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ePaper created 2014-07-29, 09:08:59 | version 1.30.01
I research Fig. 3_Placing allogeneic bone in sinus. Fig. 4_DVT after augmentative surgery. (200 mbar). Therefore, the bone is covered with per- aceticacid.Ethanolisusedtoreducethesurfaceten- sion.Afterfourhoursofvacuum-incubation,abuffer agent is applied. Eventually, the grafts are freeze- dried and packaged aseptically. Processing demon- strably inactivates HI-Virus 2, Hepatitis A-Virus, Po- lio-Virus, Pseudorabies-Virus as a model for Human Herpes-Virus, Porcine Parvo-Virus as a model for Hu- man Parvo-Virus B19 and Bovine Diarrhoe-Virus as a model for Hepatitis C-Virus. Also a reduction in the titer of viable micro-organisms (Staphylococcusau- reus, Enterococcus faecium, Pseudomonas aerugi- nosa, Bacillus subtilis, Clostridium sporogenes, My- cobacterium terrae, Candida albicans as well as sporesofBacillussubtilisandAspergillusniger)below the detection level is achieved.10-13 Surgicaltechnique Preoperatively, an antibiotic was given intra- venously (2.000mg Amoxicillin with 200mg clavu- lanic acid). All patients received a prescription for an antimicrobial prophylaxis (875mg Amoxicillin with 125mg clavulanic acid; twice a day for five days) and analgesic (600mg Ibuprofen; as needed). Local anaesthesia was performed by using a minimum of 4 ml of high-dose articaine (1:100.000). A crestal in- cisionwasmadeonthealveolarridgewithverticalre- leases into the vestibule if needed. A full-thickness mucoperiostealflapwascreatedtogainaccesstothe anterior wall of the maxillary sinus. A rectangular- shapedosteotomyiscutintothelateralantralwallby means of rotating instruments, revealing the sinus membrane. The inferior horizontal segment was kept 3-4 mm above the floor of the sinus in order to help keeping the grafting material in place in the floor of the sinus. The exposed membrane with the covering adherentbonewascarefullyelevatedwithspecialin- struments following the usual procedure (Fig. 1). The bone flap was displaced inward with the carefully liftedSchneiderianmembrane,formingthenewfloor of the maxillary sinus. Space was created in the pri- mary floor of the sinus for the grafting material. If tearing of the Schneiderian membrane occurred, re- pair was carried out with a layer of resorbable colla- gen (Osteogide®, ARGON Medical, Germany). The graftingmaterial(Osteograft®,ARGONMedical,Ger- many)wassoakedinvenousbloodtakenfromthean- tecubital fossa for five minutes and placed under- neaththesinusmembraneandlightlycondensedto- wards the sinus floor (Figs. 2 and 3). An absorbable collagen membrane was also placed onto the bony window. A complete and strainless wound closure was performed by means of sutures. Clinical and ra- diographic examinations were done during the post- operative phase, mostly by means of CBCT or or- thopantogram. Sutures were removed after 14 days. _Results All data is presented in Table 1. 36 patients under- went external sinus floor augmentation surgery us- ing allogeneic bone as grafting material. In 35 cases implants were able to be installed in a second inter- vention (97.2% success). After a mean time of 7.6 months, implants were installed. In only one case the grafting material was lost and had to be removed in additional surgery (2.8% failure). Not all implants wereinstalledinourclinic.Manypatientsarereferred toourcliniconlyforaugmentation,implantsarethen installed elsewhere. However, it is known to us that implants definitely were installed in these patients, just not the exact date. Therefore these dates are not included in our study. Mean time of follow-up after augmentation is 18.2 months. Mean time of follow- up after implantation is 11.1 months. _Discussion This study confirms previous results showing that allogeneic bone grafts work excellent as bone substi- tute and manage to build up healthy and well-di- mensionedbonesuitableforuncompromisinginstal- lationofdentalimplants.10,18-22 Mainpointofcriticism regarding allogeneic bone grafts are the often- quoted fears of possible transmission of disease and antigenicity. These potential disadvantages were studiedtoalargeextent.11,15-17 UsingthemodernPES- sterilizationprocedure,theyarepracticallynon-exis- tent. An inactivation of potential viruses, bacteria, fungi and spores takes place by means of interna- 16 I implants2_2014 Fig. 3 Fig. 4