Rational Prophylactic Antibiotic Selection for Sinus Elevation Surgery

Abstract

Focused Clinical Question For a generally healthy patient with no risk indicators for postoperative infection, what is the most appropriate perioperative antibiotic regimen for sinus elevation surgery in terms of reducing postoperative infection risk and minimizing untoward effects? Clinical Scenario A 38‐year‐old female patient in good general and periodontal health presents missing tooth #14 (Fig. ). She reports no systemic conditions, no history of sinusitis, and no allergies. Medications include acetaminophen and ibuprofen as needed for pain. The patient's dentition is minimally restored, with no active caries. Cone‐beam computed tomography reveals a clear, pneumatized left maxillary sinus and inadequate bone volume to support dental implant placement (Fig. ). No septa or pathologic lesions are present, the ostium appears patent, and no thickening of the Schneiderian membrane is appreciable. The patient states that she wants to replace her missing molar without restoring adjacent teeth (Figs. and ). Baseline clinical appearance (example sinus elevation case). The patient is a healthy 38‐year‐old female missing tooth #14. Inadequate bone volume is present for dental implant placement due to pneumatization of the left maxillary sinus. Preoperative cone‐beam computed tomography images. 2a Sagittal view. 2b Coronal view. Cone‐beam computed tomography images at postoperative month 6. 3a Sagittal view. 3b Coronal view. Definitive implant‐supported restoration, tooth #14.

Managing Antral Wall Discontinuities in Sinus Elevation Surgery

“… ■Systematic evaluation of the preoperative CBCT image, including deliberate assessment of antral wall integrity, will allow practitioners to design favorable mucoperiosteal flaps when osseous discontinuities are present. Additionally, preoperative recognition of AWD will allow clinicians to anticipate and prepare for Schneiderian membrane perforation. ■Appropriate prophylactic antibiotic coverage appears prudent 15 What are the primary limitations to success in this case?…”

“…). Freeze‐dried bone allograft particles were hydrated in an aqueous solution of tetracycline hydrochloride 15 (50 mg/mL) for ten minutes, then thoroughly rinsed with normal saline and placed in the sinus ( Figs . and ).…”

Factors influencing intraoperative and postoperative complication occurrence: A series of 1135 periodontal and implant‐related surgeries

“…However, authors disagree on whether Schneiderian membrane perforation is associated with development of a postoperative complication (Moreno Vazquez et al, 2014 ; Sakkas et al, 2016 ; Schwartz‐Arad et al, 2004 ). Perforation size (Hernández‐Alfaro et al, 2008 ) and prophylactic antibiotic regimen (Akers et al, 2020 ) may influence the incidence of postoperative complications following Schneiderian membrane perforation. Of the 51 patients receiving SES in the present study, 43 (84.3%) received perioperative amoxicillin + clavulanate, three (6%) received amoxicillin, and five (10%) received no perioperative antibiotic.…”

New Antimicrobial Biomaterials for the Reconstruction of Craniofacial Bone Defects

“…Infections associated with implantation of biomaterials are an unwanted complication of reconstructive surgery, often resulting in prolonged hospitalization, morphological and functional impairment [46]. Perioperative antibiotic prophylaxis leads to a decrease in the rate of infections associated with the implants but does not eradicate them [47][48][49][50]. Moreover, the implantation of biomaterials affects the host's innate local response and may increase the risk of infection [51].…”