Dear colleagues!
Can you help to solve a problem?
What compounds should we prescribe locally to induce a better osseointegration with implants?
Biphosphonates and BMPx (as a GF) are good candidates for a local use, but may be there are some new compounds that can enhance bone formation? Novel studies suggest dlk1 protein. Most likely it would be an expensive process.
Would be useful to use local antibiotic and anti-inflammatory drugs as well to decrease an imflammatory response and to reduce an external tissue damage?
Thank you for your help!
We have tried antibiotics, bone promotions drugs i.e. bisphoshonates and anti-inflammatory drugs in our thesises
To the best of my knowledge the strongest evidence supports the use of amoxicillin in those patients who can take amoxicillin as a prophylactic antibiotic which, when used appropriately, results in a decreased infection rate and an increased Osseo integration rate. Indeed there are other antibiotics that have been tried, clindamycin is probably the second most prominent antibiotic used in an effort to promote Osseo integration and yet with clindamycin there have been mixed results, if I had to do the mental systematic review I would suggest that clindamycin is more likely to result in a failure of the implant but this would be with far fewer study numbers than with amoxicillin. It could be that clindamycin is used in higher risk situations. I would suggest that we do not at this point have definitive answers with either of these but the amoxicillin is closer to a definitive answer as a promoter of Osseo integration then is: the clindamycin as a negative towards Osseo integration.
If we are talking about materials that we can add to the implant or to the osteotomy or to the patient in general then were probably looking primarily at the antibiotics. There may well be some medications that patients can take that shows some positive and some negative results. you can probably sit down and add materials to the list of positive or negative factors. I would suggest that there is no absolute improvement from any or degradation from any additional compounds. This is not to say that we don't see articles that promote bisphosphonates or the promote the use of strontium or hydroxyapatite or nanoparticles deposition of Other different chemicals. It's just that none of these seem to be absolutes.
Dear Satish Narula and Steven E Eckert !
Thank you for your answers!
Satish Narula is it possible to request some thesis of yours?
Steven E Eckert in case of amoxicillin - won't it cause an allergic reaction? Does it means that the proper medication would be only an antibiotic (gentamicin- ect)? What about anti-inflammatory and bone-metabolism-related compounds?
Personally I have some concerns over off label use of medications in an effort to improve implant performance. It's fine if you are doing a research project and it has institutional review but procedures such as modification of the surface may not always be the prudent thing to do.
I certainly understand that many currently accepted treatment modalities were once nothing but an idea in the head of the investigator. If your private patients understand that they are being experimented upon, and they are comfortable with this, I guess you can ask them to sign the consent and move forward. Doing this however could have consequences that are unexpected.
There are studies using Bisphosphonates, Bone Morphogenetic Proteins (BMPs) local application, Simvastatin both systemically and as a local application, melatonin in addition to the use of PRP and PRF, but the effectiveness of these materials and others on osseointegration require more evidence.
interesting question. pardon me if i didnt answer to what was required. locally means to the site of implant, vis a vis systematically, which may be taken orally or via intravenously. hence for local drugs during the osteointegration process and post surgical, the drug is usually mouthwash. ideally they should be non alochol and chlorhexidine. However, thymol and triclosan mouthwash may be used too. Other than that, some believed in gels
(chlorhexidine) for healing abutments. Some also used gels containing antibiotics. HOpe this helps
hi as far as i know the osseointegration process is concerned it should be left undisturbed. but recent studies may show evidence that the bone mimetic drugs like bone morphogenic protein can be applied. hydrogels and scaffolds also have been used as carriers of drugs.
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