• Home
• Advice
• New! FREE Webinars
• Products
• Courses
• Online CE
• Videos

>>Advertise

Bone Graft Exposed: How to Deal with this Condition?

posted in Bone Grafting, advice, Guided Bone Regeneration, Regenerative Products

« Bone Loss and Purulence Around Implant: Correct Procedure? | Using Implant as an Abutment for a Removable Partial Denture? »

Print This Post

Anon. asks:
I have an implant case which involved ridge splitting, implant placement, guided bone regeneration using Bio-Oss (Osteohealth) and Epiguide membrane (Riemser) in the left posterior mandible area (35-37). But significant wound dehiscence was present at 5 days post-op. Can anyone give me a suggestion how to deal with the condition? Should I remove the graft and try again? Should I try antibiotics and chlorhexidine rinse and observe? Should I just resuture and attempt primary closure? What will give me the best chance of success?

8 Responses to “ Bone Graft Exposed: How to Deal with this Condition? ”

• A.Romano dr. med.dr .dent. italy June 8th, 2009

  
  

  the way is to wait almost 15-25 days to observe the healing and then eventually try, if the implant remains exposed, to screw for 180 -360 degrees the same implant in the depth.

  It depends, naturally, of what kind of implant did you used.this way is not practicable if you have any purulence or inflammation around the implant.

• alejandro berg June 9th, 2009

  
  

  this kind of grafting material has really bad prognosis when exposed… I would say remove it and re graft with something like dynablast and use a resistant membrane like a pericardium one from zimmer and achieve tension free primary closure.
  dont use chlorexhidine, use diluted peroxide.

• jon June 9th, 2009

  
  

  You may want to ask yourself: “If you do not know what to do, should you be doing the procedure?”

• Joseph Kim, DDS June 9th, 2009

  
  

  Should have been using chlorhexidine the day after the procedure. Let it granulate, even if the cover screw remains exposed. In my experience, it will heal pretty well. Another graft may be necessary depending on how much bone you lose, if any. I’m not familiar w/ epiguide, but I’m sure that after 5 days, the BioOss that is deeper down is going to be fine. Significant dehiscence implies lack of adequate release of periosteum, or improper selection of suturing technique.

  Use chlorhexidine 0.12% bid, after breakfast and before bed. Let it heal for 2-3 more weeks. Re-evaluate the situation at that time.

• Craig June 9th, 2009

  
  

  Without seeing the extent of damage, it is difficult to advise. That being said, I would consider nicking the wound margins with a high speed diamond bur. This will encourage healing. See the patient every 1-2 weeks and repeat this as needed until wound is closed.
  Craig

• ljungberg June 10th, 2009

  
  

  I would suggest if there is any sign of infection or sepsis.

  If there is none, just leave it for 3 months and take CT. Curettage all the granulation tissue and add bone graft if necessary.

  If there is infection or sepsis, excavate all the grafted stuff, and take a course of antibiotics fo a week. Then, re-schedule the bone graft until the soft tissue become totally collapsed.

• Don Callan June 10th, 2009

  
  

  First, Do not use chlorhexidine on any open wound. chlorhexidine kills bacteria, it also delays healing be having a negetive effect on fibroblast, JP; 1976. You may loose the graft. Let the body repair itself and correct the problem later (re-graft and/or re implant). Treat the area as if is were expose living bone after any oral surgery procedure. Antibiotics, YES. This grafting material has really bad prognosis when exposed.

• steve c June 10th, 2009

  
  

  I agree entirely with Joseph Kim, Use chlorhexidine rinse from day one, and let the site heal to completion. Nothing you can do surgically will help at this stage, just let the body do its thing. You may end up with a success despite exposure.

---

Leave a Comment

Comment Guidelines: This is a forum for dentists for intelligent discussion. No insults. No outside links. No promotional comments. Though we require an email to route questionable comments to our editors, we will NEVER publish your email. Consumers & Patients: Please do NOT post dental questions here. Instead Visit ChooseDentalImplants.com to get Expert Advice for Implants.

Name (required)

Email (Required, Will NEVER be published)

Website

Message:

Note: At times your comment may not appear on the website immediately, because it has been sent to our editors for approval. Once approved, we will publish the comment. There is NO need to resubmit your comment, if it does not appear on the website immediately.