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Actinomycotic Oral Infection (Modern Dental Implants and Root Canals)

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By R.S. Carlson, DDS

Honolulu, May 2017

If one were to inspect the general research regarding the effectiveness and physiological acceptability and safety of the modern dental implant tooth replacement, one is met with a mixed bag of information on their real success rates, systemic biological impacts, and advisability as a method of single or multiple tooth replacement.

For example, in various credible peer reviewed journals for the years 2016 and 2017, we see that, contrary to the touted 98% success rate asserted by the implant manufacturers, it is widely held that “success” can vary from about 91 % to 49% over a three to five year period or longer depending on the opinion of the clinical observer(s). The main issue that has been identified for implant degradation and ultimate re-treatment or removal of the implant is PI— Peri-implantits.

Charalampakis et al, in their paper of 2013 from Gothenburg titled “Peri-implantitis from a microbiological perspective,” stated it precisely:

Thus, the prospect of reaching a consensus [regarding PI] is continuously hampered and the magnitude of the incidence of peri-implantitis still remains therefore a matter of academic dispute. [emphasis added]

Charalampakis et al continue:

Any factor proposed to be a risk factor for…peri-implantitis should not just be an extract of a statistical significant result in a paper but relate to the disease with biological plausibility.[emphasis added]

We would like to present biological plausibility not only relating to the implant post or fixtures locally but to the oral systemic biota—the total human.

We are not “academics” but clinical scientists. We shall not enter discussions of the “life-span” of implants, their functionality, their being the so-called “gold standard” of tooth replacement in our profession—prosthetic dentistry—but we shall offer a brief clinical scientific review of our observations and research.

The first biological factor is that of microbial infection within the soft tissues and bone about the dental implant. The second biological factor is that of the direct currents (DC electrical currents) generated by the implant fixtures, post, abutment, and replacement crown. Let us explore both of these factors that fulfill the parameter of biological plausibility in the ensuing conversation and be open to our further exploration.

Actinomyces & Actinomycosis

In the early 1980s, we began to remove infected root canal teeth and associated soft tissue and bone (Odonton) and send them for pathological inspection by a board certified histopathologist. The findings were remarkably revealing to date.

In brief, for all of the 349 “odontons” inspected, it was found that acute-chronic inflammation—sometimes marked, reactive bone, dead bone, osteomyelitis, granuloma, cyst, abscess and other attending abnormalities – was present in the jaw below the tooth in question. Having carried out this root canal research since about 1983, we have also extended this methodology to implant removal due to infections or otherwise.

IMG_2414As we know, the dead tooth has no circulatory system internally. In a sense, this is the definition of an endodontically treated tooth. As the dead tooth degrades, it gives off various chemicals such as putresciene, cadaverine, thioethers, and what we call endotoxins. This fact is no longer disputed in the scientific clinical profession, nor in academia.

Another factor for inflammation is bacterial presence in tissues where they should not be. As a habit, in the early days of our research, the pathologist noted what he called “star-like microganisms” in colonies, with rays in the bone and soft tissues. He noted that they were certainly colonies of actinomyces that surrounded the root canal. However, it must be understood that we had not asked for a determination of bacterial review; it was an incidental finding in his pathology reports to me.

Actinomyces has been known from the 1800s as the “ray fungus,” mistaken as a fungus until about 1938. It is currently identified a bacterium: Actinomyces is a genus of the Actinobacteria class of bacteria. They are all gram positive. Actinomyces species are facultatively anaerobic, and they grow best under anaerobic conditions. Actinomyces species may form endospores, and, while individual bacteria are rod-shaped, Actinomyces colonies form fungus-like branched networks of hyphe.

They are implicated in decay and periodontal disease in the oral cavity in normal residents. However, it is not normal to find actinomyces in bone or connective tissues deep in the other jawbone or in the blood vascular system. If found in the jawbone, it may lead to a condition known as “lumpy jaw”—an abscess from either dental or peri-dental origins, or both.

Many Actinomyces species are opportunistic pathogens of humans and other mammals, particularly in the oral cavity. In rare cases, these bacteria can cause actinomycosis, a disease characterized by the formation of abscesses in the mouth, lungs, or the gastrointestinal tract. Actinomycosis is most frequently caused by A. Israeli, which may also cause endocarditis, though the resulting symptoms may be similar to those resulting from infections by other bacterial species. Aggreatibacter actinomycetemcomitans has been identified as being of note in periodontal disease.

IMG_2419The genus is typically the cause oral-cervicofacial disease. It is characterized by a painless “lumpy jaw”. Lymphadenopathy is uncommon in this form of the disease. Another form of actinomycosis is thoracic disease, which is often misdiagnosed as a neoplasm, as it forms a mass that extends to the chest wall. It arises from aspiration of organisms from the oropharynx. Symptoms include chest pain, fever, and weight loss.

Abdominal disease is another manifestation of actinomycosis. This can lead to a sinus tract that drains to the abdominal wall or the perianal area. Symptoms include fever, abdominal pain, and weight loss. Some Actinomyces species have also been shown to infect the nervous system of some animals without apparent trauma.

The bacteria Actinomyces are ubiquitous and abundant in soil. They are known for the important role they play in soil ecology; they produce a number of enzymes that help degrade plant root debris and waste materials. Thus, their presence is important in the formation of compost. They are also known for causing diseases in humans and livestock, usually when they get an opportunity to gain access to the body’s interior through wounds. As with other opportunistic infections, people with immunologic issues are at higher risk. In all of the preceding traits and in their branching filament formation, they bear similarities to Norcardia causing Norcardosis a similar illness as Actinomycosis.

It is well established that actinomycosis is an endogenous infection. The causative Actinomyces species reside on mucosal surfaces and gain access to deeper tissues via trauma, surgical procedures, or foreign bodies, which disrupt the mucosal barrier. Inside the tissue, these bacteria form masses consisting of aggregates of branching, filamentous bacilli. Actinomycosis is defined as a hard mass-type lesion with a specific histopathological structure. There are a large number of case reports of actinomycosis in the literature, but in most cases, diagnosis has been based solely on clinical and histopathological findings. In the majority of early reports, microbiological confirmation of diagnosis was lacking. Even when microbiological assessment was included, culture was typically the only method used. If, however, antimicrobial treatment had been started before sample collection, the results of culture may be falsely negative. The increasing introduction of molecular bacterial detection and identification methods is helping to overcome such problems.

An internal abscess is more difficult to identify, but signs include pain in the affected area, a high temperature, and generally feeling unwell. Internal abscesses rarely heal themselves, so prompt medical attention is indicated if such an abscess is suspected. This is important in the resolution of infected abscessed teeth: that they be surgically removed and bone cleansing—cavitation—accomplished.

Dental Implant-Associated Micro-Currents

Rarely mentioned in any research in this day is the impact of direct currents on the tissues around the metal implant—corrosion impact.  Human cellular structures operate electrically in all actions in pico-ampers, 10-12 amperers.  Tiller related in Vibrational Medicine by Gerbber 1987 that currents greater than pico-amps (in the direction of nano-amps 10-9 and micro-amps 10-6) will cause cell destruction while currents smaller than pico-amps stimulate cellular growth.

In our measurements of this phenomenon in titanium implants, we have recorded amps -36 uA (uA = micro-amps) and even higher—over -100uA—when the coupled anode and cathode is put to gold crowns, metal bridges, metal partials and amalgam fillings. This is an area ripe for investigation for both titanium and zirconia dental implants. Galvanic impacts on human tissues are well known but little studied.

In the removal of infected and problematic dental implants, we have found also the deleterious impact associated with deep dental structures beyond the post above the gum, deep in the bone crypt. Again, we have over the past 17 years removed various dental implants (about 30) in 20 patients and sent them to the histopathologist at Queen’s Hospital Honolulu, Hawai’i. We present the data of both the “root canal teeth” study and the “implants” study in two tables. The first table will show implants alone and the second all teeth and implants removed since 1986.

Histopathological Studies at Queen’s Hospital, Honolulu, Hawai’i
1986 – 2017

Table 1. Dental Implants

#

 

Gender Age Implant # Pathology Bacteria
1 Female 64 Metal implant #29 uA -30  (with 28 DFC decay?)

 

Periapical granuloma, chronic inflammation, necrotic bone (+) Actionmyces
2 Female

11/2/15

56 Metal implant #4  (with sinus perforation) Fibrosis, chronic inflammation, reactive bone lesions

 

             (-)
3 Female

2/2/15

69 Metal implant  #29/30 area Periapical granuloma (prei-implantitis), acute/chornic inflammation, reactive bone

 

             (-)
4 Male

10/7/14

65 Zirconia implant posts #18 and #19 area Periapical granuloma with pus, marked acute/chonic inflammation with fibrosis and reactive bone

 

(+) Actinomyces

 

5 Male

9/26/14

65 Zirconia implant posts #30 and #29 area Periapical granuloma, marked acute/chronic inflammation

 

(+) Actinomyces

 

6 Male

8/21/13

70 Titanium implant post # 9 Peridental fibroma/scar, chronic inflammation, dead bone

 

            (-)
7 Female

9/27/13

76 Titanium implant posts #18, #19, and #20  uA -26 and mV -265

 

Peri-implantitis/osteosis, marked acute chronic Inflammation, reactive bone (+) Actinomyces

 

 

8 Female

8/3/13

63 Titanium implant posts  #4 and  #6  -36 uA current density

 

Peri-implantitis/osteitis, chronic inflammation, dead bone, reactive bone (+) Actinomyces
9 Male

2/23/13

72 Titanium implant post #14 area Granulation tissue/fibrosis, marked acute/chronic inflammation, reactive bone (+) Actinomyces
10 Female

8/6/10

60 Titanium implants  #12 and #13 Periapical granuloma (fibrous) with marked acute/chronic inflammation, dead bone, reactive bone

 

(-)
11 Female

5/16/07

62 Titanium implant #6 Peri-implantitis, granulation and fibrosis, fhronic inflammation, reactive bone

 

(+) Actinomyces
12 Female

7/3/06

59 Titanium implant #8 Granulation tissue, fibrosis, chronic inflammation

 

(-)
13 Female

8/9/05

71 Titanium implants #11 and #12 Perimplant mucositis, chronic acute inflammation, inflamed granulation tissue(granuloma), reactive bone changes (-)
14 Male

6/27/05

74 Titanium implants #17 and #18 Peri-implantitis, chronic inflammation, granulation tissue, reactive bone

 

(-)
15 Male

4/4/05

74 Titanium implants #30 and #31 Peri-implantitis, chronic inflammation and fibrosis, hyperostotic bone, reactive bone

 

(+)

Actionmyces

16 Male

3/21/05

54 Titanium implant #20 Peri-implantitis, marked chronic-acute inflammation, reactive bone

 

(+)

Actionmyces

17 Female

9/29/01

55  Titanium implants #30 and #31 Periapical granuloma, dead bone, chronic inflammation

 

(-)
18 Female

3/10/01

78 Titanium post #3

 

Peri-implantitis osteitis, chronic inflammation, granulation tissue/fibrosis, dead bone

 

(+) Actinomyces

10 of the 19 had Actinomyces, infecting attachment tissues (bone ligaments).

Table 2. Endo Teeth and Dental Implants

# Gender Age Endo # Pathology Bacteria

 

1 Female

5/20/17

68 Titanium implant #29, abscess on mental foramen -83μA Periapical granuloma/abscess, marked chronic inflammation, necrotic bone (+)

Actinomyces

2 Male

5/19/17

68 #18 Periapical abscess/granuloma, marked acute/chronic inflammation, necrotic bone (+)

Actinomyces

3 Male

12/1/16

29 #8, #, and #10 Periapical abscess/granuloma, marked acute/chronic inflammation (+)

Actinomyces

4 Male

11/13/16

54 #13 Periapical scar, fibrosis (-)
5 Female

11/11/16

54 #18 and #19 Radicular cyst, granulation fibrosis with marked acute/chronic inflammation and reactive bone (-)
6 Male

9/26/16

65 #19 Periapical granuloma/cyst, acute/chronic inflammation, reactive bone (+)
7 Female

8/27/16

88 #19 Periapical granuloma/cyst, marked acute/chronic inflammation, reactive bone (+)

Actinomyces

8 Male

7/14/16

52 #3 Radicular periapical cyst, acute/chronic inflammation, granulation/fibrous tissue (+)

Actinomyces

9 Female

7/9/16

55 #13 Radicular periapical cyst, marked acute/chronic inflammation, massive granulation tissue and reactive bone (+)
10 Female

6/23/16

75 #20 Radicular periapical cyst, granulation fibrous tissue, chronic inflammation (-)
11 Female

5/10/16

67 #18 Periapical granuloma (abscess) with marked acute/chronic inflammation (+)
12 Female

2/29/16

66 #18 Radicular periapical cyst, cystic lesion with granulation tissue and marked acute/chronic inflammation (-)
13 Male

2/16/16

72 #18 and #19 Radicular cyst, granulation fibrous tissue, acute/chronic inflammation (-)
14 Female

2/15/16

57 #18 and #19 Fibrosis/reactive bone lesions (-)
15 Female 1/28/16 60 #5 Squamous mucosa with acute and chronic inflammation (-)
16 Female

1/8/16

60 #4 Periapical radicular cyst, granulation tissue, acute/chronic inflammation (+)
17 Female

11/12/15

52 #9 Periapical fibrosis/scar, acute/chronic inflammation, reactive bone lesions (-)
18 Female

11/2/15

56 Metal implant #4 (with sinus perforation) 63μA Fibrosis, chronic inflammation, reactive bone lesions (-)
19 Female

11/2/15

56 #29, #30, and #31 Periapical granuloma, chronic inflammation, reactive bone lesions (-)
20 Female

10/24/15

33 #8 and #9 Periapical granuloma/cyst, marked acute/chronic inflammation, necrotic bone (+)
21 Female

10/24/15

33 #4 and #5 Periapical granuloma/scar, chronic inflammation, reactive bone lesions (-)
22 Female

8/31/15

60 #13 Periapical granuloma, cyst, chronic inflammation, inflamed mucosa (+)
23 Female

8/28/15

48 #29 Periapical granuloma/.cyst, marked acute/chronic inflammation, fibrosis, necrotic bone (-)
24 Female

8/27/15

33 #2 and #3 Periapical granuloma/cyst, marked acute/chronic inflammation, fibrosis, necrotic bone (-)
25 male

7/31/15

64 #3 Periapical granuloma, fibrosis, marked chronic inflammation (-)
26 Female

7/28/15

35 29 Periapical/radicular cyst/granuloma, acute/chronic inflammation, reactive epithelium, reactive bone (+)
27 Female

7/16/15

46 #15 Periapical radicular cyst/granuloma,  chronic inflammation, reactive epithelium, reactive bone (-)
28 Female

6/18/15

61 #31 Periapical radicular cyst, marked acute/chronic inflammation, reactive bone, fibrosis (+)
29 Male

6/13/15

77 #3 and #4 Periapical granuloma/cyst, marked acute/chronic inflammation, reactive bone (+)
30 Female

6/3/15

67 #12 Periapical granuloma, marked chronic/acute inflammation (-)
31 Female

5/28/15

61 #14 Periapical scar, chronic inflammation, reactive bone (-)
32 Female 5/26/15 59 #18 and #19 Periapical granuloma/cyst, marked acute/chronic inflammation, reactive bone (-)
33 Female

5/26/15

59 #18 and #19 Periapical granuloma/cyst, marked acute/chronic inflammation, reactive bone (-)
34 Female

4/23/15

64 #29 Periapical granuloma, acute/chronic inflammation (+)
35 Female

4/17/15

69 #19 Periapical granuloma, acute/chronic inflammation, dead bone (-)
36 Female 4/14/15 61 #2 Periapical granuloma, acute/chronic inflammation, reactive bone (-)
37 Female

3/21/15

73 #10 Periapical granuloma, acute/chronic inflammation (-)
38 Female

3/19/15

68 #10 Radicular (periapical) cyst, granulation tissue with fibrosis, acute/chronic inflammation, reactive bone (-)
39 Male

3//10/15

35 #19 Radicular (periapical) cyst, granulation tissue with fibrosis, acute/chronic inflammation (-)
40 Female 2/2/15 69 Metal implants #29 and #30 area -45μA Periapical granuloma, peri-implantitis, acute/chronic inflammation, reactive bone (-)
41 Male

1/31/15

86 #2 Radicular (periapical) cyst, acute/chronic inflammation, reactive bone (+)
42 Female 1/29/15 69 #5 and #3 Reactive and dead bone (+)
43 Male 1/19/15 27 #13 Periapical granuloma, fibrosis, acute/chronic inflammation, reactive bone (+)
44 Male

1/16/15

86 #18 Periapical granuloma/cyst, fibrosis, acute/chronic inflammation, reactive bone (-)
45 Female

1/10/15

83 #31 Periapical granuloma/cyst, fibrosis, acute/chronic inflammation (-)
46

 

Male

1/9/15

63 #0 Periapical granuloma/cyst, fibrosis, acute/chronic inflammation (+)
47 Female

1/61/15

71 #7 Periapical granuloma/scar, fibrosis, acute/chronic inflammation (-)
48 Female

12/22/14

70 #3 Periapical granuloma/cyst, fibrosis, marked acute/chronic inflammation, reactive bone (+)
49 Male 12/17/14 40 #30 Periapical granuloma/cyst, chronic inflammation, fibrosis, reactive bone (-)
50 Female

12/17/14

43 #19 Radicular (periapical) cyst, marked acute/chronic inflammation, fibrosis, granuloma (+)
51 Female

12/7/14

70 #15 Periapical granuloma/cyst, marked chronic and acute inflammation (-)
52 Female

11/7/14

70 #12 Periapical granuloma, marked acute/chronic inflammation, reactive bone (-)
53 Female

11/5/14

73 #3 Radicular cyst (periapical), acute/chronic inflammation, fibrosis, reactive bone (+)
54 Male

10/7/14

65 Zirconia implant posts #18 and #19 area Periapical granuloma with pus, marked acute/chronic inflammation with fibrosis and reactive bone (+)
55 Female

10/1/14

82 #18 Periapical granuloma with pus, marked acute/.chronic inflammation with fibrosis and reactive bone (-)
56 Male

9/26/14

65 Zirconia implant posts #30 and #29 area Periapical granuloma, marked acute/chronic inflammation (+)
57 Male

8/21/14

70 Titanium implant post #9 Peridental fibroma/scar, chronic inflammation, dead bone (-)
58 Male

8/14/14

51 #14 Periapical granuloma, acute/chronic inflammation, reactive bone (-)
59 Female

8/14/14

6 #29 and #31 Periapical granuloma/scar, chronic inflammation, reactive bone (-)
60 Male 8/8/14 70 #14, #15, and #16 Periapical granulomas, marked acute/chronic inflammation, dead bone, fibrous tissue (+)
61 Male

7/28/14

70 #30 Periapical granuloma, chronic inflammation, reactive bone (-)
62 Female

6/26/14

23 #9 Periapical granuloma/scar, fibrosis, chronic inflammation with reactive bone (-)
63 Female

6/22/14

77 #4 Periapical granuloma/cyst, granulation/fibrous tissue, marked acute/chronic inflammation (-)
64 Female

6/22/14

64 #6 Periapical scar, chronic inflammation, reactive bone (-)
65 Female

6/16/14

80 #14 Periapical abscess/granuloma, marked acute/chronic inflammation, necrotic bone (+)
66 Female

6/16/14

80 #12 Periapical abscess/granuloma, marked acute/chronic inflammation, necrotic bone (+)
67 Male

6/12/14

34 #29 Periapical cyst/granuloma, marked acute/chronic inflammation, reactive bone (-)
68 Female

6/5/14

66 #3 Radicular cyst (periapical), marked acute/chronic inflammation, granulation/fibrous tissue, dead bone (+)
69 Female

5/21/14

44 #9 Periapical scar/fibrosis, reactive bone (+)
70 Female

5/13/14

 

64 #30 Focal osteonecrosis, necrotic bone, reactive bone, squamous mucosa (+)
71 Male

5/5/14

34 #18 Periapical granuloma, chronic inflammation, fibrosis, reactive bone, degenerated (dead) bone, (-)
72 Female

4/22/14

59 #18 Periapical granuloma/scar, mild chronic inflammation, reactive bone (-)
73 Female

4/19/14

68 #7 Radicular (periapical) cyst, granulation/fibrous tissue with marked acute and chronic inflammation, reactive bone (+)
74 Male

4/7/14

47 #14 Periapical granuloma cyst, granulation/fibrous tissue with marked acute/chronic inflammation, dead bone (-)
75 Female

4/4/14

64 #3 Radicular periapical cyst, granulation/fibrous tissue, marked chronic/acute inflammation, dead bone (-)
76 Female

4/4/14

49 #14 Periapical granuloma/cyst, granulation/fibrous tissue with chronic inflammation (-)
77 Female

3/21/14

42 #10 Periapical granuloma/abscess, marked acute/chronic inflammation with fibrosis and granulation tissue, dead bone, reactive bone consistent with osteomyelitis (-)
78 Male

3/11/14

57 #14 and #15 Periapical cyst/granuloma, marked acute/chronic inflammation, reactive bone (+)
79 Female

2/22/14

66 #6 Periapical abscess/granuloma, marked acute/chronic inflammation, partially dead and reactive bone (+)
80 Male

2/4/14

70 #18 and #19 Cystic granuloma, marked acute/chronic inflammation, reactive bone (-)
81 Female

1/24/14

43 #10 Cystic granuloma tissue with marked chronic/acute inflammation, reactive bone (-)
82 Male

1/14/14

61 #4 Periapical scar/fibrosis, osteonecrosis (patient has bowel cancer – this tooth and two other [#12 and #13] on the same meridian were root cadavers; CA dx 6mo ago) (+)
83 Male

1/13/14

63 #29 Periapical granuloma/scar, acute/chronic inflammation, dead dentine/cementum, numerous Actinomyces/Candida (+)

1.    Candida

2.    Actinomyces

84 Male

1/11/14

34 #30 Periapical granuloma, acute/chronic inflammation, reactive bone, fibrosis (-)
85 Female

12/7/13

44 #2 Periapical abscess/scar, reactive/necrotic bone and fibrous tissue (+)
86 Female

11/2/13

66 #28 Periapical granuloma/scar, chronic inflammation, reactive bone (-)
87 Male

11/11/13

26 #10 Periapical granuloma (fistula with pus), marked acute/chronic inflammation, reactive bone (-)
88 Female

10/7/13

53 #19 Periapical granuloma/scar, acute/chronic inflammation underlying fibrosis, reactive bone (-)
89 Female

9/27/13

53 #18 and #19 Periapical granuloma scar, chronic inflammation, dead bone (-)
90 Female

9/9/13

37 #30 Periapical scar, chronic inflammation, reactive bone (-)
91 Female

9/5/13

16 #26 Periapical granuloma cyst, chronic inflammation, dead bone, reactive bone (-)
92 Male

8/27/13

63 #30 Periapical abscess, granuloma, marked acute/chronic inflammation, reactive bone (-)
93 Female

8/19/13

80 #2 Periapical granuloma, chronic inflammation, reactive bone (-)
94 Female

8/3/13

63 Titanium posts #4 and #6 -36μA Peri-implantitis/osteitis, chronic inflammation, dead bone, reactive bone (+)
95 Female

7/31/13

58 #30 Apical osteitis, dead bone, reactive bone (-)
96 Female

7/11/13

63 #5 Periapical radicular cyst, acute/chronic inflammation (+)
97 Male

6/27/13

53 #3 Periapical granuloma cyst, acute/chronic inflammation, reactive bone (-)
98 Female

6/19/13

63 #14 Periapical granuloma cyst, marked acute/chronic inflammation, reactive bone (+)
99 Female

6/18/13

56

 

#32 Periapical scar, chronic inflammation, reactive bone (+)
100 Female

6/6/13

36 #13 Periapical scar, reactive bone (+)
101 Female

6/14/13

66 #31 Radicular cyst, marked acute/chronic inflammation, reactive bone (-)
102 Female

4/18/13

40 #18 Periapical granuloma, chronic inflammation, reactive bone (-)
103 Female

5/18/13

59 #30 Periapical granuloma, chronic inflammation (-)
104 Female

3/30/13

36 #4 Periapical granuloma, fibroma, chronic inflammation (-)
105 Female

3/28/13

69 #31 Periapical granuloma, fibroma, chronic inflammation, reactive/hyperostotic bone (+)
106 Female

3/8/13

61 #3 Periapical radicular cyst, marked acute/chronic inflammation, dead bone (+)
107 Make

3/5/13

68 #20 Periapical scar, slight inflammation, dead bone (+)
108 Male

2/23/13

72 Titanium implant post #14 area 80μA Granulation tissue/fibrosis, marked acute/chronic inflammation, reactive bone (+)
109 Female

2/19/13

NG #21 Periapical granuloma, marked chronic inflammation (-)
110 Female

2/11/13

76 #19 Periapical scar, slight chronic inflammation, reactive bone (+)
111 Male

2/19/13

66 #8 Periapical granuloma scar, chronic inflammation, reactive bone (-)
112 Female

1/31/13

NG #29 Periapical granuloma, chronic inflammation, reactive bone (-)
113 Male

1/22/13

82 #8 Periapical radicular cyst, marked acute/chronic inflammation (+)
114 Female

1/14/13

64 #14 Periapical cyst, marked acute/chronic inflammation, reactive bone (+)
115 Female

12.12.12

56 #14 Fibroma, inflammation, reactive bone (+)
116 Female

12/4/12

73 #4 and #5 Inflammation, reactive bone (-)
117 Female 12/14/12 49 #3 Periapical granuloma cyst, marked acute/chronic inflammation, reactive bone (+)
118 Male

11/21/12

60 #13 Periapical granuloma, acute/chronic inflammation, dead bone (+)

Actinomyces

119 Female

11/10/12

46 #24 and #25 Periapical granuloma, acute/chronic inflammation, reactive bone (-)
120 Female

11/10/12

46 #14 Periapical granuloma, acute/chronic inflammation, reactive bone (-)
121 Female

11/6/12

62 #30 Periapical granuloma, reactive bone, condensing osteitis (non-supurative osteomyelitis) (+)
122 Male

10/27/12

56 #8 Periapical granuloma cyst, marked acute/chronic inflammation (+)
123 Female

10/4/12

57 #19 Periapical cemento-osseous dysplasia, immature bone/cementum, fibrous tissue (-1)
124 Male

9/27/12

66 #5 Periapical granuloma, marked acute/chronic inflammation, dead bone (-)
125 Female

9/11/12

55 #4 Partially devitalized bone, marked chronic inflammation (+)
126 Male

8/30/12

51 #9 Periapical granuloma cyst, marked acute/chronic inflammation (-)
127 Female

8/6/12

60 #19 Chronic osteomyelitis, dead and reactive bone, chronic inflammation (-)
128 Male

7/2012

58 #30 Periapical granuloma, acute/chronic inflammation, reactive bone (-)
129 Male

7/20/12

58 #7 and #8 Periapical cyst, acute/chronic inflammation (-)
130 Female

5/16/12

77 #30 Periapical granuloma, marked acute/chronic inflammation, reactive bone (+)
131 Male

5/17/12

60 #19 Periapical granuloma abscess, marked acute/chronic inflammation, reactive bone (-)
131 Male

5/11/12

31 #30 Periapical granuloma, marked acute/chronic inflammation (-)
132 Male

5/11/12

35 #18 Peripaical granuloma scar, chronic inflammation, reactive bone (-)
133 Female

4/10/12

51 #20 Periapical granuloma, marked acute/chronic inflammation (-)
134 Female

3/17/12

55 #12 Periapical scar, acute/chronic inflammation (-)
135 Female

2/28/12

60 #30 Periapical scar, chronic inflammation, reactive bone (+)
136 Female

2/28/12

60 #3 Periapical granuloma, chronic inflammation, reactive bone (-)
137 Female

1/3/12

42 #2 Periapical radicular cyst, marked acute/chronic inflammation, reactive bone (-)
138 Male

8/17/11

40 #8 and #9 Periapical granuloma, marked chronic inflammation (+)
139 Female

7/20/11

29 Vital #29 (PI test 7.5) Periapical granuloma scar (+)
140 Female

6/30/11

64 #8 and #10 Periapical granuloma cyst, chronic inflammation, reactive bone (-)
141 Female

5/4/11

31 #4 Periapical granuloma scar, chronic inflammation (-)
142 Female

3/2/11

31 #19 Periapical granuloma scar, granulation/fibrous tissue, chronic inflammation (-)
143 Male

11/2/10

68 #3 Periapical granuloma, acute/chronic inflammation, reactive bone (+)
144 Male

8/13/10

75 #30 Periapical granuloma, marked acute/chronic inflammation (+)
145 Female

8/6/10

60 Titanium implants #12 and #13 Periapical granuloma (fibrous tissue), marked acute/chronic inflammation, dead bone, reactive bone (-)
146 Female

8/4/10

66 #9 Periapical granuloma, marked acute/chronic inflammation, reactive bone (-)
147 Female

4/23/10

51 #3 Periapical granuloma, acute/chronic inflammation (-)
148 Male

4/15/10

56 #20 Periapical granuloma scar, chronic inflammation (-)
149 Male

2/24/10

48 #21 Periapical scar, chronic inflammation (-)
150 Male

1/19/10

48 #29 and #30 Periapical granuloma, marked acute/chronic inflammation, reactive bone (+)
151 Female

1/4/10

55 #14 and #15 Periapical granuloma, chronic inflammation, reactive bone (-)
152 Female

1/4/10

61 #4 Periapical granuloma scar, chronic inflammation (-)
153 Female

7/30/09

46 #7 Periapical, marked acute/chronic inflammation, reactive bone (+)
154 Female

7/16/09

60 #10 Periapical granuloma cyst, chronic inflammation, reactive bone (-)
155 Female

7/7/09

33 #3 Periapical granuloma scar, reactive bone (-)
156 Male

7/2/09

58 #9 Radicular periapical cyst, acute/chronic inflammation, (+)
157 Female

6/19/09

75 #31 Periapical granuloma cyst, acute/chronic inflammation (+)
158 Male

6/9/09

69 #8, #9, #10 and #11 Periapical granuloma cyst, reactive bone (+)
159 Male

5/30/09

50 #8 Periapical granuloma, marked acute/chronic inflammation, reactive bone (-)
160 Female

5/27/09

46 #15 Periapical granuloma scar, reactive bone (-)
161 Male

5/20/09

55 #3 Periapical granuloma, moderate C-inflammation (+)
162 Female

5/13/09

64 #20 Periapical granuloma, marked acute/chronic inflammation (-)
163 Female

4/10/09

38 #18 Periapical granuloma abscess, marked acute/chronic inflammation (-)
164 Female

2/26/09

60 #18 and #19 Periapical granuloma, osteonecrosis (+)

Fosamax person

165 Female

2/13/09

63 #3 Periapical granuloma, marked acute/chronic inflammation (-)
166 Female

12/13/08

56 #9 and #11 Periapical granuloma scar, chronic inflammation (-)
167 Female

12.9.08

70 #5 Radicular cyst periapical, marked acute/chronic inflammation (-)
168 Male

12/9/08

63 #5 Periapical granuloma cyst, chronic inflammation (-)
169 Female

10/6/08

34 #3 Periapical granuloma cyst, chronic inflammation (+)
170 Female

10/1/08

51 #30 Periapical granuloma scar, reactive bone (-)
171 Female

9/13/08

60 #29 and #30 Thickened partially devitalized bone and granulation tissue (granuloma) (-)
172 Male

8/11/08

29 #28 Chronic inflammation, periapical granuloma (+)
173 Male

8/11/08

29 #8 and #9 Chronic inflammation, periapical granuloma scar (-)
174 Female

7/14/08

56 #3 Acute/chronic inflammation with fibrosis and granulation tissue, (-)
175 Female

7/8/08

54 #19 Cystic ameloblastoma, fibrosis, inflammation (-)
176 Female

6/21/08

66 #9 Fibrosis, periapical scar (+)
177 Female

6/18/08

49 #7 and #9 Periapical granuloma scar, chronic inflammation (+)
178 Female

6/2/08

55 #4 Periapical granuloma (-)
179 Male

4/22/08

58 #9 Apical fibrosis scar (-)
180 Female

3/19/08

63 #6 and #8 Periapical granuloma cyst, marked chronic inflammation (+)
181 Female

1/22/08

63 #14 Periapical scar (fibrosis) with focal bacteria (+)
182 Female

1/9/08

50 #18 Periapical granuloma cyst, acute/chronic inflammation (-)
183 Male

12/5/07

45 #5 Granulation tissue/cyst, chronic inflammation (-)
184 Female

12/1/07

34 #8 and #9 Granulation tissue, marked inflammation, fibrosis (-)
185 Female

12/1/07

56 #12 and #13 Granulation tissue, partially devitalized bone, chronic inflammation (+)
186 Femals

11/9/07

68 #13 Periapical scar/granuloma, chronic inflammation (+)
187 Female

11/1/07

70 #28 and #29 Fragments of reactive, focally necrotic bone; fibrosis, chronic inflammation (-)
188 Male

12/5/07

53 #31 Periapical granuloma cyst, marked acute/chronic inflammation (-)
189 Male

9/27/07

64 #14 Radicular cyst (periapical), marked acute/chronic inflammation (+)
190 Male

9/18/07

64 #19 Periapical abscess/granuloma (+)
191 Male

8/24/07

42 #2 Periapical granuloma cyst, chronic inflammation, reactive bone changes (-)
192 Male

8/13/07

74 #19 Periapical granuloma, marked acute/chronic inflammation (+)
193 Male

8/13/07

74 #2 Periapical granuloma, marked acute/chronic inflammation (-)
194 Male

8/13/07

74 #30 Periapical granuloma, marked acute/chronic inflammation (-)
195 Female

5/23/07

51 #4 Periapical granuloma cyst, marked acute/chronic inflammation (+)
196 Female

5/16/07

62 Titanium implant #6 Peri-implantitis, granulation, fibrosis, chronic inflammation, reactive bone (+)
197 Female

4/10/07

32 #14 Periapical granuloma scar, chronic inflammation (+)
198 Female

3/31/07

59 #2 Periapical granuloma, marked acute/chronic inflammation (+)
199 Female

2/1/07

49 #29 Periapical granuloma, marked acute/chronic inflammation (+)
200 Female

7/3/06

59 Titanium implant #8 Granulation tissue, fibrosis, chronic inflammation (-)
201 Female

5/19/06

62 #4 Periapical granuloma, chronic inflammation (+)
202 Female

5/15/06

30 #9 and #10 Periapical abscess/granuloma (+)
203 Female

4/11/06

52 #24 Apical periodontitis, granulation tissue, chronic inflammation (-)
204 Male

4/1/06

57 #31 Periapical granuloma scar, reactive bone changes, chronic inflammation (-)
205 Female

2/28/06

42 #31 and #32 Periapical granuloma and cyst, reactive bone changes, marked acute/chronic inflammation (-)
206 Female

2/23/06

42 #18 and #20 Periapical granuloma scar,  marked acute/chronic inflammation, reactive bone changes (-)
207 Female

2/23/06

42 #18 and #20 Periapical granuloma scar, marked chronic/acute inflammation, reactive bone changes (-)
208 Female

2/15/06

42 #14 Periapical granuloma scar, reactive bone changes (-
209 Female

1/26/06

42 #2 Periapical granuloma, chronic inflammation, reactive bone changes (-)
210 Male

1/25/06

60 #19 Periapical abscess/granuloma, reactive bone change (+)

Actinomyces

211 Female

12/19/05

88 #24 and #25 Granulation tissue, fibrosis with acute/chronic inflammation (+)

Actinomyces

212 Female

12/15/05

45 #12 Radicular cyst (periapical) (-)
213 Male

11/8/05

83 #19 Periapical scar (+)

Actinomyces

214 Female

10/11/05

57 #5 Periapical granuloma cyst (-)
215 Female

10/10/05

62 #9 and #10 Periapical granuloma cyst (-)
216 Female

8/9/05

71 Titanium implants #11 and #12 Peri-implant mucositis, chronic/acutre inflammation, inflamed granulation tissue (granuloma), reactive bone changes (-)
217 Female

7/31/05

54 #15 Periapical granuloma, reactive bone changes (-)
218 Female

7/26/05

64 #10 Periapical granuloma cyst (-)
219 Female

7/24/05

62 #19 Periapical granuloma cyst (-)
220 Male

7/16/05

81 #5 Granuloma scar (+)

Actinomyces

221 Female

7/6/05

52 #9 and #10 Periapical granuloma cyst, reactive bone (-)
222 Male

6/27/05

74 Titanium implants #17 and #18 Peri-implantitis, chronic inflammation, granulation tissue, reactive bone (-)
223 Female

6/16/05

57 #3, #4 and #5 Fibrosis, chronic inflammation (-)
224 Male

5/18/05

67 #4 Periapical granuloma cyst (-)
225 Male

5/10/05

73 #19 Fibro-granuloma (+)

Actinomyces

226 Male 4/4/05 73 #29 Periapical granuloma fibrosis, chronic inflammation (+)

Actinomyces

227 Male

4/4/05

74 Titanium implants #30 and #31 Peri-implantitis, chronic inflammation and fibrosis, hyperostotic bone (+)

Actinomyces

228 Male

3/21/05

54 Titanium implant #20 Peri-implantitis, chronic/acute inflammation, reactive bone (+)

Actinomyces

229 Male

3/16/05

58 34 Periapical granuloma (-)
230 Female

2/15/05

41 #3 Radicular cyst (+)

Actinomyces

231 Female

2/12/05

61 #8 and #10 Periapical granulomas (+)

Actinomyces

232 Male

2/7/05

56 #6 Periapical granuloma (-)
233 Female

1/26/05

69 #4 Periapical granuloma (+)

Actinomyces

234 Female

1/24/05

42 #14 Periapical granuloma (+)

Actinomyces

235 Female

1/20/05

56 #18 Radicular cyst (+)

Actinomyces

236 Male

11/27/04

54 #9 Chronic inflammation, fibrosis, granulation tissue (granuloma) (-)
237 Male

11/20/04

56 #5 Apical periodontitis (-)
238 Female

8/31/04

51 #9 Periapical granuloma (+)

Actinomyces

239 Female

8/16/04

54 #3 Periapical granuloma (-)
240 Female

8/4/04

48 #19 Periapical abscess (+)

Actinomyces

241 Male

7/22/04

45 #3 Radicular cyst, reactive bone (+)

Actinomyces

242 Female

7/17/04

19 #19 Periapical granuloma (-)
243 Female

7/12/04

55 #30 Periapical granuloma (-)
244 Male

5/3/04

50 #10 Periapical scar/fibroma (-)
245 Female

4/12/04

65 #7 Radicular cyst, reactive bone (+)

Actinomyces

246 Female

1/2/04

61 #30 Apical periodontitis, reactive bone (+)

Actinomyces

247 Male

12/23/03

55 #2 Periapical granuloma (-)
248 Female

10/31/03

32 #12 Periapical granuloma cyst (-)
249 Female

10/18/03

53 #20 Periapical granuloma scar (-)

Biocalex-filled endo

250 Female

9/30/03

62 #13 Periapical granuloma cyst (-)
251 Female

9/19/03

39 #14 Aperiapical granuloma, periapical periodontitis (-)
252 Female

8/18/03

69 #9 Periapical granuloma (-)
253 Male

7/30/03

44 #9 Periapical granuloma (-)
254 Female

7/11/03

42 #7, #8, #9 and #10 Periapical granulomas (+)

Actinomyces

255 Male

6/6/03

38 #25 Periapical granuloma (chron. api. periodon.) (-)
256 Female

6/6/03

66 #18 Radicular (periapical) cyst (+)

Actinomyces

257 Male

6/4/03

75 #7 Devitalized bone, fibrosis (-)
258 Female

4/1/03

61 #20 Apical fibrosis (+)

Actinomyces

259 Female

3/18/03

37 #20 Periapical granuloma cyst (+)

Actinomyces

260 Male

3/17/03

66 #9 Periapical granuloma scar (+)

Actinomyces

261 Female

2/18/03

61

 

#4 Periapical granuloma (+)

Actinomyces

262 Female

2/4/03

80 #9 Periapical granuloma scar (+)

Actinomyces

263 Male

9/11/02

50 #18 Radicular (periapical) cyst (+)

Actinomyces

264 Female

8/8/02

73 #19 Periapical abscess/cyst (-)
265 Female

6/22/02

69 #28, #29 and #30 Periapical granulomas (-)
266 Female

6/17/02

53 #28 Periapical granuloma with foreign body material (-)
267 Male

6/15/02

75 #13 and #15 Radicular (periapical) cyst (+)

Actinomyces

268 Female

6/4/02

73 #11 Periapical granuloma cyst (-)
269 Female

6/4/02

75 #19 Periapical granuloma cyst (-)
270 Female

5/22/02

65 #20 Periapical granuloma scar (-)
271 Female

5/7/02

54 #15 Radicular (periapical) cyst (+)

Actinomyces

272 Male

5/6/02

43 #14 and #30 Periapical granulomas, dead bone (+)

Actinomyces

273 Female

2/2/02

55 #18 Periapical granuloms (-)
274 Male

12/3/01

61 #2 Firbosis, granulation, chronic inflammation (-)
275 Male

10/30/01

43 #2 Radicular cyst, necrotic bone (-)
276 Female

9/29/01

55 Titanium implants #30 and #31 Periapical granuloma, dead bone, chronic inflammation (-)
277 Male

9/4/01

62 #18 Periapical granuloma (RB changes) (+)

Actinomyces

278 Female

8/31/01

54 #14 Periapical granuloma, dead bone (-)
279 Male

8/27/01

51 #3 Periapical granuloma, RB changes (+)

Actinomyces

280 Female

8/1/01

31 #10 Periapical granuloma cyst (+)

Actinomyces

281 Male

7/30/01

58 #18 Periapical abscess/granuloma (RB changes) (-)
282 Female

6/27/01

58 #7 and #9 Periapical granuloma cyst, necrotic bone (+)

Actinomyces

283 Female

5/16/01

46 #9 Periapical granuloma, dead bone (+)

Actinomyces

284 Male

4/30/01

51 #4 Periapical granuloma cyst (+)

Actinomyces

285 Female

4/19/01

31 #14 Periapical granuloma with reactive bone changes (-)
286 Female

3/20/01

47 #5 Periapical granuloma (-)
287 Female

3/14/01

54 #19 Periapical granuloma scar (-)
288 Female

3/13/01

50 #14 Radicular (periapical) cyst (+)

Actinomyces

289 Female

3/12/01

53 #13 Periapical granuloma cyst (+)

Actinomyces

290 Female

3/10/01

78 Titanium post #3 Periapical granuloma cyst, chronic inflammation, dead bone (+)

Actinomyces

291 Female

2/26/01

53 #4 Periapical abscess/granuloma (+)

Actinomyces

292 Female

2/26/01

50 #29 Necrotic bone, inflammation, granulation tissue/fibrosis (-)
293 Female

2/17/01

50 #3 and #4 Periapical granuloma cyst (+)

Actinomyces

294 Female

6/8/99

22 Titanium implant #7 Peri-implantitis, chronic inflammation, reactive epithelial changes, parakeratosis and acanthosis, reactive bone (-)
295 Female

4/7/99

53 #10 Periapical granuloma scar with chronic inflammation (-)
296 Female

3/1/99

33 #14 Periapical abscess and granuloma, marked acute/chronic inflammation with fibrosis (-)
297 Male

3/6/96

37 #19 Chronic osteomyelitis with focal osteonecrosis (-)
298 Male

5/30/95

56 #7, #8, #9 and #10 Marked chronic/acute inflammation, reactive bone (-)
299 Female

5/23/95

35 #8 Periapical abscess and granuloma, marked inflammation (-)
300 Male

4/29/89

31 #8 Chronic periodontal abscess, chronic inflammation, fibrosis (-)
301 Male

10/8/87

40 #9 Periapical granuloma, chronic inflammation, cells infil (-)
302 Female

8/1/87

32 #19 Chronic periapical abscess, chronic osteomyelitis (-)
303 Male

5/2/87

37 #24 Periodontal fibrosis, chronic osteomyelitis (-)
304 Male

1/31/87

42 #4 Periapical granuloma, chronic osteitis (-)
305 Female

12/3/86

NG #14 Chronic osteitis, dental fibroma (-)

 

Conclusion

It is common in this year 2017 to read in our dental journals and hear our media extoll the modern advancements of dental implants as being the natural replacement for the failed root canal tooth. It seems that we go from the frying pan to the fire in this regard.

As our two tables reveal, the microbiologic factor from both are the presence of actinomyces; and the mirco-currents from dental metals in these oral tissues that may not only play a significant role in failures of implants and root canals but may migrate to other parts of the human biome and play their mischief.

We, as biological dental practitioners, caution the misuse of these two methods, root canals or dental implants, for treatment, particularly in our youth and seniors who may have compromised immunity.

As Charalampakis notes in his presentation referenced at the start of our inquiry:

It is common knowledge that mircroorganisims are a risk factor for peri-implantitis since disease is bacterially induced…Unfortunately the bacterial role is disease pathogenesis has been underrated because no specific bacteria have been implicated in the apical migration of the ‘barrier’ epithelium, equivalent to the junctional epithelium around teeth.

We might now humbly suggest that there may be a specific bacterium present and that it is prevalent in the oral environment with significant virulence, whose primary function in nature is the reclamation of dead and dying matter, including the human biome. Due to the microbiological difficulty of showing actinomyces odontolyticus or any of its family members in peri-implant tissue through testing methods in the lab, we may have a sub-clinical factor revealed by this clinical research as presented. We have shown that in over 50% of the implants removed and histologically inspected that colonies of actinomyces were present associated with the pathological picture. One may not conclude that actinomyces alone is a causative agent but that, perhaps, they are one of the elements to be investigated more comprehensively.

The second equally unknown factor not looked at much at all is the implication of electrical currents in tissue surrounding metal dental implants and their corrosion products/toxins. Given the fact that body cells operate on pico-amps in normal states and that the currents generated by metal implants are in the micro-amps range, about three-fold higher, this fact may give pause to our understanding of cellular destruction due to corrosion (acid base balance) and the need for immune cell phagocytosis and bacterial phagocytosis in the deep surrounding tissues of implants.

Dr. Ron Carlson Dr. RS Carlson graduated from the University of Michigan School of Dentistry in 1969 and completed Post Graduate training in pediatric dentistry with Strong-Carter Dental Clinic, Honolulu, Hawaii, 1970—71. He is a founder of Kokua Kalihi Valley Dental Clinic in 1973 and volunteered from 1973 to 1980, serving low-income families and immigrant populations from the South Pacific Islands and Asia. He has maintained a private practice in Honolulu since 1971, emphasizing Bio-Logical Dentistry. He can be reached at (808) 735-0282, ddscarlson@hawaiiantel.net or carlsonbiologicaldentistry.com. Disclosure: Dr. Carlson is the inventor of the Carlson Bridge® “Winged Pontic” tooth replacement system, a noninvasive approach to replacing missing teeth, with patents issued in November 1999 and October 2001.

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