How Do You Prevent Jaw Angle Implants From Getting Infected?
Q: Dr. Eppley, I developed an infection after getting with jaw implants. I had them taken out right away. However after the surgery my incision is having a hard time closing and I was able to express some pus from the area about 0.1 cc. The abscess from the previous infection is not back but it appears to be not healing well. I think it might be related to the closure as the mucosal remnant next to the teeth was narrower than 1cm that you try to keep when you make the incision. Or it could be that the original infection caused that mucosa to shrink a little bit. What do you do in this situation?
Also I was wondering what you find are some of the common reasons for one to get the jaw implants infected.
A: What you have is contracted or inverted mucosal edges which lead to of fluid and food debris trap as it struggles to heal. If this is a chronic problem of months then I would excise and reclose the wound in layers. If if just weeks or a month old, I would give it more time. Most of these wounds will heal but it is slower when you have a previous underlying implant pocket.
Having done a lot of jaw angle implants with every conceivable implant option, I have learned the following about the risk of infection and how to prevent it.
- Good wound closure is paramount, a two-layer closure with muscle reapposition over the implant and then a good water-tight mucosal closure. This starts with an incision placed away from the vestibular tissues so you have good tissue on both sides of the wound to close.
- Medpor implants have a higher infectivity risk than silicone due to its porous material. Pre-soaking, vacuum infiltration and antibiotic irrigation must be done.
- Avoid using the final implant as the sizer and developer of the pocket. Use the manufacturer’s sizers for this process during surgery. That way you grab and insert the final implant but one time through the mouth, a so-called minimal implant handling technique.
- Implant stability is really important but most paramount for silicone jaw angle implants. Their smooth surface makes them predisposed to being displaced after wound closure and working their back toward whence they came…getting near the incision and even work its anterior edge through it in some cases. I always use screw fixation with jaw angle implants, most easily done through a percutaneous approacsh using 1.5mm self-tapping screws.
Dr. Barry Eppley