COD and implant therapy :
In the presence of a COD, the general rule is to avoid any type of
elective surgery such as extractions, periodontal surgery or implant
therapy (4). Implant placement in these cases should only be performed
after the patient has been informed of the risks and signed a consent
form.
Litterature treating the subject of implant rehabilitation with COD is
quite poor. It has been suggested that implant placement in an affected
site could induce osteomyelitis. In fact, overheating during the
drilling sequence, added to the lack of vascularization and the reduced
capacity of bone regeneration would lead to infection and necrosis of
the surrounding tissue (9). Moreover, the lesion’s response to
antibiotics would be insufficient due to its avascular nature (3).
Shin et al. reported a case of chronic osteomyelitis induced by the
placement of dental implants on COD. The implants failed to
osseointegrate and were removed along with a sequestrum after an episode
of swelling and pain (10).
Nevertheless, Park et al. described a case of successful osseotegration
of an implant placed in a dysplasic site. The implant survived 15 years
without any complication. However, at the 16-year follow-up, the implant
was removed with a sclerotic mass due to peri-implantatis. Histology
showed that the hard mass attached to the implant was formed by a
cementum-like tissue (CLT) free of any soft tissue. The implant placed
into the FCOD lesion achieved integration similar to that of
conventional osseointegration. Rather than bone, the CLT was in direct
contact with the titanium surface. The integrity of the union was
maintained for up to 16 years (11).
To our knowledge, two case reports have described a successful implant
rehabitlitation on COD. Shadid et al. reported a successful implant
rehabilitation of a lower posterior edentulous site in presence of a
FCOD. 2 implants were placed with strict infection control. This was
acheived by prescribing prophylactic antibiotic (amoxicillin/clavulanic
acid 500 mg/125 mg) 1 h before surgery and chlorhexidine mouthwash
preoperatively and postoperatively, by ensuring sterile environment
during the procedure, minimizing periosteal reflection, making the
procedure as short as possible, and avoiding overheating of the bone
using cool sterile saline and sharp drills. No complications have
occured after an 8-year follow-up (12).
Similarly, another case report described a successful implant
rehabilitation of a posterior lower edntulism with an uneventful
functional integration at the 18-month follow-up (13).