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ePaper created 2017-01-11, 10:22:38 | version 1.38.0
Journal of Oral Science & Rehabilitation 18 Volume 2 | Issue 4/2016 O p e n h e a l i n g : A r e t r o s p e c t i v e a n a l y s i s Antibiotics were prescribed in accordance with current guidelines, that is, in patients at higher risk, such as valvular heart disease or inflam- mation due to tooth fracture prior to tooth extraction. Suture removal took place aftertwo weeks. In order to allow maturation of bone and soft tissue, sites were allowed to heal for at least six months before implant placement or secondary augmentation procedures were performed. A typical clinical case is shown in Figures 1a–m. E v a l u a t i o n In many cases, one membrane was used to cover multiple neighboring defects. These sites were defined as one surgical area. The data were retrospectively analyzed for defect mor- phology (number of remaining bone walls), size of surgical area (number of neighboring sites), indication, complications during healing, loss of graft material, possibility of performing flap- less implantation and need for follow-up aug- mentation procedures (none, planned or un- planned). The primary outcome parameterwas the need to perform an unplanned augmenta- tion during the implant procedure. The second- ary outcome parameter was complication rate during wound healing. In addition, the data were analyzed to determine whether unfavor- able defect morphology might increase the frequency of healing complications and wheth- er the membranes differed with regard to heal- ing complications. S t a t i s t i c s Explorative analysis of the data was performed using R (Version 3.2.2; R Foundation Vienna, Austria). A possible correlation between heal- ing complications and membrane type or defect morphology (number of bone walls) was evalu- ated using the exact chi-squared test or Fisher exact test for generalfrequencytables at the 5% level of significance. Additionally, a Spearman rank correlation coefficient was calculated for healing cpmplications and defect morphology. The univariate results were confirmed by a mul- tivariate logistic regression using healing com- plications as the main variable and defect mor- phology and membrane type as co-variables. Results During the observation period, a total of 127 pa- tients with 171 surgical areas were treated using the open-healing approach. Eight patients were lost to follow-up because they did not show up for implant placement. Therefore, the analysis included 160 surgical areas in 119 patients. Of the patients, 49.6% were male and 50.4% female. Mean patient age was 54.3 ± 13.0 years (aged 29–88 years). The maximum number of surgical areas per patient was four. A surgical area contained 1.89 ± 1.26 sites on aver- age (Table 1). The number of missing bone walls per surgical area is shown in Table 2. DBBM was used in 98.1% and autogenous bone in 1.9% ofthe surgicalareas. In 78.8% ofthe sur- gicalareas, NBCMwas used (Table3).Atitanium mesh was additionally applied in 11.3% of the surgical areas. Of these surgical areas, 88.9% were covered with NBCM, 5.55% with JM and 5.55% with DM. Bone augmentation procedures were per- formed in 33.1% of the surgical areas. They in- cluded bone splitting, horizontal, and/or vertical bone augmentation and sinus floor elevation. Ridgepreservationalonewasperformedin41.9% a b Fig. 1 Initial (a) clinical and (b) radiographic situation prior to tooth extraction. Owing to periodontal bone loss, teeth in the upper and lower jaws were extracted. Figs. 1a & b