Stefan Lundgren: Complications in bone augmentation

Among the various possible complication areas in implant and augmentation surgery, this lecture focuses on complications with wound dehiscence and graft exposures, donor sites, sinus infections and misplaced implants and covers the causes of these complications, options for their prevention and guidelines on how to adequately handle them. In order to avoid graft exposure, it is important to minimize flap tension by using extended periosteal incisions. If bone is exposed, Dr. Lundgren recommends resuturing with suspension sutures and handling the exposed bone carefully, avoiding active interventions. In comparison to chin grafts, donor site complications and their associated morbidity are considerably lower in case of mandibular ramus donor sites, so harvesting bone from the mandibular ramus for inlay or onlay augmentation is preferred. Sinus infections are treated with antibiotics and either naso-antral or oro-antral lavage. Augmentation/lateral sinus elevation without the use of grafting material and with simultaneous placement of the implant is less invasive and reduces the risk of sinus infection and other complications. Dr. Lundgren discusses that traumatized bone, e.g. after an accident, may tend to resorb, which needs to be taken into account when planning for implant treatment. Misplacement of implants can be avoided through careful 3D treatment planning and a guided surgery approach.