2 Bone Graft Infection in one week: How do I handle it?????

Sat, 05/07/2011 - 06:27 — Steve Wilson

I am a GP practicing in Florida, I did a bone graft and the area has now become infected I need some advice how to handle it. The area is #8 and 9, it was a buccal ridge defect. I flapped the area place the graft and the membrane and closed leaving the membrane exposed. The areas is now infected. What do I do? Antibiotics?

I also have another case where I extracted # 9 which was infected endodontically. I cleaned the socket. There was no buccal plate. I placed Puros bone and a collaplug as this is what my rep recommended who frequently helps me with these procedures. It is also infected. What should I do here?

Steve

Comments

Sat, 05/07/2011 - 07:18 — shazlovely

Graft Infections:need primary closure

Your first mistake was not primary closer. My advice is clean out the grafts and start over.

Sat, 05/07/2011 - 10:59 — Sam Busich

Need more training....Take the Salama & Pikos Synergy Course

Need more training....Take the Salama & Pikos Synergy Course. It is outstanding and many GP's attend and sit alongside OMFS and Periodontists together.
If you are leaving membranes exposed intentionally and listening to your rep for clinical advice you need more training.
Sam

Thu, 05/12/2011 - 15:29 — hawk.oms

Training...Experience

Steve, I do hundreds of socket grafts every year at the time of extraction, and I have an infection rate of less than 1%.
Are you:
1) thoroughly debriding & irrigating the site? i think it's most likely you left some granulation tissue or periapical granuloma. a full-thickness flap for direct visualization and debridement helps avoid this, especially if you're new at this.
2) are you giving a loading dose of antibiotics pre-op or at least when the patient is seated? 2gm amoxicillin or 600mg clindamycin, perhaps adding 500mg metronidazole for extended anaerobe coverage for bad infections.
3) Are you feeling the stress of doing s**t you're not good at? how about listening to it? why put your patients through your learning curve when there are specialists around the corner from you who can do this faster and more predictably than you can?
Yes, maybe I am the devil, but at least I'm an honest devil.

Sat, 05/21/2011 - 06:49 — Dr Chace Heatly

Bone graft infection: OMFS VS GP

Look I have no issues with GP taking out teeth but if you are having problems you may need to evaluate what you are doing. Hawk has some sound points above, I think consulting with your specialist certainly cant hurt.

Sat, 05/21/2011 - 06:50 — Dr Chace Heatly

Infected bone graft should be removed ASAP.

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.

Sat, 05/21/2011 - 07:02 — G Baxter

Infected Bone graft: My 2 cents, regraft at the same time.

Whenever you have an infected bone graft, you should remove the infected graft& give bactericidal Antibiotic with monitoring the infected site.

After removal and debridement, get down to bleeding bone and regraft the site at the time of removal so you dont lose more bone.

Fri, 06/03/2011 - 17:08 — fredcalavassy

We must not forget biology.

We must not forget biology. Grafts work if we follow basic biological principles. Bone grafts need osteoblasts and osteoblast come from bone bleeding. If the graft material is placed on cortical bone with minimal bleeding not only will it not integrate but risk of infection due to lack immunological defence will be greater. The cortical plate needs to be perforated to stimulate bone bleeding. Thus blood from coming from cancellous bone rich in osteoblastic activity can integrate into the graft. Also for a large defect primary closure with a tension free flap is important to maintain as sterile a field as possible. Good luck. Hope this helps. In the future.

Fri, 09/23/2011 - 12:20 — CVN65

Infections

Steve, the first case must be removed, let to heal, and regrafted later. You cannot leave a membrane exposed. In your flap design you need to have the ability to advance the flap coronally with periosteal release. If you anticipate that this will be impossible, get some pericardium to use as a membrane. I have had two puros block grafts experience opening at the suture line only to have the epithelium migrate across the gap. No other membrane supports that. The second case, the socket graft, may not actually be infected. Packing puros against the periosteum sounds like a great idea until the intense inflammatory response sets in. The periosteum tries to resorb the bone, causing the appearance of infection. Try a resorbable membrane between the bone and tissue.

Tue, 12/20/2011 - 06:06 — salman abolfazli

in some cases, topical minocycline and tetracycline can help

Topical minocycline and tetracycline can reduce the unpleasant symptoms of mild infection
but you must not forget systemic antibiotic!!