Clinical evaluation of antibiotic-supplemented bone allograft

Petri, William H.; Wilson, Therese

doi:10.1016/s0278-2391(10)80039-4

Cited by 18 publications

(7 citation statements)

References 18 publications

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“…The literature shows variation in its incidence. Petri and Wilson (1992) [8] reported a 0% incidence while Erickson et al (1960) [9] reported an incidence of 35%. Dry socket occurs due to the disintegration of the blood clot by fibrinolysis [10].…”

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confidence: 99%

Dry Socket: Frequency, Clinical Picture, and Risk Factors in a Palestinian Dental Teaching Center

Younis

Hantash²

2011

TODENTJ

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Aims: The objectives of this study were to find out the frequency, clinical picture, and risk factors of dry socket at the Dental Teaching Center of Al-Quds University in Palestine.Methods and Materials: Two previously used questionnaires were accomplished in this study over a one year period. The first questionnaire was completed for every patient who had one or more permanent teeth extracted in the Dental Surgery Clinic. The other one was completed for every patient suffered a postoperative pain and was diagnosed with dry socket.Results: There were 1305 dental extractions performed in 805 patients. The overall frequency of dry socket was 3.2%. The incidence of dry socket following non-surgical extractions was 1.7% while it was 15% following surgical extractions (P< 0.005). The incidence of dry socket was significantly higher in smokers (12%) than in non-smokers (4%) (P < 0.005), however, there is a strong association between the amount of smoking and the incidence of dry socket (P < 0.002). The incidence of dry socket was significantly higher in the single extraction cases (13%) than in the multiple extraction cases (5%) (P = 0.005). Age, sex, medical history, extraction site, amount of local anesthesia and experience of operator play no role in the occurrence of dry socket.Conclusion: Smoking, surgical trauma and single extractions are considered predisposing factors in the occurrence of dry socket. On the other hand, factors like: age, sex, medical history, extraction site, amount of anesthesia, and operator experience have no effect on the observation of dry socket.

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confidence: 99%

Dry Socket: Frequency, Clinical Picture, and Risk Factors in a Palestinian Dental Teaching Center

Younis

Hantash²

2011

TODENTJ

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“…To address this problem various methods of delivering high doses of antibiotics to graft bone have been investigated. Several studies have demonstrated antibiotic release from morsellised cortical or cancellous grafts mixed with antibiotic powder 40,[54][55][56][57][58] or soaked in antibiotic solution. [59][60][61][62] However, to our knowledge, no published technique other than iontophoresis has to date demonstrated high antibiotic loading of clinically useful segmental allografts in a short period of time.…”

Section: Discussionmentioning

confidence: 99%

Iontophoresis of antibiotics into segmental allografts

Khoo

Michalak

Yates³

et al. 2006

The Journal of Bone and Joint Surgery. British volume

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Iontophoresis is a novel technique which may be used to facilitate the movement of antibiotics into the substance of bone using an electrical potential applied externally. We have examined the rate of early infection in allografts following application of this technique in clinical practice. A total of 31 patients undergoing revision arthroplasty or surgery for limb salvage received 34 iontophoresed sequential allografts, of which 26 survived for a minimum of two years. The mean serum antibiotic levels after operation were low (gentamicin 0.37 mg/l (0.2 to 0.5); flucloxacillin 1 mg/l (0 to 1) and the levels in the drains were high (gentamicin 40 mg/l (2.5 to 131); flucloxacillin 17 mg/l (1 to 43). There were no early deep infections. Two late infections were presumed to be haemotogenous; 28 of the 34 allografts were retained. In 12 patients with pre-existing proven infection further infection has not occurred at a mean follow-up of 51 months (24 to 82).

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“…[23][24][25][26] In an effort to achieve a more sustained release of antibiotics, demineralised allograft mixed with antibiotic powders has been tried 27 and, with the addition of gelatin, has been shown to reduce infection in a dog model 28 and clinically in infected molar roots. 29 Compared with milled cancellous graft, however, cortical grafts are very dense, with a small surface area and large volume, making them unsuitable candidates for the introduction of antibiotics through a soaking regimen.…”

Section: Discussionmentioning

confidence: 99%

Iontophoresis as a means of delivering antibiotics into allograft bone

Day

Megson²,

Wood³

2005

The Journal of Bone and Joint Surgery. British volume

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Allograft bone is widely used in orthopaedic surgery, but peri-operative infection of the graft remains a common and disastrous complication. The efficacy of systemic prophylactic antibiotics is unproven, and since the graft is avascular it is likely that levels of antibiotic in the graft are low. Using an electrical potential to accelerate diffusion of antibiotics into allograft bone, high levels were achieved in specimens of both sheep and human allograft. In human bone these ranged from 187.1 mg/kg in endosteal (sd 15.7) to 124.6 (sd 46.2) in periosteal bone for gentamicin and 31.9 (sd 8.9) in endosteal and 2.9 (sd 1.1) in periosteal bone for flucloxacillin. The antibiotics remained active against bacteria in vitro after iontophoresis and continued to elute from the allograft for up to two weeks. Structural allograft can be supplemented directly with antibiotics using iontophoresis. The technique is simple and inexpensive and offers a potential means of reducing the rate of peri-operative infection in allograft surgery. Iontophoresis into allograft bone may also be applicable to other therapeutic compounds.

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Clinical evaluation of antibiotic-supplemented bone allograft

Cited by 18 publications

References 18 publications

Dry Socket: Frequency, Clinical Picture, and Risk Factors in a Palestinian Dental Teaching Center

Dry Socket: Frequency, Clinical Picture, and Risk Factors in a Palestinian Dental Teaching Center

Iontophoresis of antibiotics into segmental allografts

Iontophoresis as a means of delivering antibiotics into allograft bone

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