Retention Of Implants Research Articles

A Biodegradable Fiber Calcium Ion Sensor by Covalently Bonding Ionophores on Bioinert Nanoparticles.

Implantable sensors, especially ion sensors, facilitate the progress of scientific research and personalized healthcare. However, the permanent retention of implants induces health risks after sensors fulfill their mission of chronic sensing. Biodegradation is highly anticipated; while; biodegradable chemical sensors are rare due to concerns about the leakage of harmful active molecules after degradation, such as ionophores. Here, a novel biodegradable fiber calcium ion sensor is introduced, wherein ionophores are covalently bonded with bioinert nanoparticles to replace the classical ion-selective membrane. The fiber sensor demonstrates comparable sensing performance to classical ion sensors and good flexibility. It can monitor the fluctuations of Ca2+ in a 4-day lifespan in vivo and biodegrade in 4 weeks. Benefiting from the stable bonding between ionophores and nanoparticles, the biodegradable sensor exhibits a good biocompatibility after degradation. Moreover, this approach of bonding active molecules on bioinert nanoparticles can serve as an effective methodology for minimizing health concerns about biodegradable chemical sensors.

Measuring outcomes when odontogenic sinusitis is treated with endoscopic sinus surgery: A systematic review

AbstractAimTo determine outcome measurement when odontogenic sinusitis (ODS) is treated by Endoscopic Sinus Surgery (ESS).Materials and MethodsA PRISMA compliant systematic review using MeSH headings on Pubmed, Ovid and Embase. Inclusion criteria: Adults with odontogenic maxillary sinus disease undergoing ESS. Exclusion criteria: Adolescents, odontogenic disease related to; trauma, neoplasia, tumour resection, palatal cleft or fungal infection, previous sinus surgery, endoscopic surgery not involving the middle meatus.ResultsA total of 1462 papers were identified, 68 eligible for review. No randomised controlled trials were identified. Twenty‐three papers (34%) reported a successful outcome as no disease at endoscopy and reduced sinonasal symptoms; 14 papers (21%) based outcomes on endoscopy, reduced symptoms and resolution of sinus opacification or reduced mucosal thickness; 1 paper established success on reduced symptoms only and 7 papers (10%) based outcomes on radiographic findings only. Other primary measures of success were excision and closure of oro‐antral fistula, 6 (9%), removal of odontogenic cysts, 5 (7%), removal of displaced dental implants, 4 (6%), removal of displaced root of tooth, 3 (4%). Five papers (7%) reported no outcome measure. Additional measures of outcome were; retention of dental implants perforating the sinus floor, survival of sinus floor grafting with subsequent implant placement and retention of teeth with persistent apical periodontitis.ConclusionReported outcome measures were very heterogeneous. In consideration of the weak evidence base for the role of ESS in ODS management, more consistent measurement and reporting of patient symptoms, clinical and radiological signs with endoscopic findings is recommended to enable meta‐analysis.

Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated With United Fractures Does Not Increase Recurrence Risk.

To evaluate whether retention of antibiotic cement delivery devices after resolution of orthopaedic infection is associated with recurrence. Retrospective cohort. Academic medical center. Patients with a fracture definitively treated with internal fixation that went on to unite and develop a confirmed fracture-related infection or osteomyelitis after a remote fracture surgery and had implantation of antibiotic-impregnated cement for infection management. Patients were divided into whom the antibiotic implants were retained (Retained Cohort) and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, and need for soft tissue coverage (local flap vs. free tissue transfer) because of recurrence. Of 98 patients treated for fracture-related infection in united fractures or osteomyelitis after a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([American Society of Anesthesiology Score, P = 0.026] and [diabetes, P = 0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, P = 0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms, and laboratory values ( P = 0.360). There was no difference in incidence of subsequent infection recurrence after clinical infection resolution (1 recurrence Retained vs. 2 recurrences Removed, P = 0.605) for those considered "cured." Compared with the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs. 1.84 reoperations, P < 0.001) and admissions after implantation ( P < 0.001). Retention of antibiotic-impregnated cement delivery devices in patients with orthopaedic infection after fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Removal of Spinal Instrumentation Is Not Required to Successfully Treat Postoperative Wound Infections in Most Cases.

Controversy exists regarding whether spinal implants need to be removed to treat postoperative deep wound infections (DWIs). This retrospective study aimed to determine whether the removal or retention of implants impacts the successful treatment of a DWIafter spine surgery. Postoperative spine surgery patients presenting with signs of infection who underwent irrigation and debridement (I&D) at Twin Cities Spine Surgeons at Abbott Northwestern Hospital, Minnesota, USA, were studied. First, the persistence of infection when implants were retained or removed was assessed. Second, we analyzed the persistence of infection with respect to the number of I&D, the use of vacuum-assisted closure (VAC) treatment, pseudoarthrosis status, and functional outcomes. One hundred thirty-five patients were included. Treatment of infection with retention of implants occurred in 64% (87/135); of these, 7% (6/87) had a persistent infection. Of patients with implant removal (36%, 48/135), 6% (3/48) had a persistent infection. Thus, we observed no difference between treatment with implants present compared to implants removed (p = 1.0). Fifty of the 135 patients (37%) received I&D and primary wound closure, and 85 (63%) patients received I&D and VACtreatment. There was no statistical difference between primary wound closure and VAC treatment (p = 0.15) with respect to persistence. Repeat I&D with VAC (three or more times) had a significantly lower rate of recurrence than those with two I&Ds. Pseudoarthrosis and persistent infection were unrelated. At minimum one-year follow-up, achieving a minimum clinically important difference in functional outcome was independent of persistent infection status. Persistent infection was unrelated to the retention of implants. When VAC treatment was deemed necessary, more than two I&Ds resulted in a significantly better cure for infection. Those with a persistent infection were no more likely to exhibit pseudoarthrosis than those with no persistent infection. All patients showed improvement in functional outcomes at minimum one-year follow-up.

Removal Versus Retention of Posterior Spinal Implants in Patients with Healed Thoracolumbar Fractures: Analysis of Clinical and Radiographic Outcomes-A Randomized Controlled Trial

Removal Versus Retention of Posterior Spinal Implants in Patients with Healed Thoracolumbar Fractures: Analysis of Clinical and Radiographic Outcomes-A Randomized Controlled Trial

Prosthetic Joint Infection Due to Mycobacterium goodii/smegmatis

Total hip arthroplasty is among the most frequently performed elective surgical procedures in the United States. Infection of the implant is a rare but catastrophic complication. Generally, patients require multiple surgical procedures and intravenous antibiotics to eradicate the infection. We present the case of a patient diagnosed with a strain of rapidly growing mycobacteria not frequently encountered. He was successfully treated with retention of implants and chronic oral antibiotic therapy. A literature review was performed to identify similar cases, and the results showed that most of the patients underwent successful revision of the implant along with antibiotic therapy. We present this case to illustrate an alternative method of management for appropriate patients who may not be an adequate surgical candidate for prosthesis removal.

Nanoparticles of Cerium-Doped Zeolitic Imidazolate Framework-8 Promote Soft Tissue Integration by Reprogramming the Metabolic Pathways of Macrophages.

Soft tissue integration around the abutment of implants is the basis of long-term retention of implants. Macrophages are an important component involved in the repair of soft tissue due to their crucial role in improving the biological structure of connective tissues by regulating the fiber synthesis, adhesion, and contraction of gingival fibroblasts. Recent studies have illustrated that cerium-doped zeolitic imidazolate framework-8 (Ce@ZIF-8) nanoparticles (NPs) can attenuate periodontitis via both antibacterial and anti-inflammatory effects. However, the effect of Ce@ZIF-8 NPs on soft tissue integration around the abutment is unknown. Herein, we first prepared Ce@ZIF-8 NPs by a one-pot synthesis. Then, we probed the regulatory effect of Ce@ZIF-8 NPs on macrophage polarization, and further experiments were performed to study the changes of fiber synthesis as well as adhesion and contraction of fibroblasts in the M2 macrophage environment stimulated by Ce@ZIF-8 NPs. Strikingly, Ce@ZIF-8 NPs can be internalized by M1 macrophages through macropinocytosis and caveolae-mediated endocytosis in addition to phagocytosis. By catalyzing hydrogen peroxide to produce oxygen, the mitochondrial function was remedied, while hypoxia inducible factor-1α was restrained. Then, macrophages were shifted from the M1 to M2 phenotype via this metabolic reprogramming pathway, provoking soft tissue integration. These results provide innovative insights into facilitating soft tissue integration around implants.

Combination d-Amino Acid and Photothermal Hydrogel for the Treatment of Prosthetic Joint Infections.

Prosthetic joint infection (PJI) is a devastating complication requiring surgical intervention and prolonged antimicrobial treatment. The prevalence of PJI is on the rise, with an average incidence of 60,000 cases per year and a projected annual cost of $1.85 billion in the US. The underlying pathogenesis of PJI involves the formation of bacterial biofilms that protect the pathogen from the host immune response and antibiotics, making it difficult to eradicate such infections. Biofilms on implants are also resistant to mechanical brushing/scrubbing methods of removal. Since the removal of biofilms is currently only achievable by the replacement of the prosthesis, therapies aimed at eradicating biofilms while enabling retention of implants will revolutionize the management of PJIs. To address severe complications associated with biofilm-related infections on implants, we have developed a combination treatment that is based on a hydrogel nanocomposite system, containing d-amino acids (d-AAs) and gold nanorods, which can be delivered and transforms from a solution to a gel state at physiological temperature for sustained release of d-AAs and light-activated thermal treatment of infected sites. Using this two-step approach to utilize a near-infrared light-activated hydrogel nanocomposite system for thermal treatment, following initial disruption with d-AAs, we were able to successfully demonstrate in vitro the total eradication of mature Staphylococcus aureus biofilms grown on three-dimensional printed Ti-6Al-4V alloy implants. Using a combination of cell assays, computer-aided scanning electron microscopy analyses, and confocal microscopy imaging of the biofilm matrix, we could show 100% eradication of the biofilms using our combination treatment. In contrast, we were only able to see 25% eradication of the biofilms using the debridement, antibiotics, and implant retention method. Moreover, our hydrogel nanocomposite-based treatment approach is adaptable in the clinical setting and capable of combating chronic infections brought about by biofilms on medical implants.

Rehabilitation of Atrophied Anterior Mandible with Basal Implants: A Case Report

Basal implantology also referred to as bicortical implantology is considered to be a modern implantology system which utilizes the basal cortical portion of the jaw bones for retention of the dental implants, which are uniquely designed to engage within the basal cortical bone areas. In the present case, a 44-year-old healthy male patient reported to our department with grade III mobile 32, 33. After careful examination and treatment planning cortical implants with immediate prosthetic rehabilitation was initiated. The teeth were extracted atraumatically and two smooth surface cortical implants were placed into the extraction sockets followed by prosthetic rehabilitation using metal ceramic crowns. IOPA radiographs and CBCT were taken preoperative and immediate postoperative. The patient and operator compliance after placement of implant and prosthetic rehabilitation were analysed using a 10-point patient assessment scale. Cortical implant therapy has several advantages, it allows placement in bone that is deficient in height and width, reduced treatment length, reduced number of operations, immediate loading and better patient compliance. Keywords: Fixed Rehabilitation, Basal Implants, Atrophied Ridges

Unexpected long-term retention of subcutaneous beeswax implants and additional notes on dose and composition from four testosterone implant studies

Experimental manipulations of testosterone have advanced our understanding of the hormonal control of traits across vertebrates. Implants are commonly used to supplement testosterone and other hormones to organisms, as they can be readily scaled to produce desired hormone levels in circulation. Concerns about pharmacological (i.e. unnatural) doses of traditional silastic implants led to innovation in implant methods, with time-release pellets and beeswax implants proposed as solutions. A study comparing silastic, time-release pellets, and beeswax implants found the latter to be most effective in delivering a physiologically relevant dose. One proposed advantage to subcutaneous beeswax implants is that they are expected to degrade within the body, thus removing the obligation to recapture implanted individuals in the field. However, few studies have reported on dosage and no published literature has examined the assumption that beeswax implants readily degrade as expected. Here we present time-release androgen data in relation to implants containing varying levels of testosterone from four separate implant studies. In addition, we report long-term persistence of subcutaneous implants, including two cases of implants being retained for > 2 years. Finally, we offer recommendations on the composition and implementation of beeswax implants to aid the pursuit of minimally invasive and physiologically relevant manipulations of circulating hormones.

The Effect of Locator Attachment and Ball-O-Ring Attachment on Bone Height Change in Implant Retained Overdenture

Objectives. This study was conducted to evaluate and compare the effect of locator attachment and Ball-O-ring attachment on the peri-implant crestal bone level changes in edentulous patients rehabilitated with implant retained lower over denture. Methods. Twenty edentulous patients (male) were participating in this study, they were rehabilitated by mucosa supported maxillary complete denture and implant retained mandibular over denture by two implants installed in the canine region, patients were divided into two equal groups according to the type of attachment used, the locator attachment was used for group I and Ball-O-ring attachment was used for group II. Peri-implant crestal bone level changes were assessed using intra-oral radiographs taken with the standardized long cone paralleling technique using custom made acrylic template and the Rinn-xcp system. Periapical radiographs were taken every six months to complete a period of 18 months follow up period. The marginal bone loss at different intervals was obtained by calculating the difference in bone height at that interval from the base line measurement and statistically analyzed (t-test P &lt; 0.05). Results. The result of this study showed that the time has significant effect on the mean values of the peri-implant bone height on both groups. Moreover, group I had significantly less bone resorption from insertion to twelve months in compare to group II. Conclusion. The insignificant difference observed between comparing the peri-implant bone loss between the two groups indicates that the two treatment modalities are effective for the rehabilitation of lower denture. Locator attachments have the ability to control the amount bone loss. It could be advantageous in cases where the retention of implants retained overdentures is compromised.

Early periprosthetic hip joint infection managed by cementless one-stage revision - a case series.

Background: Early periprosthetic hip joint infection (PJI) is traditionally treated with debridement, antibiotics, and implant retention (DAIR). However, infection control rates after DAIR-treated periprosthetic hip joint infection do not exceed 77 %. Cementless one-stage revision of chronic PJI by the Cementless One-stage Revision of Infected Hip Arthroplasty (CORIHA) protocol has been evaluated positively with a 91 % success rate. We wanted to evaluate the effectiveness of cementless one-stage revision following the CORIHA protocol for early PJI in elective primary total hip arthroplasty, regarding risk of re-operation with exchange of implants. Methods: We identified 18 patients in our center with early (-week postoperative) PJI after primary total hip arthroplasty (THA) treated with one-stage cementless revision in the period January 2012–March 2018. Treatment followed the CORIHA protocol. Primary outcome was retention of implants at the most recent follow-up. Patients were followed for a minimum of 3 years. Results: Mean follow-up time was 60 months (39–105). All patients retained their implants, but two required superficial soft tissue debridement due to persistent wound seepage. Conclusion: Cementless one-stage revision appears to be an effective treatment of early PJI after primary THA and at least an equal choice of treatment compared with DAIR. Whether the potential benefit of a lower re-revision rate for postoperative PJI outweighs the increased surgical complexity of the CORIHA procedure needs further evaluation.

Design of metal-polymer structure for dental implants with stiffness adaptable to alveolar bone

Mechanical adaptability of implants to the surrounding alveolar bone is one of the critical factors that influences its long-term service. Experimental study shows that widely adopted titanium implants are prone to induce stress shielding due to the considerable mismatch of moduli between stiff implant and alveolar bone, which is considered to induce resorption of peri-implant bone tissues and impair the retention of implants. Moreover, current commercial dental implants with fixed stiffness are unable to meet various alveolar bone conditions of the patients of different ages and physical situations. To solve the two problems, a novel design of metal-polymer structure is proposed for dental implants, which combines two kinds of biocompatible materials, i.e., titanium and polyether-ether-ketone (PEEK). The proposed composite structure allows patient-specific adjustment of equivalent modulus for dental implant in a cost-effective way. In this paper, three designs are given and compared to show how an optimized biomechanical health degree of peri-implant bone can be achieved to fit the alveolar bone condition of patients.

SINGLE STAGE KNEE ARTHROPLASTY REVISION SURGERY, OUR EXPERIENCE WITH ELEVEN CASES AND REVIEW OF THE LITERATURE

Knee replacement is a widely performed and very successful procedure for the management of knee arthritis. Nevertheless, it is postulated that a total of 2-5% of primary and revision total knee arthroplasties (TKAs) is infected every year [1,2]. Despite the low incidence, the absolute numbers of prosthetic joint infections (PJIs) are growing, owing to an increased number of replacement surgeries, and are associated with significant morbidity and socioeconomic burden [3,4]. Although several definitions of PJI exist, Musculoskeletal Infection’s Society (MSIS) definition is based on strict criteria and is one of the most used [5]. Patients with certain risk factors have an increased risk to develop PJI [6,7]. Risk factors include presence of systemic or local active infection in an arthritic knee; previous operative procedures in the same knee, diabetes mellitus, malnutrition, smoking, alcohol consumption, co-morbidities, and immunosuppression; end-stage renal disease on hemodialysis, liver disease, intravenous drug abuse, and low safety operative room environment. PJIs are classified according to the depth of infection, to superficial and deep infections. Superficial infections are limited to the incision and superficial tissues, while deep infections, that involve deep layers, may occur up to one year postoperatively, and influence surgical management strategy. Timing of infection is also an important factor in guiding treatment. PJIs are classified to acute postoperative, within a month of the index procedure, acute haematogenous, presenting with acute symptoms in a previously well – functioning joint, and late chronic, where infection develops later than one month postoperatively [8]. Management of PJI’s is mainly surgical, reserving conservative treatment for patients unable to undergo surgery [9]. Surgical options include debridement and retention of the prosthetic implants (DAIR), two – stage exchange revision, single – stage exchange revision, permanent resection arthroplasty, and finally amputation as the last measure [10]. DAIR is a viable option in early stages of acute infections, but established chronic infections necessitate more radical methods. Two – stage revision that was originally described by Install [11], secondly modified through the development of static spacers [12], and then articulating spacers [13], is considered the gold standard of TKA infection management [14]. A large volume of literature reports successful eradication of PJIs in more than 90% of patients using this approach [15,16,17]. Nevertheless, this procedure is costly, time-consuming, develops stiffness, arthrofibrosis, impairs mobility and increases inpatient stay. Single-stage revision arthroplasty for infection was first described in the 1980s [18, 19], has gained popularity for use in selected patients [20]. Infection control using this approach is achieved in 67% to 95% of patients [21, 22, 23, 24]. Furthermore, it is associated with less patient morbidity, improving functional outcome and reducing cost [25, 20]. This paper seeks to systematically review the results of using single – stage revision arthroplasty for chronic infection of TKAs. Furthermore, we report our experience with eleven cases of chronic knee arthroplasty infection, which were treated with the aforementioned technique.

Tolerance of Prolonged Oral Tedizolid for Prosthetic Joint Infections: Results of a Multicentre Prospective Study.

Objectives: Data on clinical and biological tolerance of tedizolid (TZD) prolonged therapy are lacking. Methods: We conducted a prospective multicentre study including patients with prosthetic joint infections (PJIs) who were treated for at least 6 weeks but not more than 12 weeks. Results: Thirty-three adult patients of mean age 73.3 ± 10.5 years, with PJI including hip (n = 19), knee (n = 13) and shoulder (n = 1) were included. All patients were operated, with retention of the infected implants and one/two stage-replacements in 11 (33.3%) and 17/5 (51.5%/15.2%), respectively. Staphylococci and enterococci were the most prevalent bacteria identified. The mean duration of TZD therapy was 8.0 ± 3.27 weeks (6–12). TZD was associated with another antibiotic in 18 patients (54.5%), including rifampicin in 16 cases (48.5). Six patients (18.2%) had to stop TZD therapy prematurely because of intolerance which was potentially attributable to TZD (n = 2), early failure of PJI treatment (n = 2) or severe anaemia due to bleeding (n = 2). Regarding compliance with TZD therapy, no cases of two or more omissions of medication intake were recorded during the whole TZD treatment duration. Conclusions: These results suggest good compliance and a favourable safety profile of TZD, providing evidence of the potential benefit of the use of this agent for the antibiotic treatment of PJIs.

Comprehensive treatment algorithm of postoperative spinal implant infection.

Postoperative spinal implant infection (PSII) is a commonly found and serious complication after instrumented spinal surgery. Whereas early-onset PSII usually can be diagnosed by clinical symptoms, the diagnosis of late-onset PSII can be often made only by examination of intraoperatively collected samples. The treatment of PSII consists of surgical and antibiotic therapy schemes. In case of early PSII, the retention of spinal implants is a feasible option, whereas late PSII is usually treated by one-staged exchange of the spinal implants. Radical debridement of surrounding tissue should be performed in any case of PSII. The antibiotic treatment depends on either the implants can be removed or need to be retained or exchanged, respectively. If the causative pathogens are sensitive for biofilm-active antibiotic agents, the duration of antibiotic treatment amounts to 12 weeks with retention of spinal implants. In case of problematic pathogens, the application of antibiotics needs to be prolonged for an individual duration. Antibiotic treatment should always be initiated with an intravenous application for at least 2 weeks.

Responses of human gingival fibroblasts to superhydrophilic hydrogenated titanium dioxide nanotubes

Soft tissue integration is critical for the long-term retention of dental implants. The surface properties including topography and wettability can impact soft tissue sealing. In our work, a thermal hydrogenation technique was applied to modify anodized titanium dioxide nanotubes (TNTs). However, the effects of the hydrogenated surface on soft-tissue cells remain unclear. The aim of the present study was to investigate the bioactivities of human gingival fibroblasts (HGFs) on structured surfaces, which determine the early formation of soft tissue sealing. Three groups were examined: commercially pure titanium (Ti), anodized TNTs (air-TNTs) and hydrogenated TNTs (H2-TNTs). Scanning electron microscopy showed the nanotubular topography on the titanium surfaces after anodization. Then, hydrogenation ensured that the H2-TNTs were superhydrophilic with a contact angle of 3.5 ± 0.8°. In vitro studies such as cell adhesion assays, cell morphology, immunocytochemistry, wound healing assays, real-time PCR and enzyme-linked immunosorbent assays displayed enhanced adhesion, migration, relative gene expression levels, and extracellular matrix synthesis of the HGFs on H2-TNTs. Interestingly, focal adhesion kinase activation and integrin-mediated adhesion seemed to be induced by the H2-TNT surface. Our results revealed that a superhydrophilic nanostructure modified by anodization and hydrogenation can improve the bioactivity of HGFs and connective tissue regeneration, which will further promote and expand the application of titanium dioxide nanotubes in dental implants.

Infection Recurrence in Instrumented Spinal Fusion in Children.

Study Design:Level 4 retrospective case series.Objectives:Surgical site infection (SSI) is one of the main complications of instrumented spinal fusion. The aim of our study was to evaluate infection recurrence (same bacteria) or reinfection (different bacteria) in posterior spinal fusion in children.Methods:A retrospective study was conducted to evaluate patients who were successfully treated for SSI after instrumented spinal fusion due to deformity, with irrigation and debridement (I&D) procedures, followed by antibiotic therapy, with a follow-up of at least 2 years.Results:Overall, 29 patients with a mean age of 14 + 3 years were evaluated. Preoperative diagnosis was nonidiopathic scoliosis in 23, idiopathic scoliosis in 5, and Scheuermann’s disease in 1 patient. The etiology was Gram-positive cocci (40.9%), Gram-negative bacilli (27.2%), and polymicrobial infection (31.8%). A mean of 1.5 (1-3) I&D procedures were performed. Intravenous antibiotic treatment was given for a mean of 15.8 (4-86) days, followed by oral treatment for a mean of 335.1 (0-1095) days. Mean follow-up was 5 + 2 years (2 to 14 + 7 years) during which 28 patients were cured (96.6%) and 1 patient developed reinfection (3.4%). This reinfection was treated with oral clindamycin for 6 months. After the infection persisted, the decision was to remove the implants.Conclusions:In this series of 29 pediatric patients who underwent instrumented spinal fusion due to deformity, we reported one case of reinfection (3.4%). Given that 96.6% of infections were resolved, we suggest treatment with I&D procedures with retention of implants to treat acute SSI.

Bacterial Identification and Monitoring Around Two-Piece Dental Implants by Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS).

Context Early microbiological diagnosis and treatment of periodontal pathogens is important for successful retention of dental implants. Aims This study aimed to identify and monitor oral bacterial colonization after successful two-piece dental implants. Settings and Design In this study, 50 two-piece dental implant subjects were included and assessed clinically, radiographically, and microbiologically. Methods and Material All the parameters were recorded at various stages after prosthesis placement. In each stage, nonadherent (peri-implant sulcular fluid) and adherent (curetted inner threads) samples were collected. Semiquantitative anaerobic culture of the samples were done in Anoxomat system. Bacterial colonies were first identified by routine microbiological methods and then by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) method. Statistical Analysis All the results were analyzed by appropriate statistical methods (Chi-square, one factor analysis of variance, etc.). Results All the bacterial isolates were identified in the MALDI-TOF MS system with no failure. After implant placement for the nonadherent samples, the frequency (%) of Fusobacterium nucleatum, Prevotella melaninogenica, and Propionibacterium acnes decreased whereas frequency (%) of Escherichia coli, Staphylococcus epidermidis, and Streptococcus mitis increased. For adherent samples, the frequency (%) of E. coli, Enterococcus faecalis, Porphyromonas gingivalis, P. melaninogenica , and Veillonella parvula decreased, whereas frequency (%) of S. mitis and Streptococcus mutans increased. The postimplant mean nonadherent and adherent bacterial load increased with time but not significantly over the periods ( p = 0.302 and 0.123, respectively). Conclusion Combination of basic (semiquantitative culture method) and advanced microbiological method (MALDI-TOF MS) can be useful for accurate detection and monitoring of potential pathogens around two-piece dental implants.

Can We Save the Implant: Rib-based Implant Removal Rates and Risk Factors Following Irrigation and Debridement (I&D) Surgery?

In the event of a surgical site infection, management includes surgical debridement in an attempt to treat the infection and retain the implant; however they are often unsuccessful in this regard. Although studies have described the incidence of complications, current literature does not have sufficient evidence to provide clear recommendations regarding retention versus removal of implants. This study aims to identify predictive factors associated with the need for implant removal to decrease unnecessary attempts at implant retention. A retrospective review of early-onset scoliosis patients at a single institution treated with rib-based vertical expandable prosthetic titanium rib implants who developed infection requiring irrigation and debridement (I&D) due to wound problems including surgical site infection, skin slough, and wound dehiscence. All patients had a minimum of a 2-year follow-up. Univariate and multivariate logistic regression analyses were conducted to determine the odds of implant removal. Fifty-nine of 181 patients (32%) required an I&D due to a wound problem. These patients underwent the initial implant procedure at a mean age of 4.6±3.8 years. In total, 29 patients ultimately underwent implant removal. Significant predictive factors for removal included total number of wound problems, total number of I&Ds, days from identification of wound problem to I&D procedure, days on antibiotics, total number of surgeries, presence of gastrostomy tube, and nonambulatory status (P<0.0001, 0.001, 0.095, 0.093, 0.082, 0.054, and 0.026, respectively). Multiple logistic regression results indicated a total number of wound problems [odds ratio (OR): 6.00, P=0.001], average days from identification of wound problem to I&D (OR: 1.03, P=0.039), and presence of a gastrostomy tube (OR: 5.7, P=0.07) as independent predictors for implant removal. Data suggests that time from the onset of signs of infection until debridement surgery inversely correlates with the ability to retain the implants. In addition, gastrostomy tube and history of previous wound infections may be predictive clinical factors for implant removal in patients with a rib-based vertical expandable prosthetic titanium rib instrumentation. Such information can be useful for clinicians in deciding on whom to attempt implant retention versus removal when a wound problem presents itself. Level III.