4. Preoperative evaluation and premedication

Preoperative evaluation

The preoperative evaluation is done to ensure the absence of absolute or relative contraindications to bone surgery and/or local anesthesia.

It also allows for evaluation of patient risk factors, either systemic (eg, osteoporosis, infections, immune deficiency) or behavioral (eg, tobacco consumption, high risk behavior, poor hygiene).

Systemic examination

A systemic examination is compulsory for a maxillary sinus floor augmentation procedure and must be done in close collaboration with the treating physician.

Local examination

The required bone volume determines the choice of the donor site. When a large volume of bone is needed, it is routinely harvested from an extraoral site, such as the cranium or iliac, with the patient’s consent.

  • Extraoral harvesting has specific constraints that must be presented to the patient. These include the requirement for general anesthesia, postoperative conditions, and the integration of bone of a different embryologic origin (eg, iliac bone). Fortunately, intraoral harvesting is possible in most cases and solves the problems related to the loss of substance.
  • Any oral infection must be eliminated before the intervention.

– Infectious dental niches should be identified and treated by orthograde or retrograde techniques.

– Periodontal disease is not an absolute contraindication, but it should be treated before an intervention so that tissues are healthy.

– Before a sinus floor augmentation is performed, a maxillofacial or otolaryngologic surgeon should treat any sinus disorder.

A simplified preoperative hemostatic evaluation is needed to determine hemorrhagic risk during and after the surgery. This evaluation should include such factors as bleeding time (BT), platelet count, international normalized ratio (INR), and activated cephalin time (ACT). Eventually, a dose of fibrinogen can also be added.

Premedication

The prescribed medications are to be taken the day before the intervention to limit postoperative side effects and to prevent infection and inflammation.

Preoperative prescription

  • Prophylactic antibiotics are to be started the day before the surgery. According to international recommendations, their use should be continued for 6 to 10 days, until the site has completely healed.
  • Level 2 analgesics are to be taken 1 hour before the surgery and again following the intervention.
  • For optimum patient cooperation during the 2 hours of intervention, a sedative can be prescribed.
  • Short-term corticoids limit edema related to the elevation of the buccinator and masseter muscles.
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Jan 20, 2015 | Posted by in Implantology | Comments Off on 4. Preoperative evaluation and premedication
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