The effects of an immediately pre‐surgical chlorhexidine oral rinse on the bacterial contaminants of bone debris collected during dental implant surgery

Abstract

Dental implant surgery produces bone debris that can be used in the "simultaneous augmentation" technique. Although this debris is contaminated with oral bacteria, a stringent aspiration protocol has been shown to reduce the levels of contamination. Chlorhexidine mouthrinse is a well-proven antibacterial rinse that has been shown to reduce infectious complications associated with dental implants. This study examined the effect of pre-operative rinsing with a 0.1% chlorhexidine digluconate mouthrinse on the bacterial contaminants present in collected bone debris bone (CBD). Twenty partially edentate patients were randomly allocated into equal groups and underwent bone collection using the Frios Bone Collector (FBC) during the insertion of two dental implants. In group T a pre-operative chlorhexidine rinse was used, whilst in group C sterile water was used. For both groups, a stringent bone collection protocol was used. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilised for identification of the isolated microbes. Thirty-nine species were identified including a number associated with disease, in particular Actinomyces odontolyticus, Clostridium bifermentans, Prevotella intermedia, and Propionibacterium propionicum. Samples from group T (chlorhexidine mouthrinse) yielded significantly fewer organisms (P < 0.001) than in group C (sterile water mouthrinse). Gram-positive cocci dominated the isolates from both groups. It is concluded that if bone debris is to be used for the purpose of immediate simultaneous augmentation, a preoperative chlorhexidine mouthrinse should be utilised in conjunction with a stringent aspiration protocol to reduce further the bacterial contamination of CBD.

Bacterial contamination of filtered intraoral bone chips

“…The aim of the study was to analyse the presence of bacteria in bone particles gained using a bone filter. The spectrum of aerobically and anaerobically most common types of bacteria was in accordance with the findings of YOUNG et al 21,22 . These oral bacteria are connected to a variety of infections, including bone infections.…”

“…The present study dealt with the bacterial contamination of bone particles through the bone filter, and is similar to the research conducted by YOUNG et al 21,22 . These authors distinguished between a strict suction protocol (S) using two suction devices, and a non-strict suction protocol (NS) that used only one suction device to suction the entire oral cavity.…”

“…These authors distinguished between a strict suction protocol (S) using two suction devices, and a non-strict suction protocol (NS) that used only one suction device to suction the entire oral cavity. The varying number of CFU/sample resulting from the two methods was statistically relevant (P = 0.002): when using NS there were twice as many colonies as when using S. It is difficult to compare the results by YOUNG et al 21,22 with this research, because they did not provide any information about the weight of the removed bone mass. In this research, using 0.15 mg bone particle mass, the amount of CFU/sample varied significantly.…”

“…It was not possible to correlate the amount and/or types of bacteria found and postoperative healing; this may be because the number of cases (50) was too small. One clear contraindication was the use of bone from the bone filter in immunosuppressed patients 22 . Every probe of bone particles gained with a bone filter was contaminated.…”

“…In this research, using 0.15 mg bone particle mass, the amount of CFU/sample varied significantly. It is possible that the manner in which the assistants collected the bone mass used to determine the bacterial contamination made a difference 22 . Most of the procedures were surgical removals of completely or partially retained wisdom teeth.…”