Control of Infection

One of the most critical factors in success of immediate implant is to control existing infection.  When a tooth needs extraction, it usually has an infection unless due to trauma.

The patient takes an oral antibiotic 2-3 days pre-op and continues the regimen postop for totally 7 days.  Premedication may be also important in pain control intra-op.  Chlorhexidine rinse is recommended pre- and post-op.

After extraction, the socket is thoroughly debrided with a serrated curette.  Granulation tissue removal can be aided by hemostat, followed by copious irrigation with normal saline.  The socket walls should be free of granulation tissue after debridement.  The procedure should be repeated if necessary.  Small pieces of non-woven gauze soaked with an antibiotic are placed in the sockets 2-3 times. The antibiotic powder can be dissolved with small amount of anesthetic containing Epinephrine for hemostasis. Ultrasound scaling is carried out while the antibiotic gauze is being used.

Following implantation, the remaining socket is filled with bone graft to eliminate space for re-infection.  Collagen dressing is used to cover the bone graft.  The wound is sutured if needed.  An antibiotic ointment is applied to wound.  Last perio dressing is applied for wound protection and patient comfort.  The following case shows steps for infection control, although it turns out to fail in the 1st try.

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Xin Wei, DDS, PhD, MS 1st edition 07/20/2014, last revision 09/25/2014