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ePaper created 2016-01-07, 12:59:38 | version 1.38.0
I research Fig. 4_Bone regeneration surgery. Fig. 5_The importance of proper closure as the first priority, without tension on the flap. Tab. 1_Risk factors in oral surgery. immune system, in addition to the presence of con- comitantsyndromes. _Antisepsis Several studies have highlighted how in oral and implant surgery the proper preparation of a so-called clean operating room is sufficient to achieve a success rate comparable to that obtainable in a sterile room (Fig.2).10, 11 The above data can and should be interpreted in twodifferentmanners.Ontheonehand,itmeansthat it is not therefore necessary to prepare our operating room as if it were a veritable operating theatre each time we perform a surgery; on the other hand, if min- imumproceduresforthepreparationoftheoperating room and the operating field, that require little time and modest investment, are not ensured, this could leadtounnecessaryandsignificantincreaseintherisk of failure or infection of the wound (Fig. 3). The pre- scription of a systemic antibiotic therapy provided by the majority of existing guidelines, is certainly an im- portant and useful additional procedure aimed to re- ducethebacterialloadusuallypresentintheoralcav- ity, but however insufficient to prevent or to exclude the risk of infection. Therefore, although prescribed, such therapy must not be considered as a substitute fortheapplicationofallthenecessaryantisepsisrules. Since it has a preventive purpose, the antibiotic ther- apy must be started from the day before the surgery. Thesameappliestotopicalantibiotics(veryoftenuse- less). The use of mouthwashes before surgery and in the following days, although common and appropri- ate,hasnoinfluencewhatsoeveroverthereductionof the risk of infection. _Presence of foreign bodies Veryoften,itisnotconsideredthattheinsertioninto thetissueofamaterialoradevicesuchasanimplant,a biomaterialoramembrane,caninduceaforeign-body reaction (Figs. 4–5). Surgeons' way of thinking is com- pletelyoppositetothebiologicalresponse;theirgoalis toimprovethehealthconditionofthepatient,focusing on what kind of materials to insert, materials that act fromabiologicalpointofviewasforeignbodies,caus- ingabiologicalresponseandinflammation(sometimes evenanimmuneresponse).Finally,inordertoclosethe wound properly, we use sutures which are also per- ceivedbythebodyasaforeignbodythattriggersacon- sequentreaction(Figs.6–7).Forthisreasonwearefac- ingaconceptualantagonism:theprofessionalchooses a material to heal the patient, but the same triggers a foreign-bodyreaction.Thechoiceanduseofthemate- rialsisthereforecrucialinourefforttominimisethefor- 10 I implants4_2015 Fig. 4 Fig. 5 Risk factors Experience Level of experience of the surgeon Duration Relative and absolute duration of the intervention Systemic factors Age,diabetes,autoimmune and systemic disorders, smoking,medication Antisepsis Operating room set-up and equipment,use of local and systemic antibiotics Materials used and grafted Implant,biomaterials,membrane,sutures