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What are the Complications of Advanced Bone Grafting Techniques?

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This content is based on the article "Short Implants An Answer to a Challenging Dilemma?" published in Dental Clinics of North America (April 2020)

Over the years, multiple studies have been published using an intrabony implant length of 8 mm or less as the definition of a short dental implant and has been gaining acceptance worldwide.

  • The article reviews the efficacy of using the currently available short implants with enhanced macrosurface and microsurface technology and abutment interfaces allowing their placement in cases previously thought ill-advised.
  • This allows implant treatment in a potentially faster, less expensive, less complicated manner, with decreased morbidity and comparable success rates with long/standard length implants with concomitant bone augmentation procedures.
  • Short implants (<8 mm) have been promoted as a treatment option in many clinical scenarios with limited bone volume where long/standard length implants were otherwise contraindicated if not for complex, sophisticated and costly bone augmentation procedures that would have been required.

Maxillary Sinus Grafts

  • Schneiderian membrane perforation (18%): most commonly seen with maxillary sinus elevation from both a lateral or crestal/transalveolar approach.
  • Other complications include postoperative bleeding (14.5%), infections (1%), pain (0.6%), abscess formation (0.2%), sinusitis (0.2%),25 and partial or total graft loss (0.1%).

Guided Bone Regeneration

  • Premature membrane exposure or membrane loss: can cause the bone graft to become infected, leading to partial or total graft loss. This complication can occur with either resorbable membranes or nonresorbable membranes, which require removal as a secondary procedure.
  • Nonresorbable membranes, polytetrafluoroethylene, and titanium mesh have higher incidences of exposure than resorbable membranes.
  • Nonrigid resorbable membranes with insufficient support beneath them can collapse leading to inadequate volume of augmentation requiring supplemental grafting.
  • A disadvantage of all of these membranes is that they can be expensive.

Block Graft

  • This is an advanced procedure due to the following: donor site morbidity, prolonged treatment requiring 2 operative sites, and soft tissue complications, such as recipient site wound dehiscence and graft resorption and failure.
  • Inlay or interpositional grafts in the posterior edentulous mandible have a high rate of inferior alveolar nerve temporary hypoesthesia.
  • Due to soft tissue tension, there is a risk of mandibular fracture and an inability to achieve the desired vertical augmentation.
  • Intraorally, the symphysis donor region has a high incidence of temporary neurosensory deficits as opposed to the ramus, which is much lower.
  • Iliac crest grafts have their own set of potential complications, including perforation of the peritoneum or bowel, infection, ilial fracture, and gait disturbances.
  • Calvarial bone graft minor complications include incision line alopecia and hematomas.
  • Major complications could include cerebrospinal fluid leak, extradural hematoma, and direct intracerebral trauma if the inner table of the diploe is violated during the graft harvest.

Distraction Osteogenesis

  • Minor complications those that have “no effect on final result, but immediate intervention required” and major complications as “lead[ing] to technique failure."
  • Minor complications include tilting of the transport segment (secondary to in-elastic palatal mucosa or muscle pull), soft tissue dehiscence or perforation, infection, and lack of patient cooperation.
  • Major complications include distractor failure, transport fragment resorption, mandibular fracture, bony nonunion, neurosensory disturbances, and insufficient bone distraction.
  • Inferior Alveolar Nerve Transposition
  • Most common complication of inferior alveolar nerve transposition is neurosensory disturbance, including hypoesthesia (decreased sensitivity to all stimuli except for special senses), paresthesia (abnormal sensation even spontaneously or for no reason), and hyperesthesia (hypersensitivity to all stimuli except for special senses).
  • The surgical technique is technique sensitive, sophisticated, requires general anesthesia in an operating room setting, and the postoperative care is prolonged and complex.

We hope you you find the conversation interesting and helpful. We always look forward to hearing your thoughts and receiving your questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team

 

 

 

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