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ePaper created 2014-11-07, 14:16:52 | version 1.30.01
research I – a nerve stretch injury from reflection of a soft- tissue flap; – an implant drill proceeding through the top of the neurovascular canal; and – an implant violating the canal. If a post-operative radiograph shows that an implant may have slightly violated the canal space, it is prudent to unscrew the implant, intro- duce Decadron 4 mg/ml into the osteotomy site and place a shorter implant after 2–3 minutes. In addition, a corticosteroid is given orally for three to five days (the usual dose is 8–12 mg in the morning of the first day, 4–6 mg in the morning of the second day and 2–4 mg in the morning of the third day).23 3) Neurotmesis: neurotmesis is the complete sev- erance of the nerve trunk. When this occurs, all axonsdistaltotheinjuryundergoWalleriande- generation. Anaesthesia of the soft tissue in- nervated by the affected nerve is a conse- quence of this condition. When a discontinuity or gap is present between the nerve ends, scar tissueformsbetweenthestructuresandaxonal sprouts from the proximal aspect of the nerve are prevented from penetrating the endoneur- ial tubules. Neurotmesis is suspected when anaesthesia is present or has been present for more than three months. _Complications during and after second-stage implant surgery Exposure of the graft Even several months after grafting, significant amountsofnon-vitalbonecanbefound.24 Vascu- larisation of the transplanted bone is poorer than in the residual crest, and neither a humoral im- mune response nor secondary wound healing is guaranteed. This leads to the necessity of careful soft-tissuemanagementinsecond-stagesurgery. Several techniques are reported to achieve ade- quate peri-implant soft tissue.25 If parts of the transplanted bone are exposed, soft-tissue clo- sure has to be surgically performed after debride- ment.5 Mobility of the implant If an implant fails in the augmented site, gran- ulation tissue has to be removed carefully. Radi- ographic evaluation and implant placement can be performed six to eight weeks later.5 Flap necrosis Traumatic surgery, infection or insufficient vascularisationmayleadtoflapnecrosis.Second- ary healing can take place if the underlying bone is vital and well vascularised. If the underlying bone is still premature, complications can arise.5 I 21implants3_2014 Fig. 24 Fig. 25 Fig. 26 Fig. 27 Fig. 19b Fig. 20a Fig. 20b Fig. 21a Fig. 21b Fig. 22a Fig. 22b Fig. 23