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implants - international magazine of oral implantology International Edition

I research 12 I implants4_2013 ers, which adversely influenced the complications of bone grafting procedures.60 Patients with history of smokinghaveahigherfailurerateofimplants,regard- lessoftheamountofcigaretteconsumed.61 Association between retromolar bone grafting complications and smoking habits was also found in this study. Dentists, oralsurgeonsandtreatingphysiciansshouldurgetheir patientstoquitsmokingsinceitreducesthesuccessrate of ridge augmentation. Higher implant failure rates have been reported when implants are placed into graftedsites.22 However,inthisstudy,despitethenum- ber of complications, rehabilitation with oral implants wasnotpossibleinonly7.6%ofallbonegraftingpro- cedures.AghalooandMoyhavealreadyindicatedsim- ilarsuccessratesbetweenimplantsplacedintografted sitedcomparedwithimplantsplacedintonativebone.38 Small amounts of particulate bone grafts may be collected from the implant area during implant site preparation, and the resulting bone chips can then be usedtofillsmalldefects.Themaindisadvantageofthis techniqueisthecontaminationwithoralbacteria.Inac- cordancewithChiapasco,onlyboneblocksmaintainthe architecture of bone and appear to adapt easily to the recipientarea,whereasparticulatebonegraftswereas- sociatedwithboneblocksincaseofsimultaneousgraft- ingproceduresorasafillingmaterialaroundorbetween bone blocks.2 Reports on simultaneous bone grafting and implant placement have revealed complications such as graft fracture and wound dehiscence with ex- posureofimplantsandgraft,withahigherimplantfail- ureratethanthatofastagedapproach.15, 27, 29, 42 A staged surgery permits implant placement for idealprostheticalignmentwithouttheconcernofgraft fixation or remodelling.56 Staged implant placement also allows for any initial graft resorption and thus should provide a more stable foundation. None of the complications influenced the success of rehabilitation significantly. Despite the need for two surgical proce- dures,thepatientswerecompliantwiththeentiretreat- ment. Not only was the planning a key factor of every successful case, it was also essential to learn exactly what the patient expected from the surgery and to de- signthesurgicalproceduretoachievethatgoal. _Conclusion Theclinicaldatapresentedinthisstudyshowedthat onlayblockgraftsharvestedfromtheretromolarregion are a safe, effective and simple method of treating lo- calizedalveolarridgehypoplasiainpartiallyedentulous patients for implant placement. It must be considered that the postoperative phase of stage-one surgery is comparabletothediscomfortfeltfollowingmajorden- toalveolarsurgeryandthattheprocedurecaneasilybe carriedoutinanoutpatientenvironment.Therisksand morbidityofretromolarbonegraftingcanbeassociated with some complications, which do not significantly compromise rehabilitation when appropriate treat- mentisestablished. This retrospective study of bone grafting surgeries can serve as a guide in the prevention of possible fail- ures and consequently improve the quality of future procedures. More studies to determine which donor sites provide sufficient bone with the least patient dis- comfort and risk of complications are needed. Addi- tionalstudiesareneededtoevaluatethelong-termre- sults of the described method with regard to implant stabilityandresorptionofbonearoundtheimplants._ Disclosure The authors do not have any financial interests,either directly or indi- rectly,intheproductslistedinthestudy. Editorial note: A list of references is available from the pub- lisher. Andreas Sakkas Oral Surgeon Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery Military Hospital Ulm andAcademic Hospital University Ulm Ulm,Germany Tel.:+49 731 17101701 andreaszfc13@yahoo.gr _contact implants Method of treatment Frequency Chlorhexamid mouth rinse 2 Chlorhexamid mouth rinse and antibiotic per os 6 Chlorhexamid mouth rinse and antibiotic intravenous 1 Wound-freshening and plastic recovering 4 Bone graft removing 6 Abscess-incision and antibiotic i.v. 3 Re-bone harvesting 2 Abscess-incision,wound-freshening and antibiotic i.v. 1 Haemostasis 1 Total 26 Table 7_Management and surgical treatment of the postoperative complications after retromolar bone grafting.