Is Implant Placement in the Operating Room a Risk Factor for the Development of Peri-Implantitis? A Retrospective Cohort Analysis

Abstract

This study aims to identify if preoperative antibiotic administration is a protective factor for the development of peri-implantitis in implants placed in the operating room vs outpatient clinic. A retrospective cohort study was conducted at the Philadelphia Veterans Affairs Medical Center from 2006 to 2013. Physician encounter notes within 3 months of implant placement were used to gather data about patients’ health status, including the setting of implant placement in the operating room vs outpatient clinic. Operative report notes were used to assess administration of antibiotic prophylaxis, recorded as none, oral, or intravenous administrations. Implant status was assessed using dental encounter notes and radiographs from follow-up appointments at 1, 3, 5, and 10 years. Peri-implantitis was defined as radiographic evidence of changes in the crestal bone level, clinical evidence of bleeding on probing, with or without suppuration.1 Electronic medical records of 942 implants placed in 398 unique patients were retrospectively analyzed. Descriptive statistics were computed using the SAS System (SAS Institute Version 9.4, 2002-2012, Cary, NC). Predictor variables were implant placement in the operating room or outpatient clinic and administration of preoperative antibiotics. The primary outcome variable was the presence of peri-implantitis. Descriptive, bivariate, and multiple logistic regression analyses were performed to measure the association between predictive variables and development of peri-implantitis. Of the 942 implants placed, 205 (22%) developed peri-implantitis. Overall, placement of implants in an operating room was shown to be associated with an increased risk in the presence of peri-implantitis (P ≤ .0001) when compared to implants placed in the outpatient clinic. When controlling for preoperative antibiotics, patients who received implants in the operating room were still found to be at risk for developing peri-implantitis (P = .0015). The data from this study show that implants placed in the operating room were 4 times more likely to develop peri-implantitis compared to implants placed in the outpatient clinic (OR = 4.056, 95% Cl 2.697-6.102). To our knowledge, no existing literature demonstrates this significant relationship. Our data show that preoperative antibiotics are protective against the development of peri-implantitis in patients who receive implants in the operating room. When controlling for preoperative antibiotics, operating room patients’ risk of developing peri-implantitis decreased by nearly 35% (OR = 2.633, 95% Cl 1.448-4.788). Studies have demonstrated that in a peri-implantitis model, antibiotic-treated specimens attenuated natural bone loss. The authors suggest that preoperative antibiotic administration may decrease the occurrence of peri-implantitis by reversing inflammatory responses and decreasing attachment loss via attenuation of pathogenic oral bacteria at the site of implant placement.2 Therefore, the administration of preoperative antibiotics, especially in medically complex patients who cannot tolerate implant placement in an outpatient clinic, may temper the progression of pathological processes around the peri-implant tissues. Analysis of implants placed at the Philadelphia VA Medical Center revealed an important association between the setting of implant placement, use of preoperative antibiotics, and the development of peri-implantitis. Our study shows that a standardized preoperative antibiotic regimen can play an important role in decreasing the development of peri-implantitis in patients who receive implants in an operating room. Administration of preoperative antibiotics in these patients may provide an opportunity to abate inflammatory reactions as a result of an existing complex disease and provide protection against the development of peri-implantitis. In addition to completing prospective studies, identification of other protective factors in this high-risk patient population is a necessity.