Infected Bone Graft: What is the Best Treatment?

Dr. S. asks:
I did a bone graft and the area has now become infected. I want to get some advice on this and similar cases, as my experience in this treatment is limited. If I place a bone graft into an edentulous site, like an extraction socket and the graft becomes infected, what is the best treatment? If I place a bone graft around an implant and the bone graft becomes infected, what is the best treatment? I am more interested in long-term success that is most predictable. But if conservative treatment options are available, I would like to try them first.

19 thoughts on “Infected Bone Graft: What is the Best Treatment?

  1. Periodontist says:

    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.

  2. Sb oms says:

    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.

  3. peter fairbairn says:

    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

  4. sb oms says:

    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?

  5. Periodontist says:

    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.

  6. peter fairbairn says:

    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

  7. Greg Steiner says:

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

  8. Greg Kammeyer says:

    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.

  9. Dr, Zeki says:

    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.

  10. Dr. Dan says:

    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.

  11. Dr. Hwang says:

    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.

  12. Dr. Mehdi Jafari says:

    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.

  13. Robert J. Miller says:

    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

  14. fadi al shafie says:

    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>>

  15. tet says:

    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?

  16. Abg says:

    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

  17. sally says:

    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.

Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Questions, Regenerative.
Bookmark Infected Bone Graft: What is the Best Treatment?

Videos to Watch:

Suturing in Guided Bone Regeneration

This video provides clinical tips for suturing techniques in Guided Bone Regeneration. In Guided Bone[...]

Watch Now!
Socket grafting with Collagen Dressing and Bond Apatite

This video demonstrates socket grafting with just bond apatite and a collagen wound dressing.[...]

Watch Now!
Dental Implant for Lower Right Second Molar

This video shows implant placement on the lower right second molar.[...]

Watch Now!
Saving a Bridge with Periodontal Therapy

This video shows a case involving a 48-year-old male who was referred for periodontal treatment[...]

Watch Now!
Immediate Loading Full Arch

This video shows a case of Immediate loading of a full arch with simultaneous guided[...]

Watch Now!
Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, that may help the long[...]

Watch Now!
Digitally Planned Bone Augmentation and Immediate Implantation

This video shows a case using the Ring technique to provide bone augmentation along with[...]

Watch Now!
AnyRidge Implants: Replacement of Upper Left Molars

This video shows the replacement of maxillary upper left molars with Megagen AnyRidge Implants.[...]

1 Comment

Watch Now!
Guided Implant Surgery & Immediate Temporisation

This video demonstrates the placement of a missing pre-molar using computer-guided surgery and immediate temporization.[...]

1 Comment

Watch Now!
Implantoplasty to Treat Peri-implantitis

This video shows the use of the Implantoplasty technique to treat peri-implantits. Granulation tissue and[...]

9 Comments

Watch Now!
Placement of Implant Using EZ Devices

This video demonstrates the placement of a dental implant in the upper jaw using the[...]

Watch Now!
BonePen: Improve Positioning of Implants

A short video demonstrating close up the use of the BonePen Kit, a set of[...]

Watch Now!