Infected Bone Graft: What is the Best Treatment?

Did u prescribe prophylactic antibiotics? Whenever I graft I give the patient 2 gm of amoxicillin one hour preop and 500 mg tid for one week postoperative. I rarely get infections with this protocol. Try placing your patient on antibiotics and a chlorhexidine rinse at this point and monitor for supporation. If it persists you will have to remove the graft and re-attempt, preferably at a later date.

New bone grafts have no blood supply. If there is no blood supply, antibiotics and topical rinses are useless. Infected bone grafts, especially particulate, need removal ASAP. The antibiotic will simply not get to the bacteria, and therefore be useless. This site should be conservatively opened, curretted, and irrigated. The site should be monitored closely. If purulence persists, the entire graft needs removal and you need to start again. The antibiotics here are of questionable value. There is simply no bio-availability where you need them.

Aggresive curretage prior to grafting is necessary and then then use of a bacterio-static graft material will help but once infected remove the graft ASAP as is well stated by Sb oms. Further bone loss unfortunately can be the result so time is of the esssence. Peter

dr. fairbaum- what's your bacterio-static graft material of choice? do you consider a mineralized allograft hydrated in an antibiotic solution (liquid clindamycin) bacteriostatic?

I personally don't use it, but I'm familiar with some clinicians adding tetracycline (to create an acidic environment), some swear by it, not sure if it helps.

BTcP and CaSo4 , product called Vital in Europe or Genex in US ( Spinal and Orthopeadic product ). Or Easygraft a BTcP product coated with a polylactide which has shown bacterio-static properties to Staf. Both are routinely used without the need for a collagen type membrane . Using Tetracycline may pollute the implant surface , infection is always an issue and can lead to nasty suprises so I assess each case prior to any decision on immediate placement. Regards Peter

Please tell us the type of graft material used so we can consider how the infection occured and how to best resolve the problem.

I use both the Clindmycin to hydrate the bone and systemic antibiotics. I also agressively clean the site before placing the graft ( currtte then a #8 round burr). As a result I very rarely have PO infection around these sites. The systemic antibiotics help kill the residual bacteria in the bone. Tx should be to eliminate all infected graft material at this point.

when ever you have an infected bone graft, you should remove the graft up on my experience when the graft site infected it will not cure again & any delay in the removal of the infected graft my cause bone resorption , once i saw a patient with infected maxillary graft, which not removed the floor of the sinus has a complete resorption 7 the patient develop more complication & it was so har to graft abone later, so you should remove the infected graft& give bactericidal Antibiotic with monitoring the infected site.

remove and replace with another bone graft. If it was a socket, probably left infected tissue and didn't irrigate enough. If you used a non-resorbable membrane, stuff must have gone inside and caused the infection.

I had that same problem before. Now I'm using non-resorble membrane on top of ext pocket with 3mm tugging on buccal and ligual with vicryl suture. So far so good. I believe 'primary closure' is the key.

Sir, Instead of curettage or removal of the grafting material, I suggest that you begin to irrigate and disinfect the grafting site by 20 CCs of normal saline, three times a day for one week.I have been witnessing this strategy to be very effective.

The problem with this question is the lack of qualification of the original presentation of the site. Is there suppuration or just pronounced edema/bleeding? Is the problem in the apical area of the osteotomy or at the tissue margins? Was there incomplete debridement of the extraction site pre-grafting or is the problem subperiosteal? Was the infection noted within days of graft placement or several weeks later? Each of these differences belies a different etiology and thus treatment of the problem. If the infection is subperiosteal, careful debridement and saline rinses, as Dr. Jafari has suggested, may be sufficient. If the infection is in the apical part of the graft area, nothing short of removal, definitive debridement, and regrafting will be adequate. RJM

Excellent points Bob. The treatment is symptom related.

did you tri laser for steriling the area before your grafting>> see i will till you>> my first failure implant case was with bone grafting>> i remove the implant + grafted bone(there was unexpected bone resorbtion arround the grafted bone>>> then i currate the area +laser application+new implant+new grafted bone>>>>>> its work nicly>>

I february there was bone graft placed in the lower jaw, the infuse bone graf thBMP-2, also dentist have placed I believe a membrane barrier, it has been 3 months since, and all the gums got opened and show some kind of material, since I am not a dentist i dont know what is it, but looks like that membrane, it is pushing my other teeth, to the point that all gums are flying around them. can anybody tell me if I can get an infection if my gums are so opened?

Dear Dr I feel a good curettage and decortication of the defect site (it is important to induce entry of bone progenitor cells in defect area and literature supports available). You can go for autografts mixed with DFDBA in the defect site. Make sure the flap is properly approximated with the graft material not exposed to the oral environment, collagen membrane use wud b better. suture with monofilament material. Post op prescription of Chlorhexidine mouthwash.I agree with 'Sb oms' regarding antibiotics.Doxycycline can be prescribed for maintenance, however prophylactic antibiotic therapy is not an indication for bone grafts(atleast in the dose of 2gm,not encountered in literature)No question of graft mixed with antibiotics if defect site properly curetted.antibiotics mixed with graft may interfere with bone formation. U need to take care of infection seeping from the oral environment. Experts plz comment. Thanks

what if there is no suppuration, only the area feels hot after 3 days of bone grafting?

can grafting be done around an implant that has been in for a few years? I have a case where bone is lost and infection seems to persist near implant (#7) and in sinus. There seems to be a communication between mouth and sinus. The patient has had major bone and ridge construction on the upper right.

I have a pus filled blister on the gum area of a tooth which was pulled in 2011 and a bone graft was placed in the socket. I had an infection for a few weeks after this procedure, which cleared up with antibiotics. A titanium implant was installed 5 months later and 4 months later, procedures of being fitted with an abutment and a temp crown, followed by a permanent crown about 3 months later. In Oct. 2016, this pus filled blister formed. One DDS stated he could probably "zap" that area with a laser treatment. My question is: could this bone graft be contaminated although human bone grafts are described as being cleaned and sterilized ? The bone graft and titanium implant procedures were done by an Endodontist and the abutment and crown done by a respected DDS. The only treatment I have had is injection with antibiotics at the site of the blister, which returned in a few weeks - 2016. Further treatment was discussed in April 2018, by a different DDS.

Bone grafts re only require to be tested for HIV and hepatitis set by the FDA. That means you can get all sorts of possible infections. I receive mycobacterium Houstonense from a bone graft which resulted in my leg being amputated after trying to fight off the infection for six months. I know another person who got HIV from a dental bone graft even though it was supposed to be tested. Being that this is still live material, they are not sterilized to the degree you might think. Do you research. I would ask for a cotton swab test for aerobic, anaerobic, and acid fast bacteria to determine what you have and treat the virus/bacteria/fungus accordingly. Best of luck.

Bone graft area feels hot just a week after procedure. Antibiotics were taken but now a 1.5 after this issue has not resolved. The gum area looks good no signs of infection. Could the infection be on the inside? The x ray didn’t show any infection But pain, heat and tender/sore gums are persistent