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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevention and Treatment of Postoperative Infections after Sinus Elevation Surgery: Clinical Consensus and Recommendations</title><author><name sortKey="Testori, Tiziano" sort="Testori, Tiziano" uniqKey="Testori T" first="Tiziano" last="Testori">Tiziano Testori</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Drago, Lorenzo" sort="Drago, Lorenzo" uniqKey="Drago L" first="Lorenzo" last="Drago">Lorenzo Drago</name><affiliation><nlm:aff id="I2">Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Wallace, Steven S" sort="Wallace, Steven S" uniqKey="Wallace S" first="Steven S." last="Wallace">Steven S. Wallace</name><affiliation><nlm:aff id="I3">Department of Implantology, Columbia University, New York, NY, USA</nlm:aff></affiliation></author><author><name sortKey="Capelli, Matteo" sort="Capelli, Matteo" uniqKey="Capelli M" first="Matteo" last="Capelli">Matteo Capelli</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Galli, Fabio" sort="Galli, Fabio" uniqKey="Galli F" first="Fabio" last="Galli">Fabio Galli</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Zuffetti, Francesco" sort="Zuffetti, Francesco" uniqKey="Zuffetti F" first="Francesco" last="Zuffetti">Francesco Zuffetti</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Parenti, Andrea" sort="Parenti, Andrea" uniqKey="Parenti A" first="Andrea" last="Parenti">Andrea Parenti</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Deflorian, Matteo" sort="Deflorian, Matteo" uniqKey="Deflorian M" first="Matteo" last="Deflorian">Matteo Deflorian</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Fumagalli, Luca" sort="Fumagalli, Luca" uniqKey="Fumagalli L" first="Luca" last="Fumagalli">Luca Fumagalli</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Weinstein, Roberto L" sort="Weinstein, Roberto L" uniqKey="Weinstein R" first="Roberto L." last="Weinstein">Roberto L. Weinstein</name><affiliation><nlm:aff id="I4">Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Maiorana, Carlo" sort="Maiorana, Carlo" uniqKey="Maiorana C" first="Carlo" last="Maiorana">Carlo Maiorana</name><affiliation><nlm:aff id="I5">Department of Oral Surgery, Dental Clinic, School of Dentistry, Istituti Clinici di Perfezionamento (ICP), University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Di Stefano, Danilo" sort="Di Stefano, Danilo" uniqKey="Di Stefano D" first="Danilo" last="Di Stefano">Danilo Di Stefano</name><affiliation><nlm:aff id="I6">Oral Surgery, Department of Oral Science, University Vita-San Raffaele Salute, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Valentini, Pascal" sort="Valentini, Pascal" uniqKey="Valentini P" first="Pascal" last="Valentini">Pascal Valentini</name><affiliation><nlm:aff id="I7">Department of Oral Implantology, University of Corsica Pasquale Paoli, Corte, France</nlm:aff></affiliation></author><author><name sortKey="Gianni, Aldo B" sort="Gianni, Aldo B" uniqKey="Gianni A" first="Aldo B." last="Giannì">Aldo B. Giannì</name><affiliation><nlm:aff id="I8">Department of Maxillofacial Surgery, University of Milan and Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Chiapasco, Matteo" sort="Chiapasco, Matteo" uniqKey="Chiapasco M" first="Matteo" last="Chiapasco">Matteo Chiapasco</name><affiliation><nlm:aff id="I9">Department of Oral Surgery, School of Dental Medicine, Department of Medicine, Surgery and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Vinci, Raffaele" sort="Vinci, Raffaele" uniqKey="Vinci R" first="Raffaele" last="Vinci">Raffaele Vinci</name><affiliation><nlm:aff id="I10">Division of Advanced Oral Surgery, Department of Dental Medicine, University Vita-Salute, San Raffaele, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Pignataro, Lorenzo" sort="Pignataro, Lorenzo" uniqKey="Pignataro L" first="Lorenzo" last="Pignataro">Lorenzo Pignataro</name><affiliation><nlm:aff id="I11">Otorhinolaryngology Clinic, Department of Otorhinolaryngoiatric Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Mantovani, Mario" sort="Mantovani, Mario" uniqKey="Mantovani M" first="Mario" last="Mantovani">Mario Mantovani</name><affiliation><nlm:aff id="I11">Otorhinolaryngology Clinic, Department of Otorhinolaryngoiatric Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Torretta, Sara" sort="Torretta, Sara" uniqKey="Torretta S" first="Sara" last="Torretta">Sara Torretta</name><affiliation><nlm:aff id="I11">Otorhinolaryngology Clinic, Department of Otorhinolaryngoiatric Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Pipolo, Carlotta" sort="Pipolo, Carlotta" uniqKey="Pipolo C" first="Carlotta" last="Pipolo">Carlotta Pipolo</name><affiliation><nlm:aff id="I12">Head and Neck Department, San Paolo Hospital, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Felisati, Giovanni" sort="Felisati, Giovanni" uniqKey="Felisati G" first="Giovanni" last="Felisati">Giovanni Felisati</name><affiliation><nlm:aff id="I12">Head and Neck Department, San Paolo Hospital, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Padoan, Giovanni" sort="Padoan, Giovanni" uniqKey="Padoan G" first="Giovanni" last="Padoan">Giovanni Padoan</name><affiliation><nlm:aff id="I13">Department of Surgical Sciences, University of Insubria, Varese, Italy</nlm:aff></affiliation></author><author><name sortKey="Castelnuovo, Paolo" sort="Castelnuovo, Paolo" uniqKey="Castelnuovo P" first="Paolo" last="Castelnuovo">Paolo Castelnuovo</name><affiliation><nlm:aff id="I13">Department of Surgical Sciences, University of Insubria, Varese, Italy</nlm:aff></affiliation></author><author><name sortKey="Mattina, Roberto" sort="Mattina, Roberto" uniqKey="Mattina R" first="Roberto" last="Mattina">Roberto Mattina</name><affiliation><nlm:aff id="I14">Department of Public Health, Microbiology and Virology, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Del Fabbro, Massimo" sort="Del Fabbro, Massimo" uniqKey="Del Fabbro M" first="Massimo" last="Del Fabbro">Massimo Del Fabbro</name><affiliation><nlm:aff id="I15">Section of Oral Physiology, Department of Biomedical, Surgical and Dental Science, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22927851</idno><idno type="pmc">3423929</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423929</idno><idno type="RBID">PMC:3423929</idno><idno type="doi">10.1155/2012/365809</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002D48</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002D48</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevention and Treatment of Postoperative Infections after Sinus Elevation Surgery: Clinical Consensus and Recommendations</title><author><name sortKey="Testori, Tiziano" sort="Testori, Tiziano" uniqKey="Testori T" first="Tiziano" last="Testori">Tiziano Testori</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Drago, Lorenzo" sort="Drago, Lorenzo" uniqKey="Drago L" first="Lorenzo" last="Drago">Lorenzo Drago</name><affiliation><nlm:aff id="I2">Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Wallace, Steven S" sort="Wallace, Steven S" uniqKey="Wallace S" first="Steven S." last="Wallace">Steven S. Wallace</name><affiliation><nlm:aff id="I3">Department of Implantology, Columbia University, New York, NY, USA</nlm:aff></affiliation></author><author><name sortKey="Capelli, Matteo" sort="Capelli, Matteo" uniqKey="Capelli M" first="Matteo" last="Capelli">Matteo Capelli</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Galli, Fabio" sort="Galli, Fabio" uniqKey="Galli F" first="Fabio" last="Galli">Fabio Galli</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Zuffetti, Francesco" sort="Zuffetti, Francesco" uniqKey="Zuffetti F" first="Francesco" last="Zuffetti">Francesco Zuffetti</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Parenti, Andrea" sort="Parenti, Andrea" uniqKey="Parenti A" first="Andrea" last="Parenti">Andrea Parenti</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Deflorian, Matteo" sort="Deflorian, Matteo" uniqKey="Deflorian M" first="Matteo" last="Deflorian">Matteo Deflorian</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Fumagalli, Luca" sort="Fumagalli, Luca" uniqKey="Fumagalli L" first="Luca" last="Fumagalli">Luca Fumagalli</name><affiliation><nlm:aff id="I1">Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Weinstein, Roberto L" sort="Weinstein, Roberto L" uniqKey="Weinstein R" first="Roberto L." last="Weinstein">Roberto L. Weinstein</name><affiliation><nlm:aff id="I4">Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Maiorana, Carlo" sort="Maiorana, Carlo" uniqKey="Maiorana C" first="Carlo" last="Maiorana">Carlo Maiorana</name><affiliation><nlm:aff id="I5">Department of Oral Surgery, Dental Clinic, School of Dentistry, Istituti Clinici di Perfezionamento (ICP), University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Di Stefano, Danilo" sort="Di Stefano, Danilo" uniqKey="Di Stefano D" first="Danilo" last="Di Stefano">Danilo Di Stefano</name><affiliation><nlm:aff id="I6">Oral Surgery, Department of Oral Science, University Vita-San Raffaele Salute, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Valentini, Pascal" sort="Valentini, Pascal" uniqKey="Valentini P" first="Pascal" last="Valentini">Pascal Valentini</name><affiliation><nlm:aff id="I7">Department of Oral Implantology, University of Corsica Pasquale Paoli, Corte, France</nlm:aff></affiliation></author><author><name sortKey="Gianni, Aldo B" sort="Gianni, Aldo B" uniqKey="Gianni A" first="Aldo B." last="Giannì">Aldo B. Giannì</name><affiliation><nlm:aff id="I8">Department of Maxillofacial Surgery, University of Milan and Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Chiapasco, Matteo" sort="Chiapasco, Matteo" uniqKey="Chiapasco M" first="Matteo" last="Chiapasco">Matteo Chiapasco</name><affiliation><nlm:aff id="I9">Department of Oral Surgery, School of Dental Medicine, Department of Medicine, Surgery and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Vinci, Raffaele" sort="Vinci, Raffaele" uniqKey="Vinci R" first="Raffaele" last="Vinci">Raffaele Vinci</name><affiliation><nlm:aff id="I10">Division of Advanced Oral Surgery, Department of Dental Medicine, University Vita-Salute, San Raffaele, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Pignataro, Lorenzo" sort="Pignataro, Lorenzo" uniqKey="Pignataro L" first="Lorenzo" last="Pignataro">Lorenzo Pignataro</name><affiliation><nlm:aff id="I11">Otorhinolaryngology Clinic, Department of Otorhinolaryngoiatric Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Mantovani, Mario" sort="Mantovani, Mario" uniqKey="Mantovani M" first="Mario" last="Mantovani">Mario Mantovani</name><affiliation><nlm:aff id="I11">Otorhinolaryngology Clinic, Department of Otorhinolaryngoiatric Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Torretta, Sara" sort="Torretta, Sara" uniqKey="Torretta S" first="Sara" last="Torretta">Sara Torretta</name><affiliation><nlm:aff id="I11">Otorhinolaryngology Clinic, Department of Otorhinolaryngoiatric Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Pipolo, Carlotta" sort="Pipolo, Carlotta" uniqKey="Pipolo C" first="Carlotta" last="Pipolo">Carlotta Pipolo</name><affiliation><nlm:aff id="I12">Head and Neck Department, San Paolo Hospital, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Felisati, Giovanni" sort="Felisati, Giovanni" uniqKey="Felisati G" first="Giovanni" last="Felisati">Giovanni Felisati</name><affiliation><nlm:aff id="I12">Head and Neck Department, San Paolo Hospital, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Padoan, Giovanni" sort="Padoan, Giovanni" uniqKey="Padoan G" first="Giovanni" last="Padoan">Giovanni Padoan</name><affiliation><nlm:aff id="I13">Department of Surgical Sciences, University of Insubria, Varese, Italy</nlm:aff></affiliation></author><author><name sortKey="Castelnuovo, Paolo" sort="Castelnuovo, Paolo" uniqKey="Castelnuovo P" first="Paolo" last="Castelnuovo">Paolo Castelnuovo</name><affiliation><nlm:aff id="I13">Department of Surgical Sciences, University of Insubria, Varese, Italy</nlm:aff></affiliation></author><author><name sortKey="Mattina, Roberto" sort="Mattina, Roberto" uniqKey="Mattina R" first="Roberto" last="Mattina">Roberto Mattina</name><affiliation><nlm:aff id="I14">Department of Public Health, Microbiology and Virology, University of Milan, Milan, Italy</nlm:aff></affiliation></author><author><name sortKey="Del Fabbro, Massimo" sort="Del Fabbro, Massimo" uniqKey="Del Fabbro M" first="Massimo" last="Del Fabbro">Massimo Del Fabbro</name><affiliation><nlm:aff id="I15">Section of Oral Physiology, Department of Biomedical, Surgical and Dental Science, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Dentistry</title><idno type="ISSN">1687-8728</idno><idno type="eISSN">1687-8736</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Introduction</italic>. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone.
<italic>Aim</italic>. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections.
<italic>Materials and Methods</italic>. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus.
<italic>Results and Conclusion</italic>. The incidence of postop infections is relatively low (2%–5.6%). A multidisciplinary approach is advisable. A list of clinical recommendation are given.
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article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Dent</journal-id><journal-id journal-id-type="iso-abbrev">Int J Dent</journal-id><journal-id journal-id-type="publisher-id">IJD</journal-id><journal-title-group><journal-title>International Journal of Dentistry</journal-title></journal-title-group><issn pub-type="ppub">1687-8728</issn><issn pub-type="epub">1687-8736</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22927851</article-id><article-id pub-id-type="pmc">3423929</article-id><article-id pub-id-type="doi">10.1155/2012/365809</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Prevention and Treatment of Postoperative Infections after Sinus Elevation Surgery: Clinical Consensus and Recommendations</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Testori</surname><given-names>Tiziano</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Drago</surname><given-names>Lorenzo</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wallace</surname><given-names>Steven S.</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Capelli</surname><given-names>Matteo</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Galli</surname><given-names>Fabio</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zuffetti</surname><given-names>Francesco</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Parenti</surname><given-names>Andrea</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Deflorian</surname><given-names>Matteo</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fumagalli</surname><given-names>Luca</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Weinstein</surname><given-names>Roberto L.</given-names></name><xref ref-type="aff" rid="I4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Maiorana</surname><given-names>Carlo</given-names></name><xref ref-type="aff" rid="I5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Di Stefano</surname><given-names>Danilo</given-names></name><xref ref-type="aff" rid="I6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Valentini</surname><given-names>Pascal</given-names></name><xref ref-type="aff" rid="I7"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Giannì</surname><given-names>Aldo B.</given-names></name><xref ref-type="aff" rid="I8"><sup>8</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chiapasco</surname><given-names>Matteo</given-names></name><xref ref-type="aff" rid="I9"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vinci</surname><given-names>Raffaele</given-names></name><xref ref-type="aff" rid="I10"><sup>10</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pignataro</surname><given-names>Lorenzo</given-names></name><xref ref-type="aff" rid="I11"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mantovani</surname><given-names>Mario</given-names></name><xref ref-type="aff" rid="I11"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Torretta</surname><given-names>Sara</given-names></name><xref ref-type="aff" rid="I11"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pipolo</surname><given-names>Carlotta</given-names></name><xref ref-type="aff" rid="I12"><sup>12</sup></xref></contrib><contrib contrib-type="author"><name><surname>Felisati</surname><given-names>Giovanni</given-names></name><xref ref-type="aff" rid="I12"><sup>12</sup></xref></contrib><contrib contrib-type="author"><name><surname>Padoan</surname><given-names>Giovanni</given-names></name><xref ref-type="aff" rid="I13"><sup>13</sup></xref></contrib><contrib contrib-type="author"><name><surname>Castelnuovo</surname><given-names>Paolo</given-names></name><xref ref-type="aff" rid="I13"><sup>13</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mattina</surname><given-names>Roberto</given-names></name><xref ref-type="aff" rid="I14"><sup>14</sup></xref></contrib><contrib contrib-type="author"><name><surname>Del Fabbro</surname><given-names>Massimo</given-names></name><xref ref-type="aff" rid="I15"><sup>15</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Via Riccardo Galeazzi 4, 20161 Milan, Italy</aff><aff id="I2"><sup>2</sup>Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</aff><aff id="I3"><sup>3</sup>Department of Implantology, Columbia University, New York, NY, USA</aff><aff id="I4"><sup>4</sup>Department of Biomedical, Surgical and Dental Science, School of Dentistry, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</aff><aff id="I5"><sup>5</sup>Department of Oral Surgery, Dental Clinic, School of Dentistry, Istituti Clinici di Perfezionamento (ICP), University of Milan, Milan, Italy</aff><aff id="I6"><sup>6</sup>Oral Surgery, Department of Oral Science, University Vita-San Raffaele Salute, Milan, Italy</aff><aff id="I7"><sup>7</sup>Department of Oral Implantology, University of Corsica Pasquale Paoli, Corte, France</aff><aff id="I8"><sup>8</sup>Department of Maxillofacial Surgery, University of Milan and Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</aff><aff id="I9"><sup>9</sup>Department of Oral Surgery, School of Dental Medicine, Department of Medicine, Surgery and Dentistry, San Paolo Hospital, University of Milan, Milan, Italy</aff><aff id="I10"><sup>10</sup>Division of Advanced Oral Surgery, Department of Dental Medicine, University Vita-Salute, San Raffaele, Milan, Italy</aff><aff id="I11"><sup>11</sup>Otorhinolaryngology Clinic, Department of Otorhinolaryngoiatric Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy</aff><aff id="I12"><sup>12</sup>Head and Neck Department, San Paolo Hospital, University of Milan, Milan, Italy</aff><aff id="I13"><sup>13</sup>Department of Surgical Sciences, University of Insubria, Varese, Italy</aff><aff id="I14"><sup>14</sup>Department of Public Health, Microbiology and Virology, University of Milan, Milan, Italy</aff><aff id="I15"><sup>15</sup>Section of Oral Physiology, Department of Biomedical, Surgical and Dental Science, I.R.C.C.S. Galeazzi Institute, University of Milan, Milan, Italy</aff><author-notes><corresp id="cor1">*Tiziano Testori: <email>tiziano.testori@unimi.it</email></corresp><fn fn-type="other"><p>Academic Editor: Silvio Taschieri</p></fn></author-notes><pub-date pub-type="ppub"><year>2012</year></pub-date><pub-date pub-type="epub"><day>9</day><month>8</month><year>2012</year></pub-date><volume>2012</volume><elocation-id>365809</elocation-id><history><date date-type="received"><day>7</day><month>5</month><year>2012</year></date><date date-type="accepted"><day>6</day><month>6</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2012 Tiziano Testori et al.</copyright-statement><copyright-year>2012</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p><italic>Introduction</italic>. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone.
<italic>Aim</italic>. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections.
<italic>Materials and Methods</italic>. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus.
<italic>Results and Conclusion</italic>. The incidence of postop infections is relatively low (2%–5.6%). A multidisciplinary approach is advisable. A list of clinical recommendation are given.
</p></abstract></article-meta></front><body><sec id="sec1"><title>1. Introduction</title><p>Maxillary sinus surgery can be defined as a routine and predictable procedure for the prosthetic rehabilitation in the atrophic maxilla [<xref rid="B1" ref-type="bibr">1</xref>–<xref rid="B7" ref-type="bibr">7</xref>].</p><p>In the past, implant treatment was applied to total edentulous patients [<xref rid="B8" ref-type="bibr">8</xref>, <xref rid="B9" ref-type="bibr">9</xref>] and was later extended to partially edentulous patients; however, the resorption of the alveolar ridges in the maxilla often limits the available bone for positioning dental implants unless a reconstructive phase was performed and different classifications of bone atrophy and relative treatments protocols were proposed [<xref rid="B10" ref-type="bibr">10</xref>–<xref rid="B12" ref-type="bibr">12</xref>].</p><p>Management of patients undergoing sinus lift procedure often requires an interdisciplinary approach involving various specialists in the presurgical phase to optimize surgical results and reduce complications [<xref rid="B13" ref-type="bibr">13</xref>–<xref rid="B15" ref-type="bibr">15</xref>].</p><p>There are anatomic alterations and pathological conditions such as inflammatory-infective processes or sinus manifestations of systemic or cancer related diseases that represent contraindications and should be treated prior to maxillary sinus elevation [<xref rid="B16" ref-type="bibr">16</xref>, <xref rid="B17" ref-type="bibr">17</xref>].</p><p>Complications are infrequent and can be easier managed if promptly diagnosed.</p><p>Postoperative infections are relatively infrequent, with infection rates reported between 2% and 5.6%, with no distinction being made between true sinus and sinus graft infections. </p><p>Infections after sinus elevation surgery can occur in two locations. Most commonly the infection is not a true sinus infection but an infected sinus graft. It should be realized that the sinus graft is not actually in the sinus but is located below the elevated sinus membrane, hence the term subantral augmentation. True sinus infections are less common but may have more widespread consequences such as a pan-sinusitis which can occur as a result of the interconnectivity of the sinus network [<xref rid="B18" ref-type="bibr">18</xref>–<xref rid="B22" ref-type="bibr">22</xref>].</p><p>The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologist, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose and treat postoperative infections.</p><p>The clinical questions addressed by the panel of experts are as follows.<list list-type="order"><list-item><p>What is the normal postoperative patient response to sinus surgery?</p></list-item><list-item><p>What is the correct preop and postop pharmacological treatment after sinus surgery?</p></list-item><list-item><p>In case of persistence of signs and symptoms beyond 3 weeks, what are the proper clinical recommendations?</p></list-item><list-item><p>What is the difference between early and delayed complication?</p></list-item><list-item><p>(a) Which postop infections can be managed only with pharmacological treatment? (b) Which postop infections require a combined pharmacological and surgical approach?</p></list-item><list-item><p>What are the clinical indications for a microbiologic assay?</p></list-item><list-item><p>In case of surgical management of postoperative infections, is a reentry possible and how long should the surgeon wait?</p></list-item><list-item><p>What are the most appropriate clinical recommendations to reduce the incidence of postop complications?</p></list-item></list></p></sec><sec id="sec2"><title>2. Materials and Methods </title><p>A panel of experts in different fields of dentistry and medicine like periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists after having reviewed the available literature on the topic and taking into account their long standing clinical experience gave their response to the above mentioned questions and reached a clinical consensus.</p></sec><sec id="sec3"><title>3. Results</title><p><statement id="head1"><title>(1) What Is the Normal Postoperative Patient Response to Sinus Surgery?</title><p>A normal postoperative patient's response could be swelling, ecchymosis, and mild-to-moderate discomfort that is rarely spontaneous within the first few days and usually resolves within three weeks. Minor nose bleed might be present.</p><p>The resolution of symptoms after three weeks suggest a normal postop period. Usually acute spontaneous pain is absent; however, if present it is a warning sign for the clinician to investigate promptly.</p></statement></p><p><statement id="head2"><title>(2) What Is the Correct Preop and Postop Pharmacological Treatment after Sinus Surgery?</title><p>Usually sinus surgery is a surgical procedure carried out under antibiotic prophylaxis and postoperative drug therapy as seen in <xref ref-type="table" rid="tab1">Table 1</xref>. This pharmacological regimen is based on clinical experience and indirect evidence. In implant dentistry, there is a trend that favor the use of prophylactic antibiotics to reduce infections [<xref rid="B23" ref-type="bibr">23</xref>, <xref rid="B24" ref-type="bibr">24</xref>].</p></statement></p><p>With regard to preop or postoperative corticosteroid therapy, a common consensus was reached regarding the use of corticosteroid but not on the dosage due to the heterogeneity of the pharmacological regimens utilized by the different experts. </p><p><statement id="head3"><title>(3) In Case of Persistence of Signs and Symptoms beyond 3 Weeks, What Are the Proper Clinical Recommendations?</title><p>The presence of signs and symptoms beyond three weeks calls for a careful examination and monitoring of the patient until total recovery. </p><p>If the patient has not fully recovered after 3 weeks, CT is suggested to evaluate maxillary sinuses, nasal, and sinus endoscopy can be added if necessary.</p></statement></p><p><statement id="head4"><title>(4) What Is the Difference between Early and Delayed Complication?</title><p>Early complication happens within 21 days following surgery.</p><p>Delayed complication sets in more than 21 days after the surgery.</p><p>A clear distinction between early and delayed complications allows a time-related assessment of the complication. This classification is useful in communicating among clinicians and writing scientific papers.</p></statement></p><p><statement id="head5"><title>(5a) Which Postop Infection Can Be Managed Only with Pharmacological Treatment?</title><p>Graft infection well contained under the sinus membrane, as seen in the scan, with only a clean serum exudate from the surgical incision can be managed only with pharmacological treatment (<xref ref-type="table" rid="tab2">Table 2</xref>).</p><p>A strict monitoring of the patient is needed until resolution of the complication.</p></statement></p><p><statement id="head6"><title>(5b) Which Postop Infection Require a Combined Pharmacological and Surgical Approach?</title><p>If the graft is well contained under the schneiderian membrane (as seen in the CT scans) but signs and symptoms still persist beyond 3 weeks associated with additional symptoms (like tenderness, nasal obstruction, pain, fistulization, purulent discharge from the nose and throat, flap dehiscence, and suppuration), partial or total removal of the bone graft by oral access combined to pharmacological therapy is recommended.</p><p>If the graft is not contained under the sinus membrane and a loss of graft material inside the sinus is present (as seen in the CT scans) a multidisciplinary approach to manage the complication is mandatory. Functional endoscopic sinus surgery (FESS) could be suggested along with the removal of bone graft and dental implants from an oral approach [<xref rid="B25" ref-type="bibr">25</xref>].</p><p>A quick and multidisciplinary approach to the patient with sinus complications is required in these clinical scenarios. </p></statement></p><p><statement id="head7"><title>(6) What Are the Clinical Indications for a Microbiologic Assay?</title><p>Microbiologic assay is always suggested but a negative result (bacteria absence) does not mean absence of infection. Usually during antibiotic therapy, bacterial cultures are negative. If possible it is recommended to make a second test some days after the end of the pharmacological therapy. </p><p>The indications to request a microbiologic assay have to be evaluated in relation to the antibiotic response in term of days versus recovery speed, seriousness of the complication, and general patient condition. A close patient monitoring is always advised. </p></statement></p><p><statement id="head8"><title>(7) In Case of Surgical Management of a Postoperative Infection, Is a Reentry Possible and How Long Should the Surgeon Wait?</title><p>A sinus reentry is possible after a CT evaluation and preferably an ENT reevaluation to confirm a complete sinus healing (which on the average requires 6–9 months). </p></statement></p><p><statement id="head9"><title>(8) What Are the Most Appropriate Clinical Recommendations to Reduce the Incidence of Postop Complications?</title><p>The clinical recommendation are as follows:<list list-type="roman-lower"><list-item><p>careful assessment of the medical history of the patient,</p></list-item><list-item><p>proper patient selection with healthy maxillary sinus,</p></list-item><list-item><p>to take a pre-operative CT scan to evaluate sinus anatomy and identify preexisting pathology,</p></list-item><list-item><p>a smoking cessation protocol is always recommended and, especially in case of heavy smokers (≥15 cigarettes a day), evaluated with caution [<xref rid="B26" ref-type="bibr">26</xref>],</p></list-item><list-item><p>preventive resolution of periodontal and endodontic diseases,</p></list-item><list-item><p>adequate antibiotic prophylaxis,</p></list-item><list-item><p>to achieve full mouth plaque score (FMPS) and full mouth bleeding score (FMB5) <15%. In case of provisional crowns it is advisable to remove the temporary crowns and disinfect the abutments with antiseptic solution,</p></list-item><list-item><p>preop disinfection of the skin with an antiseptic solution and mouth rinses with chlorhexidine,</p></list-item><list-item><p>use of sterile draping and infection-control protocol,</p></list-item><list-item><p>to keep the incision distant from the antrostomy,</p></list-item><list-item><p>salivary-contamination prevention for bone graft and/or other biomaterials, </p></list-item><list-item><p>intra- and postoperative control of the hemostasis,</p></list-item><list-item><p>prevention of bone overheating,</p></list-item><list-item><p>use of two different surgical sets of instruments: one for the flap elevation phase and the other for the grafting phase,</p></list-item><list-item><p>to rinse the surgical field with sterile saline solution,</p></list-item><list-item><p>to keep the surgical time as short as possible,</p></list-item><list-item><p>postoperative chlorhexidine rinses,</p></list-item><list-item><p>correct postoperative pharmacological therapy,</p></list-item><list-item><p>preplanned patient controls: weekly for the first month and monthly for the following 3 months.</p></list-item></list></p></statement></p></sec><sec id="sec4"><title>4. Conclusion</title><p>The maxillary sinus elevation procedure using a lateral window approach has been shown to be the most successful bone augmentation procedure that is performed as a pre-prosthetic procedure before implant placement [<xref rid="B5" ref-type="bibr">5</xref>]. When success is measured by patient outcome (success of the grafting procedure), the excellent result rate achieved is due to the fact that complications are minimal and possibly further on prevented through proper case selection, good surgical technique, and proper and prompt handling of intraoperative and postoperative complications. Properly performed sinus grafting does not alter neither sinus function [<xref rid="B13" ref-type="bibr">13</xref>] nor the characteristics of the voice [<xref rid="B25" ref-type="bibr">25</xref>]. When measured by implant outcome (implant survival rate), it has been shown that implant survival rates in the high 90th percentile can be achieved through proper decision making with regard to implant surfaces (textured), graft materials (highest survival with xenografts), and the placement of a barrier membrane over the window. Complications are infrequent and those that occur after sinus grafting procedures are for the most part localized and readily resolved. 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In press</comment></element-citation></ref></ref-list></back><floats-group><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Prophylaxis and post-operative drug therapy in sinus lift patient.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">Prophylaxis</th><th align="left" rowspan="1" colspan="1">Post-operative therapy</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Patient not allergic to penicillin</td><td align="left" rowspan="1" colspan="1">Amoxicillin/clavulanic acid 1 gr twice a day (BID) per os starting 24 hours before surgery</td><td align="left" rowspan="1" colspan="1">Amoxicillin/clavulanic acid 1 gr three times a day (TID) per os for 7 days</td></tr><tr><td align="left" rowspan="1" colspan="1">Patient allergic to penicillin</td><td align="left" rowspan="1" colspan="1">Clarithromicin 250 mg BID + Metronidazole 500 TID per os starting 24 hours before surgery</td><td align="left" rowspan="1" colspan="1">Clarithromicin 250 mg BID + Metronidazole 500 TID per os for 7 days</td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Drug therapy for sinus lift complications.</p></caption><table frame="hsides" rules="groups"><tbody><tr><td align="left" rowspan="1" colspan="1">Patient not allergic to penicillin</td><td align="center" rowspan="1" colspan="1">Amoxicillin/clavulanic acid 1 gr TID and Metronidazole 500 mg TID per os</td></tr><tr><td align="left" rowspan="1" colspan="1">Patient allergic to penicillin</td><td align="center" rowspan="1" colspan="1">Levofloxacin 400 mg BID per os until 72 hours to symptom remission</td></tr><tr><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td colspan="2" align="center" rowspan="1">Usually these regimens are utilized for 7–10 days</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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