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implants - international magazine of oral implantology No. 4, 2015

I research 08 I implants4_2015 and make sure the wound is protected against super- infection and trauma, although it is located in a dy- namic and contaminated environment. Buthowcanapost-surgicalinfectionbeprevented? Basedonmedicalliteratureandmyextensiveexpe- rienceasanERsurgeonanddentalsurgeon,Ithinkthat there are different parameters to take into considera- tionwhenperformingadentalsurgery:theexperience of the surgeon, the duration of the surgery itself, the concomitant risk factors, the aseptic conditions of the operating field and the careful selection of the materi- alsused. Itisalsoessentialtokeepinmindthatoralsurgeryis not just about implants or various regenerative tech- niques.Evenaseeminglycommonavulsioncanbefully consideredasurgicalintervention,hencesubjecttoin- fectionwithmoreorlessserioussideeffectsforthepa- tient(Fig.1). Wewillnowreviewtheaboveriskfactorsforanin- depthexaminationofeverysinglesituation. _Experience Experience proves to be the most important factor inasuccessfuloutcomeofasurgicalintervention.Ithas beenreportedthattheriskofinfectioninthecaseofless experiencedsurgeonsisfourtimeshighercomparedto that of more experienced surgeons.4 Nevertheless, ex- perience is definitely not a parameter that can be changed(unlessbyagingandthroughhardwork!)but it is necessary to take note of it, and then young col- leagueswhofacesurgeryshouldpaymoreattentionto theirworkawareofthisaspect. _Duration In defining the duration of the intervention, there are two factors that must be considered: the duration, inarelativesenseandinanabsolutesense.Theabsolute value indicates the time required for the execution of thesurgicalprocedureinoptimumconditionsbyasur- geonwithadequateexperience.Virtually,therightexe- cutiontime,withnorushbutalsowithoutunnecessary expenditureoftime.Ontheotherhand,whenlackofex- perienceorinsecurityleadtoextendedduration,wetalk about relative value: basically, it is the time actually spentbutthatcouldhavebeenreduced.Ithasbeenre- ported that a duration of the intervention below one hourposesariskofsuperinfectionof1.3%,whilesuch riskisincreasedto4%iftheinterventionlastsforabout threehours.Everyadditionalhourdoublestheriskofsu- perinfection5 . Once again, it should mentioned that these values refer to the correct duration of the inter- vention.Toclearthisup,ifaninterventionexecutedcor- rectly lasts one hour, the risk is 1.3 %, if it lasts three hours, the risk rises to 4 %. But if the relative interven- tioncanbedoneinonehour,butittakesthreehoursdue tosurgeon'slackofexperience,theriskofinfectionin- creasesconsiderablybeyondtheabovesaid1.3%. _Systemic factors Therearesystemicfactorsthatpromotesuperinfec- tion of the blood clot including uncompensated dia- betes (which also prolongs healing time much more than usual), autoimmune and systemic disorders, and smoking.6, 7, 8 Concomitant use of drugs should also be carefully considered to avoid that some of them could heavilyinterferewiththehealingprocess(justthinkof thebisphosphonates,aproblemthatismoreandmore present in our clinical activity). The age of the patient shouldalsobecarefullyevaluated;duringtheavulsion procedure of a third molar, the risk of post-surgery complications is of 10% in twenty-years-of-age pa- tientsand30%ina40-year-oldpatient.9 Actually,age involves very often the use of medicines and impaired Fig. 2_Adequately prepared surgical table. Fig. 3_Incorrect preparation of a surgical table. Fig. 2 Fig. 3

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