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Management of infection after grafting of the sinus bone

Authors:
Please
cite
this
article
in
press
as:
Ayna
M,
et
al.
Management
of
infection
after
grafting
of
the
sinus
bone.
Br
J
Oral
Maxillofac
Surg
(2016),
http://dx.doi.org/10.1016/j.bjoms.2016.06.021
ARTICLE IN PRESS
YBJOM-4932;
No.
of
Pages
2
British
Journal
of
Oral
and
Maxillofacial
Surgery
xxx
(2016)
xxx–xxx
Available
online
at
www.sciencedirect.com
ScienceDirect
Technical
note
Management
of
infection
after
grafting
of
the
sinus
bone
M.
Ayna a,b,c,
A.
Gülses d,,
I.
Mede e
aCenter
for
Implant
Dentistry,
Duisburg,
Germany
bRuhr
University
Bochum,
Germany
cDanube
University
Krems,
Austria
dGülhane
Military
Medical
Academy,
Department
of
Oral
and
Maxillary
Surgery,
Ankara,
Turkey
ePrivate
Practice,
Neukirchen-Vluyn,
Germany
Accepted
27
June
2016
Keywords:
bone
grafting;
infection;
maxillary
sinus
Introduction
An
acute
postoperative
infection
of
the
maxillary
sinus
may
threaten
the
survival
of
any
implants
and
material
used
for
grafting.1,2 It
is
important
to
prescribe
antimicrobial
drugs
and
remove
all
foreign
bodies,
including
the
graft
mate-
rial,
through
a
Caldwell-Luc,
or
a
transnasal
endoscopic
approach
so
that
we
do
not
have
to
operate
again.3We
describe
the
technique
we
have
used
for
several
years
in
The
Duisburg
Centre
for
Implantology
to
prevent
postoperative
infection.
Method
To
drain
the
abscess,
we
make
two
vertical
incisions
of
1
cm
in
the
vestibular
sulcus,
raise
a
tunnel-like
mucope-
riostal
flap,
and
remove
the
collagen
membrane
from
the
lateral
bony
wall.
We
then
place
a
Redon©drain
(Braun,
Melsungen,
Hessen,
Germany)
along
the
length
of
the
flap
and
secure
it
with
3/0
silk
sutures
to
both
vertical
incisions
(Figs.
1–3).
The
area
is
irrigated
with
3%
hydrogen
perox-
ide
solution
twice
a
day
for
10
days
until
there
are
no
more
free-floating
particles.
We
prescribe
co-amoxiclav
1000
mg
three
times/day,
ibuprofen
600
mg
three
times/day
and
a
nasal
Corresponding
author.
Gülhane
Askeri
Tıp
Akademisi,
A˘
gız
Dis¸
C¸
ene
Cerr.
AD,
General
Tevfik
Saglam
Cad.
06010
Etlik-
Ankara,
Turkey
Tel.:
+905326954048;
fax:
+903123114609.
E-mail
address:
aydingulses@gmail.com
(A.
Gülses).
Fig.
1.
The
preoperative
panoramic
radiograph
of
the
patient.
spray
twice
daily
for
10
days.
The
spray
contains
dexametha-
sone
1.14
mg,
naphazolin
hydrochloride
5
mg,
chlorobutanol
30
mg,
polypropylene
glycol
500
mg,
sodium
hydrogen
phos-
phate
3
mg,
and
sodium
dihydrogen
phosphate
50
mg,
and
water.
Ten
days
later
the
surgical
area
should
be
free
of
any
infection.
The
drain
is
removed
and
the
vertical
incisions
closed
primarily.
After
six
months,
we
insert
two
implants
(3.5
×
11.5
mm
and
4.3
×
11.5
mm)
(Nobel
Biocare®Ser-
vices
AG,
Zürich,
Switzerland)
(Fig.
4).
Discussion
In
2014,
the
Medicines
and
Healthcare
Products
Regulatory
Agency
declared
that
hydrogen
peroxide
is
not
recommended
for
use
in
the
United
Kingdom
in
closed
body
cavities,
or
in
http://dx.doi.org/10.1016/j.bjoms.2016.06.021
0266-4356/©
2016
The
British
Association
of
Oral
and
Maxillofacial
Surgeons.
Published
by
Elsevier
Ltd.
All
rights
reserved.
Please
cite
this
article
in
press
as:
Ayna
M,
et
al.
Management
of
infection
after
grafting
of
the
sinus
bone.
Br
J
Oral
Maxillofac
Surg
(2016),
http://dx.doi.org/10.1016/j.bjoms.2016.06.021
ARTICLE IN PRESS
YBJOM-4932;
No.
of
Pages
2
2
M.
Ayna
et
al.
/
British
Journal
of
Oral
and
Maxillofacial
Surgery
xxx
(2016)
xxx–xxx
Fig.
2.
The
Redon©drain
in
place
(Braun
AG,
Size
Ch
06,
DI
1
cm–DA
2
cm).
Fig.
3.
Orthopantomograph
taken
with
the
Redon©drain
in
place.
(Please
note
the
radio-opaque
component
of
the
product).
Fig.
4.
After
six
months,
two
implants
(Nobel
Biocare®3.5
×
11.5
mm
and
4.3
×
11.5
mm)
were
placed
into
the
grafted
area.
wounds
that
are
large,
or
deep,
because
of
the
risk
of
gas
embolism.4
In
our
technique,
the
defect
shares
a
border
with
the
max-
illary
sinus,
so
molecular
oxygen,
(which
could
cause
either
venous
or
arterial
embolism)
can
easily
penetrate
the
max-
illary
antrum
through
the
membrane
of
the
maxillary
sinus,
and
the
presence
of
the
drain
could
decrease
the
pressure
dur-
ing
irrigation.
The
risk
of
embolism
could
also
be
considered
relatively
low
because
of
the
size
and
the
vascular
anatomy
of
the
region,
and
the
amount
of
hydrogen
peroxide
solution
used
for
irrigation.
The
technique
does
not
offer
an
exact
solution
for
pre-
vention
of
infections
after
grafting,
but
it
is
simple
and
minimally-invasive,
and
could
avoid
the
laborious
rescue
procedures
that
were
previously
required.
Conflict
of
interest
We
have
no
conflicts
of
interest.
Ethics
statement/confirmation
of
patient’s
permission
All
procedures
were
approved
by
the
responsible
committee
on
human
experimentation
(institutional
and
national)
and
with
the
Helsinki
Declaration
of
1964
and
later
versions.
Our
patients
gave
consent
to
be
included
in
this
study.
References
1.
Galindo
P,
Sánchez-Fernández
E,
Avila
G,
et
al.
Migration
of
implants
into
the
maxillary
sinus:
two
clinical
cases.
Int
J
Oral
Maxillofac
Implants
2005;20:291–5.
2.
Chiapasco
M,
Felisati
G,
Zaniboni
M,
et
al.
The
treatment
of
sinusitis
following
maxillary
sinus
grafting
with
the
association
of
functional
endo-
scopic
sinus
surgery
(FESS)
and
an
intra-oral
approach.
Clin
Oral
Implants
Res
2013;24:623–9.
3.
Nkenke
E,
Stelzle
F.
Clinical
outcomes
of
sinus
floor
augmentation
for
implant
placement
using
autogenous
bone
or
bone
substitutes:
a
systematic
review.
Clin
Oral
Implants
Res
2009;20:124–33.
4.
Beattie
C,
Harry
LE,
Hamilton
SA,
et
al.
Cardiac
arrest
following
hydro-
gen
peroxide
irrigation
of
a
breast
wound.
J
Plast
Reconstr
Aesthet
Surg
2010;63:e253–4.
... Metronidazole has also been advocated as local antibiotherapy included in the initial graft to reduce anaerobic bacterial contamination 40 . Another solution to avoid secondary grafting -prolonged sub-periosteal drainage -was described by Ayna et al. 14,41 . This solution avoided graft removal, and DI were placed successfully 6 months later. ...
Article
Sinus graft infections are rare but serious complications, as they are associated with significant morbidity and sinus graft loss. The aim of this study was to systematically review the management of sinus graft infection in order to define which protocols should be implemented. The terms searched in each database were "sinus graft infection management", "maxillary sinus lift infection", "maxillary sinus graft infection", "maxillary sinus elevation infection", and "maxillary sinus augmentation infection". The management of the sinus graft infection was assessed. The outcomes evaluated were maxillary sinus health and dental implantation results. The initial search yielded 1190 results. Eighteen articles were included, reporting a total of 3319 patients and 217 sinus graft infections. Drainage was performed with an intraoral approach in 13 studies, an endoscopic approach in two studies, and a combined approach in three studies. In every study, a disease-free sinus was finally obtained in all patients, but the outcomes of the graft and the dental implant were more varied. It is not possible to define the best treatment protocol for sinus graft infections based on the published data, since the level of evidence is poor. Management is very heterogeneous. This review highlights the necessity of surgical treatment associated with antibiotic therapy.
Article
Recently, a technical note describing a promising method for the management of infections after sinus bone grafting by irrigating the corresponding area with hydrogen peroxide based solution with an aid of a drain has been published. The aim of this paper was to present the histological and radiological results of the above mentioned technique. A total of 17 patients who have presented with infections secondary to sinus bone grafting enrolled in the study. During implant placement, bone was collected from the originally grafted site with a trephine burr for radiological examination via micro-computed tomography and histological examination. According to the results of the current study, Bio-Oss acted as a scaffold, and mature fibrous bone formed trabeculae, which assembled to an interlinked trabecular structure. Average results obtained from the microradiography confirmed the higher percentage of Bio-Oss (27.21% ± 3.31%) at the corresponding area; whereas the amount of newly formed bone was slightly lower (6.79% ± 1.13%) As a conclusion, this simple and minimally invasive technique might be beneficial in avoiding removal of bone graft material and could help in rescuing the former laborious procedure.
Full-text available
Article
To date, there are still no clear cut guidelines for the use of autogenous bone or bone substitutes. The aim of the present review was to analyze the current literature in order to determine whether there are advantages of using autogenous bone (AB) over bone substitutes (BS) in sinus floor augmentation. The focused question was: is AB superior to BS for sinus floor augmentation in partially dentate or edentulous patients in terms of implant survival, patient morbidity, sinusitis, graft loss, costs, and risk of disease transmission? The analysis was limited to titanium implants with modified surfaces placed in sites with 6 mm of residual bone height and a lateral wall approach to the sinus. A literature search was performed for human studies focusing on sinus floor augmentation. Twenty-one articles were included in the review. The highest level of evidence consisted of prospective cohort studies. A descriptive analysis of the constructed evidence tables indicated that the type of graft did not seem to be associated with the success of the procedure, its complications, or implant survival. Length of healing period, simultaneous implant placement or a staged approach or the height of the residual alveolar crest, sinusitis or graft loss did not modify the lack of effect of graft material on the outcomes. Three studies documented that there was donor site morbidity present after the harvest of AB. When iliac crest bone was harvested this sometimes required hospitalization and surgery under general anesthesia. Moreover, bone harvest extended the operating time. The assessment of disease transmission by BS was not a topic of any of the included articles. The retrieved evidence provides a low level of support for selection of AB or a bone substitute. Clear reasons could not be identified that should prompt the clinician to prefer AB or BS.
Article
To present the results of a prospective study on the management of infectious complications following maxillary sinus floor elevation procedures with a combined endoscopic (FESS) and intra-oral approach. From 2005 to 2009, twenty consecutive patients were diagnosed for sinusal chronic infectious complications refractory to medical treatment following maxillary sinus floor elevation and grafting procedures. All patients were treated with a combination of functional endoscopic sinus surgery (FESS) through a transnasal approach and an intra-oral approach, performed by an ear, nose, and throat team and an oral and maxillofacial team, respectively, in the same surgical session under general anesthesia. In 16 of 20 patients, the 4-week endoscopic control demonstrated a complete clinical healing and recovery of the normal sinus ventilation and drainage. In two patients, the persisting sinusitis at the 4-week control was successfully treated (8th week) with an antibiotic therapy based on the antibiogram carried out on the bacterial culture obtained by the aspiration of the sinusal content. In one patient, the persisting sinusitis (3 months after surgery) was successfully treated with the aspiration of the infectious material from the maxillary sinus. In one patient, finally, it was necessary to perform a second combined surgical treatment to treat the persisting sinusitis. In this study, a relevant number of cases of chronic infectious complications following sinus floor elevation procedures are presented. To the authors' knowledge, it is the first time that well-defined treatment protocols based on a combined endoscopic (FESS) and intra-oral surgical approach are proposed. The positive, albeit preliminary, results obtained in this study seem to validate this treatment modality.
Article
Hydrogen peroxide is commonly used for the decontamination of wounds. We report a case of a probable venous oxygen embolism resulting in cardiovascular collapse following irrigation of a necrotic breast wound with hydrogen peroxide. We discuss the differential diagnosis, mechanism of oxygen embolism and question the relative advantages versus disadvantages of using hydrogen peroxide for wound decontamination.
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Invasion of the maxillary sinus is a relatively frequent complication in dental implant treatment of patients with inadequate bone height in the posterior maxilla. This event usually occurs during surgery and sometimes produces sinusitis. There is a paucity of reports in the literature of implants migrating into the sinus cavity after a period of function. In the 2 clinical cases presented, an intraosseous apical movement of the implants was produced several years after placement of the implants. Hypotheses and possible mechanisms by which an implant may migrate into the maxillary sinus are described.