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Microflora of normal maxillary sinuses: does it justify perioperative antibiotic treatment in sinus augmentation procedures

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Clinical Oral Investigations
Authors:
Oren Peleg at Tel Aviv Sourasky Medical Center
Oren Peleg
Danielle Blinder
Danielle Blinder
Danielle Blinder
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Keren Yudovich
Keren Yudovich
Keren Yudovich
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Arkadi Yakirevitch
Arkadi Yakirevitch
Arkadi Yakirevitch
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Abstract and Figures

Objectives To investigate bacterial flora of normal maxillary sinuses in order to facilitate perioperative antibiotic management in sinus augmentation procedures. Materials and methods Specimens of maxillary sinus mucosa were harvested during planned orthognatic surgery in 18 patients with no evidence of rhinosinusitis. The samples were processed according to hospital routine for aerobic and anaerobic cultures. Results Ten maxillary sinuses were found sterile. Twenty-six (72%) maxillary mucosa specimens were culture-positive. Aerobes were recovered in 21 sinus samples (58%), predominantly as polymicrobial flora (18 cultures, 50% of all specimens), S. aureus in 2 sinuses of the same patient (6% of the samples), and Bacillus sp. in 1 sinus (3%). Anaerobes were isolated in 20 of 26 culture-positive specimens (56% of all sinus samples). They were recovered alone in 5 samples. Fifteen anaerobic cultures were polymicrobial (42% of all samples). Propionibacterium acnes was isolated from another 5 sinuses (14%) of 3 patients. Conclusions Our data support the policy of perioperative antibiotic prophylaxis in sinus augmentation procedures where Schneiderian membrane is perforated. Clinical relevance Evaluating the need of a perioperative antibiotic therapy in sinus augmentation procedures.
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ORIGINAL ARTICLE
Microflora of normal maxillary sinuses: does it justify perioperative
antibiotic treatment in sinus augmentation procedures
Oren Peleg
1
&Danielle Blinder
1,2
&Keren Yudovich
3
&Arkadi Yakirevitch
4,5
Received: 2 August 2017 /Accepted: 25 September 2018 /Published online: 2 October 2018
#Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Objectives To investigate bacterial flora of normal maxillary sinuses in order to facilitate perioperative antibiotic management in
sinus augmentation procedures.
Materials and methods Specimens of maxillary sinus mucosa were harvested during planned orthognatic surgery in 18 patients
with no evidence of rhinosinusitis. The samples were processed according to hospital routine for aerobic and anaerobic cultures.
Results Ten maxillary sinuses were found sterile. Twenty-six (72%) maxillary mucosa specimens were culture-positive. Aerobes
were recovered in 21 sinus samples (58%), predominantly as polymicrobial flora (18 cultures, 50% of all specimens), S. aureus in
2 sinuses of the same patient (6% of the samples), and Bacillus sp. in 1 sinus (3%). Anaerobes were isolated in 20 of 26 culture-
positive specimens (56% of all sinus samples). They were recovered alone in 5 samples. Fifteen anaerobic cultures were
polymicrobial (42% of all samples). Propionibacterium acnes was isolated from another 5 sinuses (14%) of 3 patients.
Conclusions Our data support the policy of perioperative antibiotic prophylaxis in sinus augmentation procedures where
Schneiderian membrane is perforated.
Clinical relevance Evaluating the need of a perioperative antibiotic therapy in sinus augmentation procedures.
Keywords Maxillary sinus .Microflora .Tissue culture .Sinus augmentation
Introduction
The routine use of antibiotics in oral implant treatment seems to
be widespread. Antibiotic therapy in conjunction with implant
surgery and its correlation with failure and success rates remain
poorly documented, however. The debate regarding overpre-
scription of antibiotics raises the need for a critical evaluation of
proper antibiotic coverage in association with implant treat-
ment and sinus augmentation procedures. In the setup of dental
implantology, knowledge of the bacterial flora of normal max-
illary sinuses is important for planning the perioperative man-
agement. However, the knowledge of presence and nature of
the sinus flora is not clear. According to some studies, healthy
paranasal sinuses are sterile [1,2]. Nonetheless, others have
found bacteria in normal sinuses [3–5].
Additionally, possible correlation between the microflora
of nasal cavity and maxillary sinus could guide the choice of
postoperative antibiotic prophylaxis. So far, research on this
correlation lacks. In attempt to shed some light on these issues,
we conducted a study of nasal cavity and maxillary sinus
mucosa cultures obtained during elective orthognatic surgery
for maxillary deformities. The tissue culture was chosen as it
is deemed the most reliable method of sampling [6,7].
Materials and methods
Patient selection
The study was performed at the tertiary medical center, from
2007 to 2013. Recruited patients were planned for orthognathic
*Oren Peleg
orenpeleg@gmail.com
1
Department of Oral and Maxillofacial Surgery, Sheba Medical
Center, Tel Hashomer, Israel
2
Maurice and Gabriela Goldschleger School of Dental Medicine, Tel
Aviv University, Tel Aviv-Yafo, Israel
3
Department of Oral and Maxillofacial Surgery, Rambam Medical
Center, Haifa, Israel
4
Department of Otolaryngology-Head & Neck Surgery, Sheba
Medical Center, Ramat Gan, Israel
5
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Clinical Oral Investigations (2019) 23:2173–2177
https://doi.org/10.1007/s00784-018-2662-0
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Zinser et al. [42] evaluated risk factors in sinus lifts with 1-or 2-stage DI placement, showing that prescribing PAT does not significantly influence DI or graft failure rates compared to not prescribing PAT (LoE 2+). Some authors only recommend prescribing PAT if Schneider's membrane perforation occurs because of the high failure rate due to graft infection [45] (LoE 2+) (OR = 16.82 [46]). The rate of sinus membrane perforation in these procedures has been estimated at 18.3% [46]-23.5% [47]. ...
... Of these, 11.3% will experience sinusitis and infection (compared to 1.4% in the case of no perforation), most likely due to colonisation by native sinus bacteria. These authors recommend applying, in the case of non-perforation, the same protocols applied to the placement of ordinary DIs [45], i.e., 2 or 3 g of amoxicillin 1 h before surgery [29,48] (LoE 1+). ...
Consensus Report on Preventive Antibiotic Therapy in Dental Implant Procedures: Summary of Recommendations from the Spanish Society of Implants
Article
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  • May 2022
Current patterns of preventive antibiotic prescribing are encouraging the spread of an- timicrobial resistance. Recently, the Spanish Society of Implants (SEI) developed the first clinical practice guidelines published to date, providing clear guidelines on how to prescribe responsible and informed preventive antibiotic therapy (PAT) based on the available scientific evidence on dental implant treatments (DIs). The present document aims to summarise and disseminate the recom- mendations established by this expert panel. These were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were analysed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist templates and ranked according to their level of evidence. They were then assigned a level of recommendation using the Grading of Recommendations, Assessment, Development and Evaluation system (GRADE). Guidelines were established on the type of PAT, antibiotic and dosage of administration in the placement of DIs without anatomical constraints, in bone augmentation with the placement of DIs in one or two stages, placement of immediate DIs, sinus elevations, implant prosthetic phase, as well as recommendations in patients allergic to penicillin. Therefore, the PAT must be adapted to the type of implant procedure to be performed.
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... First, provided there is no penetration of the Schneiderian membrane, the sinus is distinguished from other oral implant sites in that it constitutes a largely sterile environment [85]. This differs from implants placed in native bone where, despite best efforts, osteotomies are invariably populated by oral bacteria [86]. ...
Biomechanical Basis for Bone Healing and Osseointegration of Implants in Sinus Grafts
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  • Dec 2024
  • CLIN IMPLANT DENT R
A thorough comprehension of the mechanisms controlling new bone formation and implant osseointegration after maxillary sinus floor elevation is crucial for aligning our treatment choices with biological principles and enhancing clinical outcomes. The goal of bone regeneration in sinus lift procedures is to provide a sufficient amount of newly‐formed tissue to support implant osseointegration. However, it is still unclear whether there is a minimum quantity of vital bone within the newly‐formed tissue required for effective support, though it is generally assumed that vital bone is essential for this process. The source and integration of new bone in maxillary sinus floor elevation procedures remain debated. Most clinical studies suggest a paramount role for sinus floor and bony walls, with a centripetal pattern of new bone formation, while conflicting reports exist regarding the osteogenic role of the Schneiderian membrane. The influence of mechanical input on peri‐implant bone formation, mineralization, and maturation is significant, with bone remodeling regulated by mechanical strains generated during loading. Defining optimal loading for implants, particularly in sinus lift procedures, is challenging, as early loading may damage interfacial tissue, interfering with osteogenesis. Differences in osseointegration dynamics between native and augmented bone may arise from biological and mechanical factors, but also from patient‐specific factors which should be evaluated in treatment planning. Factors to consider include sinus anatomy, patient and site‐specific regenerative potential, and the selection of graft material that matches the osteogenic and mechanical requirements. Tailored approaches integrating patient‐specific considerations and refined implant strategies will enhance predictability and longevity of treatment.
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... Nonetheless, based on expert opinion, antibiotics are usually prescribed and can be started before surgery and continue for seven days postoperatively. Antibiotics are recommended in case of surgical complications, such as Schneiderian membrane perforation [28,29,41]. Guided bone regeneration with or without simultaneous implant placement is a common procedure in which antibiotics are usually prescribed. ...
Towards Wiser Prescribing of Antibiotics in Dental Practice: What Pharmacists Want Dentists to Know
Article
Full-text available
  • Oct 2024
Antibiotics have various indications for treatment and prophylaxis in dental practice. While only a handful of antibiotics are typically prescribed in dentistry, unlike in medicine, clear indications and appropriate dosing and duration remain controversial among antibiotic-prescribing dentists, which may result in inappropriate or excessive antibiotic prescriptions. This practice can increase the risk of antibiotic resistance and expose patients to unnecessary side effects. Moreover, the concept of antibiotic stewardship in dental practice remains in its early stages. This review was developed by pharmacists (general and infectious disease pharmacists) in collaboration with a periodontist and a maxillofacial surgeon to provide an antibiotic prescription guide for dentists who frequently prescribe antibiotics. It also sheds light on antibiotic stewardship. The review discusses in detail antibiotic indications for treatment and prophylaxis in dental practice and provides tables that can be used by dentists in their everyday practice. It also discusses the concept of antibiotic stewardship and provides recommendations that can be applied to the practice of antibiotic prescribing in dentistry. Antibiotic prescribing in dental practice should be limited to cases with documented infections or when indicated for prophylaxis. Every dentist can act as an antibiotic steward by prescribing antibiotics wisely and only when necessary, using their discernment to identify appropriate cases and exclude those that do not meet infection criteria. Collaboration with pharmacists is encouraged to provide such recommendations and implement antibiotic stewardship interventions, such as developing antibiotic prescription protocols.
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... In the case of sinus membrane perforation, this regimen could be extended for 7 days postoperatively, due to the associated higher risk of graft infection. 39 This complication occurs in a high percentage of sinus elevation surgeries (18.30% 28 to 23.50% 40 ), and if it does occur, 11.30% will experience sinusitis and infection (compared with 1.40% if it does not), which may indicate a superinfection of the graft by native sinus bacteria. In penicillin-allergic patients, ciprofloxacin 500 mg/12 hours is recommended, starting 1 hour before and, in case of sinus membrane perforation, continuing for the following 9 days. ...
Preventive Antibiotic Therapy in Sinus Elevation Procedures: A Systematic Review
Article
  • Mar 2023
  • INT J ORAL MAX IMPL
Purpose: To study whether the use of preventive antibiotic therapy reduces the sinus graft infection and/or dental implant failure rates in maxillary sinus elevation surgeries (primary outcome), and to identify the associated best protocol (secondary outcome). Materials and Methods: The MEDLINE (via PubMed), Web of Science, Scopus, LILACS, and OpenGrey databases were searched between December 2006 and December 2021. Prospective and retrospective comparative clinical studies with at least 50 patients and published in English were included. Animal studies, systematic reviews and meta-analyses, narrative literature reviews, books, case reports, letters to the editor, and commentaries were excluded. Assessment of the identified studies, data extraction, and risk of bias were performed independently by two reviewers. Authors were contacted if required. Collected data were reported by descriptive methods. Results: A total of 12 studies fulfilled the inclusion criteria. The only retrospective study comparing the use of antibiotics vs no use of them showed no statistically significant differences for implant failure; however, no data were reported for sinus infection rates. The only randomized clinical trial comparing different courses of antibiotics (only the day of surgery vs 7 additional postoperative days) reported no statistically significant differences between groups in terms of sinus infection rate. Conclusion: Not enough evidence is available to support either the use or nonuse of preventive antibiotic therapy for sinus elevation surgeries or to support the superiority of any protocol over others.
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... A consensus statement has been published in favour of amoxicillin-clavulanic acid, or clarithromycin associated with metronidazole in cases of penicillin allergy, as antibiotic prophylaxis and as postoperative antibiotic therapy 12 . However, there are authors advocating antibiotic therapy only in cases of Schneiderian membrane perforation 34 . Based on antibiograms of sinus flora cultures, the antibiotics found to have the greatest efficacy were ampicillin, amoxicillin-clavulanic acid, and ciprofloxacin 38 . ...
Management of sinus graft infection—a systematic review
Article
  • Sep 2021
  • INT J ORAL MAX SURG
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.
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Direct Sinus Lift
Chapter
  • Jul 2021
The direct sinus lift procedure has been in use for decades and is a reliable way to increase bone volume in the posterior maxilla, usually with the ultimate goal for implant placement. Surgeons have many grafting materials available for use including autogenous bone, allograft, xenograft, and bone morphogenic protein. Some providers will even select for a direct sinus lift with immediate implant placement and a “graftless” augmentation. Contemporary modifications to the direct sinus lift include modern instruments, for example, the piezoelectric, and technological advancements such as computer-aided implant planning software to create a fully digital workflow. Potential complications of the direct sinus lift include membrane perforation, bleeding, infection, and implant loss for which management strategies will be discussed. While other techniques now exist for sinus augmentation, the direct sinus lift remains a reliable strategy when a significant amount of bone gain is required in the posterior maxilla with implant survival typically greater than 95%.
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Advances in the study of chronic sinusitis microbiology using 16SrRNA gene sequencing technology
Article
  • Jul 2021
Traditional conventional bacterial culture techniques can cultivate fewer types of bacteria, aiming to isolate and identify specific pathogens, guide antibiotic treatment and eradicate pathogens.Macrogenomics techniques can simultaneously identify both cultured and uncultured bacteria in the flora, providing the possibility for the study of symbiotic flora. With the vigorous development of SrRNA and application of 16 gene sequencing technology, the microbial ecology research of chronic sinusitis （chronic rhinosinusitis,CRS） has once again become a hot topic.And the CRS view of microbial community composition and microbial diversity were presented. This review describes the use of 16 SrRNA gene sequencing in recent years advances in technical studies CRS microbial ecology.
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The antibiotic of choice determined by antibiogram in maxillary sinus elevation surgery: a clinical study
Article
Full-text available
  • Mar 2016
  • CLIN ORAL IMPLAN RES
Objectives: This study set out to make antibiograms of positive bacteria cultures in samples collected when performing maxillary sinus elevations to determine a specific and effective antibiotic in each case. Material and methods: A total of 174 patients (90 women and 84 men) with a mean age of 55.92 years underwent 227 sinus elevations. As the membrane was lifted, a sample was collected from the maxillary sinus floor with a cotton swab and placed on a blood agar and chocolate agar culture to incubate for 48 h at 37°; the samples then underwent microbiological analysis. Antibiograms were made for each positive culture to identify the most sensitive antibiotic, which were regrouped according to their mechanism of action as: beta-lactam (penicillins), beta-lactam (cephalosporins), macrolides, quinolones, fosfomycin, aminoglycosides, or trimethoprim-sulfamethoxazole. Results: Of 227 cultures, 18.1% were bacteria-positive. Of the germs, 45% were of the Streptococcus genus, most of which belonged to the Streptococcus viridans group (61.1%). The germs studied showed greater resistance to macrolides and greater sensitivity to penicillins, cephalosporins, and ciprofloxacin. The antibiotics that showed the greatest efficacy were as follows: ampicillin, amoxicillin-clavulanate, and ciprofloxacin. Conclusions: On the basis of antibiograms of positive cultures, the antibiotics presenting the greatest efficacy against possible complications were as follows: ampicillin, amoxicillin-clavulanate, and ciprofloxacin. Clinically, the antibiograms proved useful as they allowed the prescription of specific antibiotics to resolve possible postoperative sinus infections.
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Risk factors for postoperative complications following oral surgery
Article
Full-text available
  • Sep 2015
Objective The objective of this study was to clarify significant risk factors for postoperative complications in the oral cavity in patients who underwent oral surgery, excluding those with oral cancer. Material and Methods This study reviewed the records of 324 patients who underwent mildly to moderately invasive oral surgery (e.g., impacted tooth extraction, cyst excision, fixation of mandibular and maxillary fractures, osteotomy, resection of a benign tumor, sinus lifting, bone grafting, removal of a sialolith, among others) under general anesthesia or intravenous sedation from 2012 to 2014 at the Department of Oral and Maxillofacial Reconstructive Surgery, Hiroshima University Hospital. Results Univariate analysis showed a statistical relationship between postoperative complications (i.e., surgical site infection, anastomotic leak) and diabetes (p=0.033), preoperative serum albumin level (p=0.009), and operation duration (p=0.0093). Furthermore, preoperative serum albumin level (<4.0 g/dL) and operation time (≥120 minutes) were found to be independent factors affecting postoperative complications in multiple logistic regression analysis results (odds ratio 3.82, p=0.0074; odds ratio 2.83, p=0.0086, respectively). Conclusion Our results indicate that a low level of albumin in serum and prolonged operation duration are important risk factors for postoperative complications occurring in the oral cavity following oral surgery.
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EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists
Article
Full-text available
  • Mar 2012
  • Rhinology
The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.
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A biofilm exists on healthy mucosa of the paranasal sinuses: A prospectively performed, blinded, scanning electron microscope study
Article
Full-text available
  • Apr 2010
  • Clin Otolaryngol
Based on our hypothesis that biofilm is nothing else but normal, otherwise abundantly colonised mucosal mucous blanket, the aim of this study was to check out whether bacterial biofilm exists exclusively at the diseased mucosal surfaces or at healthy mucosa of paranasal sinuses as well. Prospective and blinded. Tertiary academic hospital. The patients suffering from the diseases not related to the chronic inflammation of the paranasal sinuses. Mucosal tissue samples from healthy sphenoid sinuses were taken from 48 patients who underwent pituitary gland surgery and from ethmoidal sinuses mucosa of the 17 patients who underwent endonasal endoscopic orbital decompression because of Graves' disease. The samples were submitted blindly along with similar samples from patients with chronic rhinosinusitis to two scanning electron microscope experts. In all samples the looked for the main signs of biofilm presence of: the 'towers', rod-shaped bacteria and water channels. Signs of biofilm presence were found in 45 out of 48 pituitary gland surgery patients (94%) and in all of 17 EEOD patients (100%). Our study showed the presence of the biofilm at the surface of the healthy mucosa of the paranasal sinuses. This suggests that perhaps so called bacterial biofilm is nothing else but regular respiratory mucosal blanket, a part of the mucociliary system itself, containing a great number of bacteria.
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Complex systematic review - Perioperative antibiotics in conjunction with dental implant placement
Article
  • Jun 2015
The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews. A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed. The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking. Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Complication Rate in 200 Consecutive Sinus Lift Procedures: Guidelines for Prevention and Treatment
Article
  • Dec 2013
Maxillary sinus grafting is a predictable and reliable procedure that has been routinely performed for more than 30 years. The complication rate is low, but some cases may require additional surgery, and the outcome of oral rehabilitation may be affected. The purpose of the present study was to evaluate the early and late complications after sinus lift procedures performed in the authors' center, with special attention to risk factors and their connection to the principles of prevention and treatment. A retrospective analysis of 127 patients was performed. During an 8-year period, patients underwent preprosthetic surgery with implants and a maxillary sinus lift procedure because of maxillary atrophy. In total, 202 sinus lift procedures were performed and 364 implants were placed (117 simultaneously and 247 delayed). Clinical data, local or systemic disease, risk factors, type of surgery, intraoperative and postoperative complications, and the evolution of the implant zone were recorded. The most common intraoperative complication was damage to the Schneiderian membrane (25.7%), which did not show any connection to postoperative complications. Thirty patients (14.9%) developed postoperative complications, including wound infection, abscess, or dehiscence with drainage (9 cases), maxillary sinusitis of the operated area (6 cases), partial exposure of the simultaneous onlay graft (6 cases), and loss of the graft (2 cases). Sinus lift surgery is a proven and reliable technique because of the low observed rate of postoperative complications and the success rate of implants placed into the grafted area. To minimize risk, care must be taken with all technical details and risk factors that can lead to fatality.
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Correlation Between Schneiderian Membrane Perforation and Sinus Lift Graft Outcome: A Retrospective Evaluation of 359 Augmented Sinus
Article
  • Sep 2013
The aim of this study was to estimate the incidence of sinus membrane perforation in maxillary sinus augmentation surgery using a lateral approach and the impact of sinus integrity on incidence of sinusitis and bone graft survival in the maxillary sinus. A total of 359 sinus augmentation procedures (208 patients) were evaluated retrospectively for sinus integrity during augmentation, complications, graft failure, and implant loss. The incidence of sinus membrane perforation was 41%. There was an overall sinus graft failure rate of 6.7%; of the failed sinus grafts, 70.8% had a perforated sinus membrane at augmentation. There were 11.3% of sinuses with perforated membranes at graft placement that failed compared with 3.4% of sinuses with intact membranes failing (general linear model [GLM], P = .003). Age, gender, and provider type were not significantly associated with sinus integrity at 1 year. Overall, 11.3% of sinuses with perforated membranes at graft placement required secondary antibiotics for sinusitis and infection compared with 1.4% of sinuses with intact membranes (GLM, P < .0006). Of the sinuses requiring secondary antibiotics, 30% failed compared with 5% of untreated sinuses (GLM, P = .0071). Of the sinuses developing sinusitis or secondary infection requiring antibiotics, 85% had a membrane perforation during augmentation compared with 39.2% of those not requiring antibiotics; gender, age, and provider were not associated with antibiotic use. In the present study, antibiotic use for postoperative sinusitis and infection and graft failure were shown to be statistically higher in sinuses with perforated membranes at augmentation.
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Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review
Article
  • Jun 2010
CONFLICT-OF-INTEREST STATEMENT: Marco Esposito is the first author of two of the included studies; however, he was not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications' published in The Cochrane Library (see http://www.cochrane.org for more information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane Review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration. To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective. The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2 June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Meta-analyses were conducted. Four RCTs were identified: three comparing 2 g of preoperative amoxicillin versus placebo (927 patients) and the other comparing 1 g of preoperative amoxicillin plus 500 mg four times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the four trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics: risk ratio=0.40 (95% confidence interval (CI) 0.19 to 0.84). The number needed to treat (NNT) to prevent one patient having an implant failure is 33 (95% CI 17-100), based on a patient implant failure rate of 5% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one in the placebo group. There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduce failures of dental implants placed in ordinary conditions. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether post-operative antibiotics are beneficial, and which is the most effective antibiotic.
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Bacterial Flora in Normal Adult Maxillary Sinuses
Article
  • May 2009
Conflicting data exist about the presence of bacteria in healthy maxillary sinus cavities. This study was designed to determine the bacterial flora and to quantify the level of bacterial presence in healthy maxillary sinus cavities. Subjects included 34 patients undergoing Lefort I osteotomy for orthognathic surgery. All patients were preoperatively evaluated by a questionnaire and a complete physical examination including sinus endoscopy. Our exclusion criteria were presence of sinonasal symptoms, asthma, antibiotic treatment in the past 3 months, treatment with local steroids, previous sinonasal surgery, traumatic surgery, and an abnormal CT scan or sinus endoscopy. Washes were obtained from maxillary sinuses before surgery through an antral puncture. The sinus was irrigated with sterile saline followed by aspiration with a syringe attached to the trocar. Basic sterility rules were rigorously applied. Specimens were transported to the laboratory in an air-free syringe. Time between collection of materials and inoculation of the specimen did not exceed 15 minutes. Specimens were inoculated for aerobic and anaerobic organisms. After applying the selection criteria, 14 patients (28 sinuses) remained. Eight (57.1%) were men with a mean age of 22.7 years; 82.14% of the specimens were sterile. Bacterial organisms were recovered in only four patients with two different coagulase-negative staphylococci in the same patient: one in each sinus with 200 UFC/mL in the left sinus and 10 UFC/mL in the right sinus, one Citrobacter fundii (70 UFC/mL) and two polymorphic floras. This descriptive study shows the large predominance of sterile maxillary sinus cavities in asymptomatic adults with endoscopically normal mucosa.
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Bacteriology of the Maxillary Sinus in Healthy Volunteers
Article
  • Feb 1992
In order to investigate the bacteriology of the healthy maxillary sinus, 12 volunteers were subjected to antral puncture with instillation of sterile saline, followed by aspiration. Maximum efforts were used to obtain aspirates without contamination. None of the aspirates showed bacterial growth.
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