The Possible Role of Dental Implants in the Etiology and Prognosis of Osteomyelitis: A Retrospective Study

Purpose: The aim of this study was to describe the clinical outcome of osteomyelitis of the mandible or maxilla following dental implants. A detailed treatment protocol is also proposed. Materials and Methods: Electronic data of all the patients who were treated between October 2009 and November 2014, in three maxillofacial surgical departments, were reviewed. Computed databases were searched for the diagnosis of osteomyelitis of the mandible or maxillas (ICD9 code 526.2), and medical files were analyzed. Treatment outcome was considered successful if only primary treatment (debridement and antibiotic therapy) was applied. Statistical analysis was performed to compare treatment outcomes in the different etiologic groups. Results: The cohort included 29 men and 25 women, with histologically and clinically proven osteomyelitis. The mean age was 59 years (range, 24 to 70 years). Forty patients had complete remission, as opposed to 14 patients who failed the primary treatment and required a more aggressive surgical intervention (11 had segmental mandibulectomy, 2 patients had marginal mandibulectomy, and 1 patient had maxillectomy). Most failures were in the dental implantation group. A previous dental implant was an independent factor for primary treatment failure and the need for aggressive surgical intervention (P = .0001). Conclusion: The results of this retrospective study suggest that a previous dental implant is an independent predictive factor of failure in primary treatment in osteomyelitis of the mandible or maxilla. Also, dental implant-induced osteomyelitis is a rare pathology, but it presents an aggressive subtype of osteomyelitis, and requires a broader and more comprehensive management. Keywords: dental implant, maxillectomy, osteomyelitis of the jaws, segmental mandibulectomy