Bone graft infection: any recommendations?
I did an extraction and a bone graft with a titanium membrane. I prescribed Keflex 500mg bid for 7 days. Patient returned with persistent soreness and bad taste. The titanium membrane was still in place. I consulted with my oral surgeon who said to continue the Keflex for another 7 days. Any recommendations for follow up treatment?
24 Comments on Bone graft infection: any recommendations?
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CRS
9/22/2014
I like to have the patient dab the top of the membrane with peridex, it gets rid of the bad taste. How does the soft tissue look ?
Dee
9/24/2014
Been using peridix
peter Fairbairn
9/23/2014
Hi , just a short note a ascertain what graft material was used and the status of the site prior to grafting ...
Peter
ssargent
9/23/2014
I prefer Augmentin 500mg b.i.d. for 10 days as it covers the anaerobes more efficiently.
Vipul G Shukla
10/1/2014
I agree. Augmentin [called Clavulin in Canada] is preferred antibiotic for extensive grafting techniques.
Daniel Sweet
9/23/2014
Infections are a sure way to ruin a bone graph. I would check around the mouth and see if there are any sources of bacteria and remove them. You are probably in for a re-do of this one ,, so don't be surprised.
Good luck
Dee
9/24/2014
Thank you.
Ken Templeton
9/23/2014
Closure of flap without tension most common source of graft failure. Is there a wound dehiscence?
Does patient have any systemic compromise or smoking habit?
Dee
9/24/2014
Good news Ken. Membrane out and looks Good. Measurements for implant in November.
dennis
9/23/2014
Are they a smoker?
Tom Wierzbicki
9/23/2014
Any significant findings on the medical history (e.g. diabetic, smoker, etc)?
What is the history of the extraction site (e.g previous endodontic treatment, vertical root fracture)?
Sounds like the grafted site is infected.
Gently push on the areas around the membrane to see if you get pus expressed - I won't be surprised if you do. If there is exudate, I recommend cleaning the grafted site out, let it heal by secondary infection, and when you get good soft tissue closure go back in and redo the graft.
Best of luck!
Dee
9/24/2014
Liquid oozing when pushing the membrane. Infection taste. Calling the surgeon in 6 minutes. Getting worse.
Dee
9/24/2014
Root canaled tooth fracture and abcessed prior to bone graft..part of a failed bridge done 13 years ago.
Dee
9/24/2014
Thanks Tom. Membrane out and felt infection go with it. Looks good :-) Appointment in Nov. for implant measurement.
Dee
9/24/2014
Some electronic cigarettes.
peter Fairbairn
9/24/2014
Hi Dee , sounds like a clear out is needed , post the removal of this type of long term infected tooth , site preparation is critical . It is very important to clean the site extensively then if grafting always use a bacterio-static material ( some materials are even bacterio-scidal ) .
Membranes are difficult to use here as well due to closure issues .
Maybe best to remove and let heal .
Regards
Peter
Dee
9/24/2014
Hi Peter, Good news membrane out. Felt the infection go with it. Bone graft looks good. Tissue reddish pink will heal. Fabulous! Will see the surgeon Nov. 17 for measurements for the implant. Thank you.
CRS
10/1/2014
Your tissue granulated in well under the Teflon as it should. The infection may have been food debris and biofilm. These membranes get pretty grungy over time using peridex helps. My protocol is to disinfect the old RCT with the Nd-yag at grafting. Watch this case carefully for Periimplantitis after the implant us placed prior to restoration sometimes the walled off bacteria can be re-exposed at implant placement. Good luck
.
Timothy Hacker DDS FAAID
10/7/2014
The infections from failed endo, failed apicoectomy, root fractures, are persistent. It is common to see these return around the implants even after a year or so in function. This is an ideal indication for the NdYg laser to disinfect, sterilize and get a good initial clot formation when you graft.
If you see any kind of fistula on the radiograph, a good clean out and laser tx is indicated.
Tom Wierzbicki
10/7/2014
I agree, grafting and/or implants in areas with previously failed endodontic treatment are quite tricky. The more treatment (e.g re-treatment or apicoectomy) the trickier. I recommend very good debridement and irrigation, and allow the site to granulate in on its own until you get complete soft tissue closure, only then continue with implant and/or graft placement. The human body does an amazing job of healing when we give it a chance.
The Nd Yag treatment sounds interesting, I will definitely need to try it. CRS and Timothy what settings do you use for the Nd Yag? What about other lasers e.g. diode, CO2, any experience with those?
RMT
10/8/2014
Nice poster at EAO from Professor Kakar covering 50 odd consecutive socket preservation in infected sited using laser and alloplastic, in situ hardening bone graft (GUIDOR easy-graft). 95 % success rate. Cant remember the time scale.
peter Fairbairn
10/10/2014
Yes RMT , interesting material and very good , my material of choice for Socket grafting as sets hard so no membrane needed to complicate matters .
We have a nice study coming out in Compendium later this year using this material in ridge preservation .
Peter
DrT
10/10/2014
How does one get this material, Peter in the US?
Peter Fairbairn
10/11/2014
I Believe Sunstar US based in Chicago will have information as not sure myself.
Regards
Peter
