Patients at high risk for infective endocarditis (IE) may be at risk of an endocardial infection in the case of bacteremia . The oral cavity is known to be a source of pathogens that may affect the heart valves and other heart anatomic anomalies . In the case of IE, bacterial seeding takes place by direct hematogenous spread. It has been suggested that bacteremia occurs during dental treatments, as well as during everyday activities such as tooth brushing and mastication. It is believed that some patients are more susceptible than others, and therefore at higher risk .

Major medical authorities have recently published new clinical guidelines for the prevention of IE. These protocols suggest that the use of antibiotics as a prophylactic measure for reducing the incidence of IE should be reserved only for those at high risk for IE. In 2006, the British Society for Antimicrobial Chemotherapy (BSAC) was the first to call for the use of prophylactic antibiotics to be minimalized . Nevertheless the new protocol still recognizes the group of patients at high risk for IE as being exposed to an increased risk of infection.

From 2006 to 2009, four new evidence-based clinical guidelines were published, providing a definition of high-risk patient groups and the dental treatments requiring prophylactic therapy. In general, patients with an artificial heart valve, those with a history of IE, and those with certain congenital defects remained the only patients considered at high risk. The National Institute for Health and Care Excellence (NICE; Department of Health, UK), which provides recommendations and clinical guidelines for the UK National Health Service, revised its guidelines in 2008 and ended the concept of pre-treatment with antibiotics, except in the group of patients at high risk for IE . The list of dental treatments requiring prophylactic antibiotics included periodontal procedures and peri-apical manipulation, but with no specific reference to dental implants . This begs the question whether the use of dental implants is safe and justified in patients at high risk for IE.

The spread of infection from dental implants may occur at various stages. The early stage is the time at which the implant is inserted . A later stage relates to bacterial mucositis – the implant equivalent to gingivitis. This infection is evident in the peri-implant mucosa following the healing phase . Following implant exposure and placement of the prosthesis, bacteremia may originate from extensively inflamed and infected tissue around the implant with loss of alveolar bone, known as peri-implantitis . This risk remains for as long as the implant is in place and is similar to periodontitis around natural teeth.

No information regarding the safety of dental implant placement is available in the medical literature. This article summarizes our experience of dental implant placement in patients at high risk for IE.