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).