of osseointegrated implants may be different from that of teeth. It is unknown whether simultaneous marginal inflammation and excessive implant load further increase the loss of alveolar bone height. Both the light microscopic and ultrastructural characteristics of marginal tissues of implants and teeth are similar except for a lack of root cementum with inserting gingival collagen fibers of implants. Clinical inflammatory reactions are histologically characterized by an increased number of inflammatory cells infiltrating the connective tissue. The scattered subgingival microbiota associated with osseointegrated implants surrounded by healthy or slightly inflamed marginal tissues is similar to that of teeth with healthy gingiva. The microbiota associated with implants affected by marginal inflammation and bone loss is complex and consists predominantly of gram-negative anaerobic rods; this, again, is a similarity to periodontal disease.

Alveolar Bone Loss↗
PubMed1992

Antimicrobial treatment of peri-implant infections.

The purpose of this study was to investigate the possibility of antimicrobial treatment of peri-implant infections associated with a periodontitis-like subgingival microbiota. Nine partially or fully edentulous patients with titanium hollow cylinder implants were selected which showed loss of bone and probing depths > or = 5 mm on one or several implants after at least 6 months following installation. They also yielded subgingival microbial samples with > or = 10(6) CFU/ml, including > or = 20% gram-negative anaerobic bacteria. The treatment included mechanical cleaning, irrigation of all peri-implant pockets > 3 mm with 0.5% chlorhexidine and systemic antimicrobial therapy (1000 mg ornidazole for 10 consecutive days). After therapy, bleeding scores decreased immediately and, over a one-year observation period, remained significantly lower than before treatment. A significant gradual reduction in mean probing depths was detected over this one-year period; only one case showed no improvement of local probing depth. Microbiological parameters indicated an instantaneous quantitative and qualitative change following treatment. Subsequently, several of these parameters tended to shift back towards pretreatment values. In the second half of the observation period, however, this tendency was reversed, and levels significantly different from baseline were eventually established. This study demonstrated that treatment aiming at reducing the subgingival bacterial mass and suppressing the anaerobic segment had a beneficial effect in patients suffering from peri-implantitis.

Bacteria, Anaerobic↗
PubMed1992

How to treat ailing and failing implants.

This article describes treatment of the ailing implant (bone loss with pocketing but static at the maintenance checks) and the failing implant (bone loss with pocketing, bleeding upon probing, purulence, and evidence of continuing bone loss irrespective of therapy). Because the surface of the implant is contaminated with endotoxin, it must be detoxified before any regenerative therapy. Studies have shown that citric acid is effective in detoxifying the hydroxyapatite-coated surfaces while tetracycline is more effective in sterilizing the metallic substrate fixtures. Guided tissue regeneration is useful as a "barrier" to prevent exfoliation of the grafted material. Both nonresorbable and resorbable materials have been used with great success. Allografts (freeze-dried bone) and alloplasts (synthetic materials) may be used to achieve a sulcus of decreased depth and possibly some type of osseous regeneration. The author recommends the use of the allograft if the surface is completely detoxified and the alloplast if it is not certain that the surface is sterilized and free of endotoxin. The allograft, being resorbable, will not effect biologic healing against a contaminated surface; hence, the use of the alloplast to "fill" the defect and prevent epithelial invagination.

Alveolar Bone Loss↗
PubMed2026

The diagnostic potential of combined quantitative polymerase chain reaction and next-generation sequencing using the same primers for periprosthetic joint infection.

Next-generation sequencing (NGS) enables the detection of specific pathogens unidentifiable by conventional cultures, but its application in orthopedics remains inconsistent due to background contamination and irreproducible findings. This study evaluated the diagnostic performance of a novel workflow combining broad-range 16S rRNA gene quantitative PCR (qPCR) screening with downstream NGS, focusing on bacterial biomass thresholds. The qPCR assay demonstrated excellent intrarater reliability, with an intraclass correlation coefficient (ICC) of 0.961 (95% confidence interval, 0.881 to 0.997). Based on serially diluted positive controls, a quantitative threshold of 10&#x2075; CFU/mL was established as the minimum concentration required for the consistent detection of fastidious taxa, such as Escherichia coli. When evaluated against conventional cultures using 95 sonicate fluid and 276 pre/intraoperative tissue samples, the qPCR assay achieved a sensitivity of 80% and a specificity of 72%. Subsequent NGS sequencing of 26 clinical samples and 9 controls showed concordance in 4 of 6 culture-positive infected cases with NGS taxonomy, whereas the remaining discrepancies were likely attributable to culture-based phenotypic misidentification. Notably, among the qPCR-positive cases, three were culture-negative, including two hip prosthesis loosening cases exhibiting polymicrobial profiles, and one post-traumatic osteoarthritis case harboring low-level Staphylococcus. Crucially, this post-traumatic patient developed delayed periprosthetic joint infection (PJI) 2 years post-surgery, with cultures identifying Staphylococcus previously detected by the initial NGS analysis. Integrating qPCR screening with targeted NGS effectively refines pathogen identification, filters environmental artifacts, and overcomes the diagnostic limitations of culture-negative infections in orthopedic practice.IMPORTANCENext-generation sequencing (NGS) enables the detection of specific pathogens in clinical samples that are not identifiable by conventional methods. However, NGS applications in orthopedics have not been quantitatively evaluated, and findings have been inconsistent owing to contaminants and the presence of non-credible causative organisms. These factors primarily stem from the failure to evaluate low-biomass samples and the absence of proper controls, such as negative controls or mock community DNA samples. This study demonstrates that interpreting results from low-biomass samples requires careful consideration because NGS relies on relative bacterial abundances; distinguishing likely pathogens from contaminants is particularly challenging when bacterial loads are low. We demonstrated that combining NGS with quantitative PCR (qPCR) and applying a Cq cutoff can reduce false positives.

Humans↗
PubMed2026

Antibiotic-impregnated bone graft to prevent infection after total hip arthroplasty (ABOGRAFT): protocol for a randomised, double-blind, placebo-controlled trial.

INTRODUCTION: Studies have shown promising results using bone graft as a carrier for local administration of antibiotics to reduce the risk of prosthetic joint infection (PJI). The objective of this clinical trial is to determine if tobramycin and vancomycin-impregnated bone graft is safe and effective in reducing the rate of PJI after total hip arthroplasty (THA). METHODS AND ANALYSIS: This study is an international, randomised, double-blinded, placebo-controlled clinical drug trial. Patients scheduled for THA (n=1100) requiring bone grafting (excluding revisions due to an ongoing infection) are randomised in a 1:1 ratio to prophylactic treatment with tobramycin and vancomycin or placebo-impregnated bone graft.The primary outcome is the time to reoperation due to infection or diagnosis of PJI, expressed as a relative risk difference between the two groups. A risk reduction of at least 50% is considered clinically relevant. Secondary outcomes are time to and reason for reoperation and implant revision, type of micro-organism and antibiotic susceptibility pattern within 2 and 5 years after surgery. Safety outcomes are the number of adverse events and revision rate due to aseptic loosening. The primary analysis will be performed using proportional hazard models. ETHICS AND DISSEMINATION: The study has been approved under the Clinical Trial Regulation No 536/2014 (EU CT; 2024-510921-25-00). Results will be published in open-access peer-reviewed journals and disseminated to patient organisations and the media, and de-identified individual participant data will be curated and shared on reasonable request in accordance with the Findability, Accessibility, Interoperability and Reuse principles, subject to the laws and regulations governing data protection in each participating country. TRIAL REGISTRATION NUMBER: NCT05169229.

Humans↗
PubMed1992

Long-term oral ciprofloxacin in the treatment of prosthetic valve endocarditis due to Pseudomonas aeruginosa.

Prosthetic valve endocarditis caused by Pseudomonas aeruginosa is refractory to medical treatment alone and early valve replacement is necessary. We describe a 40-year-old patient in whom endocarditis developed in the early postoperative period, and reoperation was not considered feasible. Ciprofloxacin was administered orally in order to suppress bacteremia for 36 months. Long-term oral ciprofloxacin may provide an opportunity in the treatment of prosthetic valve endocarditis caused by Ps. aeruginosa in patients who are unfavorable candidates for reoperation.

Administration, Oral↗
PubMedDate not supplied

Intralymphatic antibiotic delivery for reducing acute prosthetic graft infection.

The lymphatic system has been implicated as a source of synthetic graft contamination when grafts are implanted in the presence of a distal septic focus. In previous studies, radical lymphatic excision and ligation were shown to reduce acute graft sepsis. However significant lymphedema precluded its clinical application. The present study was undertaken to evaluate methods for reducing acute graft sepsis while avoiding lymphatic obstructive complications. Twenty dogs were divided into one control and two experimental cohorts. Femoral interposition grafts were placed in each dog. A hind paw septic focus was introduced and therapy included a control (Group I--no therapy), intravenous antibiotics in Group II and intralymphatic antibiotics in Group III. Graft, blood and tissue cultures from each dog were taken at 48 hours. Lymphatic antibiotic therapy resulted in significantly improved graft culture results when compared to the control (p = 0.0003) and intravenously treated animals (p = 0.007). Blood cultures in the intralymphatically treated group were also significantly better (p = 0.003) than the control group.

Animals↗
PubMedDate not supplied

Salmonella infection of a Dacron aortic bifurcation graft.

We report a case of primary salmonella infection of a dacron aortofemoral bypass graft. Local graft excision with extra-anatomic bypass resulted in a successful outcome. Salmonella, whilst the commonest cause of infected abdominal aortic aneurysms, is currently a rare cause of prosthetic graft infection. However, given the increasing prevalence of salmonellosis in the community, we believe this situation will change and surgeons should be alert to this new and dangerous addition to the list of graft pathogens.

Aorta, Abdominal↗
PubMed1992

Plaque-induced inflammation around implants.

This article is a review of plaque-induced inflammation around dental implants. The microflora around successful implants is similar to healthy sulci, while that associated with failing implants is similar to periodontally diseased sites. Implant microflora is similar to the tooth microflora in the partially edentulous mouth. The microflora of implants in partially edentulous mouths differs from that in edentulous mouths. This seems to indicate a bacterial reservoir around the teeth and the possibility of reinfection of the implant sulcus by periodontal pathogens. The maintenance of a tooth microflora consistent with periodontal health in partially edentulous mouths may lead to maintaining an implant microflora consistent with peri-implant health. Thus, periodontal and implant maintenance are linked and neither can be overlooked.

Animals↗
PubMed1992

Radionuclide investigation of osteomyelitis.

The diagnosis of osteomyelitis in the presence of fracture and orthopedic appliances and in the diabetic foot can be a formidable challenge to radionuclide imaging. Radiophosphate is highly sensitive in detecting bone disease, but of low specificity; to improve specificity it must be complemented by 67Ga or radiolabeled leukocytes. These latter agents are not without limitations, and the search for new agents and novel imaging strategies continues. The relative roles of nuclear medicine and MR imaging are coming into focus, and a diagnostic algorithm based on the shortcomings of both methods is suggested.

Diabetes Complications↗
PubMed1992

Is a totally implantable artificial heart realistic?

The incidence of local infection that occurred after the implantation of the intrathoracic Jarvik 7 total artificial heart (J-7 TAH) in patients was a major problem of this cardiac prosthesis. Infection rates increased when the J-7 TAH was implanted for longer periods of time, which was contrary to the results that were obtained by the implantation of the left ventricular assist devices (LVAD) either in the abdominal cavity or in the abdominal wall. Currently, the general belief is that the implantation of a cardiac prosthesis inside of the chest cavity is not safe, due to higher rates of infection. Thus, Part I of this paper deals with the question: "Is a total artificial heart physiologically acceptable?" We believe structural differences of the J-7 TAHs and other LVADs are an important part of the problem. The J-7 TAH is a volumetrically dynamic pump, and the other LVADs are a volumetrically fixed stationary pump. Based upon experiences of this investigator, intrathoracic implantation of a smooth surface pulsating device (or a volumetrically dynamic pump) generated persistent local inflammatory reactive tissues directly adjacent to the device. These tissue capsules were nonadherent to the device, and therefore may produce an ideal environment for allowing bacteria to grow. The findings were opposite to those for a non-pulsating surface pump inside the chest cavity. Part II of this paper discusses the question: "Is a totally implantable artificial heart technically achievable?" Many technical problems for the totally implantable TAH were already resolved during the development program of the totally implantable LVAD. However, there are three TAH specific problems that remain to be solved before achieving a clinically useful totally implantable TAH system. They are (a) anatomical compatibilities of the TAH system; (b) reliable control of the TAH system, (c) reliable and effective long-term operation of the TAH system. We have resolved the anatomical problem by the integral design of the pump-actuator system. Overall size of the hard shell Baylor TAH system is 510 cm3 with a diameter of 97 mm and a width of 82 mm. Its stoke volume was reduced to 63 cm3. The stable and reliable control of TAH performances was established by the three sets of Hall effect sensors with left master alternate mode of pumping. No physiological parameter was used as a feedback signal. Reliable long-term operation of the TAH system was established by the electromechanical actuation system. A simple drive mechanism with commercially available components and subsystems was used.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1992

Antibiotic prophylaxis for prevention of bacterial endocarditis and infections of major joint prostheses [corrected].

The current trend in antibiotic prophylaxis for prevention of endocarditis is toward more simple, effective regimens to promote better patient and dentist compliance. All national medical groups are now recommending oral regimens for all at-risk patients, and most of these groups recommend single-dose oral regimens. The Swiss Working Group recommends multiple-dose amoxicillin for high-risk patients. The American Heart Association recommends two-dose oral regimens for all at-risk patients. Clindamycin appears to be the second drug of choice. The many pharmacokinetically different erythromycin preparations and the high rate of intolerance to many of these preparations has led to this change. No national or international medical groups recommended prophylaxis for patients with prosthetic joints. Most reviews conclude that there is little or no scientific evidence to support this use. It is time to stop the practice of prophylaxis for patients with prosthetic joints. The only patients with joint prostheses who should even be considered for prophylaxis are those patients considered at "high" risk.

American Heart Association↗
PubMedDate not supplied

Treatment of implants demonstrating periapical radiolucencies.

This article presents two implant cases where a periapical radiolucency developed, with a sinus tract, while the implants were still submerged. A corrective surgical treatment for these unique lesions is detailed, and the possible etiologies are discussed.

Aged↗
PubMed1992

[BCG osteoarthritis on knee prosthesis after intra-vesical BCG therapy].

A case of Calmette-Guérin bacillus (BCG) infection of a knee implant during intravesical BCG-therapy is reported. The course was favorable after replacement of the implant and administration of antituberculous agents. This case of septic osteoarthritis due to the BCG is different from cases of reactive polyarthritis reported after intravesical instillations of BCG. It probably resulted from diffusion of the BCG via the bloodstream.

Administration, Intravesical↗