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ePaper created 2014-07-29, 09:08:59 | version 1.30.01
I research Fig. 5_Right sinus totally shadowed with infected graft. Fig. 6_Remains of graft and slightly thickened membrane. the result of augmentation two days after surgery. A swelling of the sinus membrane exists on both sides; additionally a haematoma is visible on the right side. Two weeks after surgery, a light swelling of the right posteriormaxillaryareaappearedandthepatientfelt a discomfort at the surgical area. Radiologic exami- nationrevealedinfectionoftherightsinus(Fig.5),in- dicatinganimmediateremovalofthegraft.Theother side healed normally and showed clinically and radi- ologically no signs of infection or rejection. Removalofgraftinadditionalsurgery Sinus floor augmentation is in fact a very pre- dictable procedure and complications are rare.7, 28, 29 Failures can be caused by perforation of the sinus membrane, excessive bleeding, infection of the grafted tissues e.g. with saliva, wound dehiscence, and lack of aseptic conditions.30-33 Infected sinuses should be treated immediately. Different studies show success in treatment with antibiotics and local debridement or on the other hand complete surgical removal of the graft combined with high dosage ad- ministrationofantibiotics.30,34,45 Wedecidedtocom- pletely remove the graft in an additional surgery. Saline irrigation had been performed for over one week due to chronic sinusitis and antibiotics were prescripted (875 mg Amoxicillin with 125 mg clavu- lanic acid; twice a day for five days). The infected si- nus was successfully treated leaving sparse remains ofgraftingmaterial(Fig.6).Weseethereasonforfail- ureinaknownmassiveperforationofthesinusmem- brane. The inserted membrane possibly did not cover the entire perforation. Repeating surgery was planned but the patient decided not to undergo this procedure. This case presents another advantage of allogeneicbone.Iffailureoccurs,repeatingsurgeryis notasextensiveasusingautogenousboneandcanbe more excusable from a patient’s point of view. Postoperativefollow-up The postoperative follow-up ranges to 18.2 months from first augmentative surgery and 11.1 monthsfrominstallationofdentalimplants.Onlypa- tients with successfully installed implants were con- sidered in this issue. A longer range has not been analysed yet, due to the relatively recent implemen- tation of the grafting materials. The short period of follow-up might stand out as a possible point of crit- icism of this study. But considering the relatively quick remodelling time (compared with some xenogenicbonesubstitutes),alongerperiodmaynot actually be necessary for the discussion of this fact. Histologic studies show already after six to nine monthsofhealingtimevital,newlyformedbonewith sparseremainingallograftparticleswithoutevidence of acute inflammatory infiltrate.36-39 Allogeneic bone grafts show analogous histologic characteristics as autogenous bone chips.19 Allogeneic bone is com- pletely transformed into patient’s own bone tissue.40 However, further studies must discuss the relevance on long term success of dental implants in allogeneic grafts. _Conclusion Our experience and the results of various studies show that the use of allogeneic bone grafts for bone augmentation of the atrophic alveolar ridge works successfully. After a period of healing, the resulting bone is equal to autogenous bone. And additionally, weseemoreadvantagesintheuseofallogeneicbone than in autogenous bone._ Editorialnote:Alistofreferencesisavailablefromthepub- lisher. 18 I implants2_2014 Fig. 5 Fig. 6 Dr Phillip Wallowy Fachzahnarzt für Oralchirurgie Zahnarztpraxis Dr Hornstein & DrWallowy Laiblinsplatz 6,72793 Pfullingen,Germany Tel.:+49 712 178866 Fax:+49 712 13884492 info@hornstein-wallowy.de www.hornstein-wallowy.de _contact implants