An investigation of post-operative morbidity following iliac crest graft harvesting _ article _ british dental journal

• When treatment options are being discussed with a patient, it is important for the GDP and specialist to fully inform the patient of the possible morbidities that can be experienced at the donor site.

Results Ninety-eight patients (80%) returned post-operative questionnaires. Pain after wisdom tooth extraction worse at night Eighty of the 98 (81.6%) patients suffered post-operative pain with 70% of patients being pain-free after four weeks. Wisdom tooth extraction recovery However, 10% of patients experienced pain for more than 16 weeks. Soft foods after tooth extraction Eighty-five (86.7%) patients were able to walk without any difficulties six weeks post-operatively. Tooth extraction healing time Gait disturbance was not related with age, however there was a significant association between pain and disturbance of gait ( P< 0.001). Tooth extraction site Twenty two patients required the use of a walking stick and the use of such aids varied from 0.5 to 26 weeks. Upper wisdom tooth extraction Women used walking aids for longer periods than men ( P< 0.05). Home remedies for tooth extraction pain Twenty five patients had altered sensation with about half of them experiencing altered sensation in the distribution of the lateral femoral cutaneous nerve. Recovery time for tooth extraction Other morbidities included deformity at the hip site (2.4%), haematoma (2.4%), infection (3.2%), stress fracture (4.1%) and meralgia paraesthetica in one patient. Sinus problems after tooth extraction Despite the above morbidities, 82 patients were willing to undergo the same procedure again and 89 patients would recommend the procedure to their relatives and friends.

Conclusion This study demonstrates considerable morbidity following anterior iliac crest bone harvest for intra-oral augmentation.


Wisdom tooth extraction care Clinicians referring patients for such bone graft procedures must be aware of the above morbidities so that any patients referred for such procedures are fully informed.

Teeth are usually lost as a result of disease or trauma but some patients may have congenitally missing teeth. Molar tooth extraction One of the key elements involved in successful prosthetic rehabilitation is the remaining volume and contour of alveolar bone and covering mucosa. Aftercare for tooth extraction 1 Following a dental extraction, the residual alveolar bone undergoes a period of accelerated resorption for about 10 weeks followed by slower resorption. Is wisdom tooth extraction painful Atwood in 1971 proposed that residual ridge resorption is a multifactorial disease, which includes anatomic, biologic and mechanical factors which all co-operate in resorption. Dry socket after tooth extraction Anatomical reasons include the size and shape of the ridge, the type of bone and mucoperiosteum, and metabolic reasons including age, sex, hormonal balance and osteoporosis. Symptoms of wisdom tooth pain Mechanical factors include the forces applied to the ridge, the type of denture base and the interocclusal distance. Infected gum after tooth extraction Decreased physical activity, diet, race and hereditary causes may also play a role in age related bone loss. After tooth extraction pain 3 Therefore, following tooth loss, patients may require prosthetic rehabilitation or dental implants. Tooth extraction healing stages pictures Patients increasingly demand implant therapy. Wisdom tooth extraction pain Successful treatment of such patients depends on sufficient alveolar bone volume. Impacted canine tooth surgery cost The use of autogenous corticocancellous block grafts for augmentation of compromised alveolar volume has become a well established and accepted technique with studies reporting high graft success and subsequent osseointegration for implants placed into these grafted sites. Wisdom tooth extraction procedure The three main indications for bone grafting are inadequate ridge width, inadequate ridge height and improper ridge trajectory. Wisdom tooth extraction pain relief 4 However, augmentation of narrow ridges with autogenous grafts carries considerable morbidity.

A graft harvested from the ilium provides a large number of pluripotent or osteogenic precursor cells in particulate cancellous bone and in the marrow portion of the graft. Bump on gum after tooth extraction It is considered the gold standard for graft material. After tooth extraction 5 The ilium has two great reservoirs of cancellous bone at the anterior and posterior ilium. Cpt code for tooth extraction Consequently, two different approaches have been suggested to harvest bone. Recovery from wisdom tooth extraction At the posterior ilium there is more bone available and the morbidity is minimal. Tooth extraction pain after 7 days 6 However, the main disadvantage is that it adds two hours to surgery time because simultaneous ilium and facial surgery cannot be accomplished and it also risks the position of the endotracheal tube during repositioning of the patient on the operating table. Tooth extraction recovery In 1993 Marx suggested that this technique should only be used if 50 cc or more of cancellous bone graft material is required and the preferred donor site for intra-oral augmentation is the anterior ilium. Tooth extraction recovery time 7

Iliac crest graft harvesting is performed under general anaesthesia. Signs of infection after tooth extraction The iliac crest is palpated as the site of harvest is between the anterior superior iliac spine (ASIS) and the tubercle of the crest some 5 cm posterior to the ASIS. Salt water rinse after tooth extraction Here the ilium is at its greatest medio-lateral width and facilitates cancellous bone harvest.

Donor site morbidity still remains a major problem ( Fig. Wisdom tooth extraction cost india 1). Surgical extraction of wisdom tooth The most frequent complication is pain, 8 other complications include sensory disturbance, 7 gait disturbance, 1, 10 infection, 11 meralgia paraesthetica, 12 adynamic ileus, 13 contour deformity, 11 fracture of the iliac crest 11, 14 and unsightly scaring. Infection after tooth extraction symptoms 9

Eighty-five (86.7%) of patients were able to walk without any difficulties 6 weeks post-operatively ( Fig. Jaw pain after tooth extraction 6). Pain relief after tooth extraction home remedies However, of the five patients who suffered with disturbance of gait for more than 14 weeks, four had a single iliac graft harvest and one patient had bilateral iliac crest graft harvest on two separate occasions. Molar tooth extraction healing time Although, age did not correlate with problems with gait, there was a significant association between pain and disturbance of gait ( P<0.001) indicating that patients who experienced more pain had greater problems with walking.

In the current study, harvesting from the inner table of the anterior iliac crest provided sufficient quantities of bone for alveolar augmentation for all patients. Gum pain after tooth extraction The advantages of this donor site include easy accessibility, a high ratio of cancellous to cortical bone and a high concentration of osteoblasts, which induce additional bone growth at the recipient site. Infection after tooth extraction 7, 15 Bone harvest from this site, however, has the disadvantage of the need for a separate donor site with its inherent morbidity. Sore gums after tooth extraction The complications of the anterior iliac approach include prolonged post-operative pain, 16, 17, 18 altered gait, 10, 19 sensory nerve damage, 17, 18 poor scar placement and altered bone contour, 18 delayed healing, 18 herniation of abdominal contents, 11 clicking during walking, 18 ilium fracture, 20 peritonitis, 6 excessive blood loss 18 and rarely retroperitoneal haematoma. Tooth extraction infection pictures 21

The precise cause of donor site pain remains obscure. Complications after tooth extraction Some patients experience no pain whilst 10% experienced considerable pain for up to 16 weeks. Wisdom tooth extraction complications The findings here concur with previous observations of patients suffering pain at 6 months after surgery. Gum infection after tooth extraction 8 It is postulated that this is either muscular or periosteal, secondary to the stripping of abductors from the ilium or neurogenic secondary to sensory nerve injury. Symptoms of infection after tooth extraction In order to overcome the problem of pain at the wound site, several technical modifications have been suggested 8, 11, 25, 26, 27 and furthermore, the use of Bupivicaine for post-operative pain relief. Complications of wisdom tooth extraction 30 Other modifications include, placement of a vertical or oblique skin incision to avoid cutting cutaneous nerves, incisions greater than or equal to 3 cm dorsal to the anterior superior iliac spine and sub-periosteal dissection with careful haemostasis. Gum infection after tooth extraction symptoms 11, 15, 31, 32 It has been suggested that incisions directly over the crest are avoided as this increases the incidence of delayed healing. How long after tooth extraction can i eat solid food 18 However, the use of medially and crestally placed incisions also increases the risk of damage to the lateral cutaneous nerve of the thigh. Infection after tooth extraction picture Paraesthesia of the anterior thigh also occurs when the lateral femoral cutaneous nerve is injured. Complications of tooth extraction The incidence of altered sensation in the distribution of the latter nerve is 11.2% in our series compared with the reported range of 1.3–37%. Extracted tooth infection 8, 11, 22, 23, 24, 25, 26, 27, 28 Variations in the position of the lateral femoral cutaneous nerve may be a contributing factor associated with injury of that nerve. Healing process after tooth extraction 29

Gait disturbance after bone harvesting from the inner table is a minimal and temporary inconvenience. Tooth extraction blood clot fell out 6, 7, 10, 17, 18, 27 This may also be related to pain and was present for greater than 14 weeks in the five patients who developed post-operative stress fractures. Tooth extraction dry socket Three patients reported deformity at the donor site and this has been reported on previously. How long after tooth extraction can i eat normal food 18 Donor site deformity can be minimised by repositioning of the osteoplastic flap and suturing with a strong resorbable suture. Pain after tooth extraction and bone graft 22 Three patients (2.4%) developed a haematoma at the operation site. Molar tooth extraction aftercare Haematoma formation results from inadequate intra-operative haemostasis, improper sub-periosteal dissection or cancellous bone bleeding. Tooth extraction healing process pictures 11 Haematoma formation can be reduced by use of sheets of absorbable haemostatic sponge at the end of surgery as well as expeditious removal of surrounding cancellous bone marrow. Gum after tooth extraction 15 Placement of a drain into the site of surgery may also prevent haematoma formation. Throbbing jaw pain after tooth extraction 24 None of the patients in this study developed a seroma. What to expect after a tooth extraction Post-operative deep infections requiring surgical intervention have been reported to have occurred in less than 1% of cases. Tooth extraction healing process white stuff 11 Infection usually results from improper technique particularly in immuno-compromised or nutritionally depleted hosts. Bleeding after tooth extraction how to stop Treatment of deep post-operative infections requires incision and drainage, irrigation, debridement and a course of culture-directed intravenous and oral antibiotics. Wisdom tooth extraction bleeding 11 The one patient in this study who developed such an infection was treated with antibiotic therapy.

Stress fractures at the iliac crest have been reported previously 14, 33 and this possibly may be caused by the anterior iliac crest bone graft being harvested too close to the anterior superior iliac spine thereby pre-disposing the patient to a fracture of the anterior superior iliac spine from the iliac wing. When can you smoke after a tooth extraction Five patients experienced stress fractures several weeks after harvest of the iliac crest graft. Bleeding after wisdom tooth extraction Three of these patients had falls post-operatively which may have contributed to their stress fracture. Food after tooth extraction Radiographic examination confirmed that the fractures in all patients were undisplaced and therefore treated conservatively. Wisdom tooth extraction healing process We also examined scar satisfaction with 60% of patients reporting satisfaction. Wisdom tooth extraction dry socket A significant number of younger patients were dissatisfied with the appearance of their scar. Food after wisdom tooth extraction Tension-free skin closure along with meticulous multiple layer closure so that the skin edges sit in approximation or near approximation before sub-cuticular closure of the skin is important. Dry socket after wisdom tooth extraction Despite the above morbidities, 85.6% were willing to undergo the procedure again with 91.8% of patients reporting that they would recommend the procedure to relatives and friends. Wisdom tooth extraction swelling The rates of satisfaction after harvest of anterior iliac crest bone grafts have been reported between 82% and 86.1%. Gum swelling after tooth extraction 9, 34