Ziv I had to handle the above situation a couple times in my career. While I have been able to clear up the infection I always get an uneasy feeling because I feel I cant remove all the graft particles.

How do you remove all the graft particles?

What is your protocol for draining the sinus and rinses? Do you use a drain?

As far as the PRP, I think most people realize it only works for soft tissue, although Marx would say it does help bone healing. I still use PRP and dont thing it would hurt the sinus graft.

Once the infection clears, think long and hard about why the infection may have developed.

Mutiple studies document infection rates for oral and periodontal surgery at around 1%. Did the patient have any preop sinus issues? Sterile gowns vs. no gowns? Sterile gloves vs. non-sterile?

This is an interesting thing. I know some people that wear full-on space suits to do a surgery while others use nothing other than non-sterile gloves. Curious to ask what others are doing.

As for me, I wear a hair cover, use sterile gloves, and clamp a sterile towel over my scrub top. I would say my infection rate is less than 1%.

So far I've been using PRGF by BTI and haven't run into infections. It is my understanding that PRP is totally different than PRGF since the later concentrates growth factors and no cellular components which can introduce at least inflammation. I'm studying the new book by E.A. of BTI, so I don't know all of his research yet but there appears to be quite a sophisticated group in Spain working on these things. And no, I have nothing to do with BTI marketing.
We always use augmentin whenever possible also. I've lost confidence in clindamycin.

There is a lot of misunderstanding in using autologous growth factors.Recently there is a quest in applying all kinds of growth factors into the surgical field and one has to know biology of hard and soft tissue repair.
I have used PRP in the past from the early beginning and experienced acceleration in soft tissue healing.The effect of PRP and PRGF is immediately at the time of placement yet there is no influence or sustained release afterwards.PRF on the other hand has the ability to influence afterwards as was published in several articles due to the fact that PRF membranes continue to release groowth factors like TGF,VEGF,PDGF and thromboplastin for at least 7 days post placement.I think this is the biggest advantage of using PRF.
One has to know that these growth factors need cells in order to act and therefore mixing them with just Xenografts or other materials without the presence of bone or mesenchymal cells will not have any benefit.
I will be covering PRF in two courses given in April. The first is in NYC on April 9-10 details in www.augmentationcourse.com and the second in Atlanta on April 16-17 a two day state of the art in sinus augmentation coure- details in www.dentalxp.com

I did over thirty cases of lateral window sinus lift and immediate implantation without using bone graft,only tow cases failed . recently I use only PRF membrane and have good result.

YOU ARE CORRECT AND THE PERFORATED CORTEX IS MOST IMPORTANT!

Bovine bone is slow to show bone regeneration. Even though I waited 6 M haeling in cases using Bio-Oss and collagen membrane,Sometimes I disppoined with the result from Bovine bone.

When I applied PRF (exactly CGF from Silfradent) barrier over bovine bone, I get good result after only 3-4 M healig.

As possilble, I try to get many cortication.4-8 perforations for two implant placment.

DS

Resolve the situation first by opening it up and cleaning the sinus.

Take all the graft material out and rinse.

Place the patient on Zitromax+Flagyl or augmentin.

Cover with a membrane and regraft at a later date (2-3months later)

I would agree with zivmazor and the other posters here.

If its infected at this early stage its not hard to treat as the lateral window has not ossefied. Reflap the area making the incisions in the same manner. manually scoop out any affected graft that is noticable and flush the sinus area with saline with doxy in it, flush out any loose particles. then you can close and allow to heal or use new graft with doxy mixed in it and repack and close. place the pt on systemic antibiotics for 2 weeks and a good decongestant. If its a frank infection then would wait on regrafting till its healed for a few weeks. If in cleaning it out the sinus membrane is torn dont worry just close it and allow to heal for a few months the sinus membrane will restablish itself. Is the patient a smoker? have a hx of chronic sinus issues?

Bobe graft is not a prerequsite for sinus augmentation.

So Do not use any bone graft for sinus augmentaion.

No more bone graft, No more infection...

I agree with you partially.
Bone over the implant apex may not exist.
But we can see same results when auto bone or allograft used in the sinus.

I had performed sinus augmentaion wiht bone graft for more than 10 Y. I have a few case of infection. This complication is painful to me and patients.

I have performed no bone added sinus agumentaion for last 4 years, and any infection was not developed.

The success rate is very good. So I feel very comfortable with no bone added sinus augmentaion

According to my study on bone reformation in sinus with/without bone graft in rabbit, The sinus with membrnae alone showed much higher new bone than Bio-Oss group. I believe that Bio-Oss occupied space for new bone growth..

This results mean more higer bone to implant contact in the no bone added sinus.
DS

Dear Dr.Choukroun,

First of all, I's like to say that I respect you as developer of PRF.
I have lectured on PRF and CGF in some countries.

My comments on differences between PRF and CGF came from Prof. Rodella's research, not my study as I posted before.

Before I read it,I knew CGF was same with PRF.

If you want this data, I can e-mail you Pr. Rodella's Data.

But I compared PRF and CGF in my office uisng my and my resient doctor's blood. The speed of shirinkage of PRF was faster than CGF. CGF was more dense than PRF. I have photos on that

I believe PRF is also effective to accelerate new bone formation as CGF does.

I have performed many sinus augmentation using PRF or CGF alone for a few years. And the results are very good.

A article on that was published and many cases were posted in dentaltown and icoikorea.org

I guess this is the firt publication on sinus agumentaion using CGF alone.

DS

PRP & PRGF, as 1st generation of platelet concentrate, use bovine thrombine and calcium chloride . In addition, they are technique sensitive and time consuming procedure becauese they need double pippetting procedure.
And PRP use 10% of taken whole blood for augmentaion in final step. 90% of whole blood goes to waste basket.
They both use special centrifuge.

As 2nd generation of platelete concentrate, PRF and CGF is 1) simple to make, 2) No biomaterials required 3) No pipetting required.
4)30-50 % of taken whole blood is used for tissue regeneration.

PRF was reported by Dr. Choukroun, and CGF was reported by Dr. Sacco.

PRF can be made by conventional centrifuge with single speed , but CGF use special centifuge with variable spood.

However no documentaion to compapare these platelet concentrates is available as I know.

Prof. Rodella's data shows the differences between two,but not documented in journal.

Sorry, Dr Sacco didn't report nothing.. never.
As I wrote here, we tried with Silfradent, the first machine of the "new PRF" as CGF, however, the results were the same. dramatically. The theory of silfradent was interesting, but only for marketing diffusion.
I decided, to leave the technique because it was no change to PRF. I wait fundamental publications trying the 2 techniques to show the difference..
You say that the fibrin is most dense. but what cytokines in the fibrin ?? what release ?
The feeling is not sufficient. we must give scientific proofs.
I repeat that the CGF is a vulgar copy of PRF.