implants - international magazine of oral implantology International Edition

No incision-line dehiscence occurred in the donor site areas.Elevenpatientsmentionedsensorydeficitsinthe lowerlipandmentalforamenareaandthreeofthemex- periencedalteredsensationinthementalandlowerlip areaaswellasinthetongue.Noneofthepatientsexpe- rienced altered sensation localised in the region of the buccal nerve terminal branch. The incidence of tempo- rary mental nerve paraesthesia was 10.5% (11/104). At the time of implant insertion, there were no reports of symptomsotherthanthepersistenceofalteredsensa- tionintwopatientswhohadreportedpareasthesiadur- ing suture removal. One of the patients experienced postoperative bleeding and was treated with local haemostasis (Tab. 5). A relation between smoking or medical history and complications of the donor site is notpossible,becausetheseincidentsareusuallycaused iatrogenically. In the ten patients who underwent impacted third molar tooth extractions combined with bone harvest- ing,atemporaryparaesthesiaorwoundinfectionwere observed in six of them. In the recipient sites, the fre- quencyofcomplicationswashigherthanindonorsites. Except the minor complications such as wound infec- tion with pus exit or incision-line opening, graft expo- sureandscrewmobilizationaswellascombinationsof them(Tab.6).InFigure4,somecomplicationsinrecipi- entsitesarepresented. Seven (31.8%) of them were observed in smokers and 15 (68.2%) in nonsmokers in a total of 22 bone grafts.Thetemporaryparesthesiaonthepercipientsite observedbyonepatientwasnottakeninconsideration. Figure 6 presents the separation of the postoperative complications both of the donor and recipient site ac- cording to smoking. Statistic significance between smoking and complications was to be considered (p=0.009). Inonediabeticpatient,lossofboneparticles after infection was observed and no implantation was realizable. Wound infection and graft exposure were alsoobservedintwopatientswithpreoperativelydiag- nosedgeneral-advancedperiodontitis.However,noas- sociation was found in this study between retromolar bone grafting complications and medical history, be- causeofthelownumberofpatients. A great value was given to the management of the postoperative complications. Minor effects were treated conservatively with mouth rinse included chlorhexamid and antibiotics either orally or intra- venously.Patientswithabscesshadtobetreatedsurgi- callyandwerealsocoveredwithantibiotics.Bygraftex- posure,thebonesequesterswereremovedandthebone blockwasrefreshed,whilethewoundwasclosedwitha buccal fat pad under antibiotic cover. By patients with screwmobilization,healingwasuneventfulafterthere- movalofthescrew.Ineight(7.6%)ofthecases,thebone graftwastotallyexposedcombinedwithwoundinfec- tionandexitofpus.Thesurgicalremovalofthegraftwas research I Fig. 2_Association between periodontitis and complications of the recipient site. Table 1_Complications associated with retromolar bone grafts. I 07implants4_2013 Complications Etiology Prevention Management Infection, membrane contamination Microbial contamination Antibiotics and aseptic surgical procedure Remove infection source, systemic antibiotics and antimicrobial mouth rinse Incision line opening,membrane exposure,wound dehiscense, perforation of mucosa Tension-free closure not achieved Achieve tension-free primary closure systemic antibiotics and antiseptic mouth rinse Nerve dysfunction Damage to infra-alveolar nerve Know the anatomy,wait and some- times palliative treatment may be needed Graft mobilization Inadequate fixation (insufficient screws,screw loosening) Secure fixation screws,use >1 screw,ensure no-mobility and no dead space principle Remove and regraft at later time Loss of bone graft particles Primary closure not achieved Achieve tension-free primary closure,use of membrane Do nothing and allow for proper healing