Q: Dear Dr. Eppley, I would like to get Medpor malar and paranasal implants. However I am a bit concerned about the possibility of implant infection. Although I know that impregnating these porous implants in an antibiotic solution prior to implantation combined with good oral hygiene usually works well, I also would like to go for a dental dam that limits the contact of the implant to the mucosa during surgery. Would you use a dental dam if the patient asks for this? Do you think a dental dam can lower the risk of implant infection if the implant is placed through the mouth?
I know that malar and paranasal implants are inserted into the same pocket through the same incision. Considering this, do you usually charge for the combined malar and paranasal procedure like this would be two separate facial implant procedures or do you charge only a bit more than for a malar procedure alone plus additional cost of the implant material? Thank you in advance for your reply
A: Porous implants like those comprised of Medpor material do have a higher risk of infection in my experience. Thus everything that can be done to limit this potential problem is done from antibiotic soaking and irrigation, limited insertion and removal for try-ins, and a change in gloves when the implants are finally inserted. You are correct in assuming in assuming that the risk of infection is highest when placed through an intraoral approach due to potential contamination from the oral mucosa. The dental dam is an interesting but impractical method of recipient site isolation. The dental dam is used in tooth restoration because it wraps around the neck of the tooth being worked on so the rest of the mouth is covered. This places the tooth in front of the covered mouth. It can not be used effectively in reverse because the inside of the lips and the maxillary vestibular mucosa is still exposed to the recipient site even if the teeth are not. So no I do not think it would be an effective method for reducing the risk of implant infecrion.
While the malar and paranasal implantation sites can be done through the same incision, the work to place the implants is still doubled. Shaping, placing and fixating the implants is the bulk of the operation. Four implants require twice as much work as two implants. Making the incision and closing it is but a minimal amount of time for either operation. Some cost reduction is seen when both types of facial implants are done together based on the time saved as it relates to incisional management.
Dr. Barry Eppley