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14 mos ago I experienced an apicoectomy with bone graft of human bone.  Within 2 days my face was red and warm, and seemed to be photosensitive.  I took oral diphenhydramine without effect.  The oral surgeon administered IV diphenyhydramine without effect.  He was convinced that the rash was unrelated to the surgery.  My family physician prescribed topical corticosteroids without effect.  CBC and Differential showed nothing remarkable, i.e., eosinophils were not elvevated.  Family doctor prescribed 2 short courses of prednisone which were effective in reducing the symptoms, which now also included rash on face, neck, and hands.  Was referred to local dermatologist who did a punch biopsy which was not definitive other than that it ruled out lupus.  Was sent to an allergist who performed patch test on numerous materials, including the bone graft powder.  Was sent to a regional teaching hospital.  I have had numerous sessions with a dermatologist there and they have not been successful in identifying the problem, other than to say that the condition has some similarities to autoimmune disseases.  I am using Protopic ointment, 0.1% on my back, chest, abdomen, arms, and legs, and am 6 weeks into a course of Soriatrane, 25mg/day, with minimal effect.  At this point, 16 mos post surgery, I am wondering if there has been any reports of autoimuune type reactions to human bone implantation.  Early on, the oral surgeon said he would remove the implant if I wished, but didn't think it would do any good.  I'm thinking seriously of asking him to remove it, and would appreciate your perspective.  Thank you for your help!

Hello Michael,

I don't understand why your surgeon placed any bone after a simple apicoectomy! This just would have healed normally and bone ingrowth happens uneventfully.
There are many things that need to be adressed:
1-What KIND of bone was placed i.e the specific type of allograft because most of bone of human origin in the market have no organic contents that can lead to immune reaction. It is basically a mineral matrix that allows your own bone to grown in.
2-I am sure you ruled out any possible reaction from the medicines given postoperatively e.g antibiotics.
3-You are 16 months after surgery, the graft should be totally "dissolved" and replaced by your own bone right now and a cone beam CT could be done to make sure it's the case. If it still there, then YES it should be removed since it has not induced any bone formation.



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Chawket MANNAI, DDS,Ph.D Diplomate ABOMS


I am a US board certified Oral & Maxillofacial Surgeon trained at UCLA and Parkland Memorial Hospital (Dallas) with more than 25 years of experience and will provide answers to all questions pertaining to the Oral& Maxillofacial Surgery region including Orthognathic Surgery, Trauma,TMJ, Implantology, tumour surgery (excluding cancer and Oral Dermatology),reconstructive surgery...


Extensive in all fields for the past 25 years hospital and office based.

American Association of Oral & Maxillofacial Surgeons American College of Oral & Maxillofacial Surgeons British Association of Oral & Maxillofacial Surgeons

2006: Mannai Chawket Early implant loading in severely resorbed maxilla using xenograft, autograft, and platelet-rich plasma in 97 patients. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2006;64(9):1420-6. Bayonne, France. 1998: Bell W H; Mannai C [An interview with Dr. W.H. Bell and Dr. C. Mannai. Interview by Colette Orival-Demange.] L' Orthodontie franšaise 1998;69(1):225-9. 1988: Abemayor E; Zemplenyi J; Mannai C; Webb D J; Canalis R F The fixation of malar fractures with the transnasal Kirschner wire. The Journal of otolaryngology 1988;17(4):179-82. Division of Head and Neck Surgery, Harbor-UCLA Medical Center, Torrance 90509. 1988: Wald R M; Abemayor E; Zemplenyi J; Mannai C; Lesavoy M A The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study. Annals of plastic surgery 1988;20(5):409-13. Division of Plastic Surgery, Harbor/UCLA Medical Center. 1988: Di S; Bell W H; Mannai C; Seale N S; Hurt W C; Taylor J; Waite D E Long-term evaluation of human teeth after Le Fort I osteotomy: a histologic and developmental study. Oral surgery, oral medicine, and oral pathology 1988;65(4):379-86. Division of Oral and Maxillofacial Surgery, University of Texas Health Science Center, Dallas. 1988: Bell W H; Mannai C; Luhr H G Art and science of the Le Fort I down fracture. The International journal of adult orthodontics and orthognathic surgery 1988;3(1):23-52. 1986: Mannai C; Schwartz H C Juvenile nasopharyngeal angiofibroma presenting as a facial swelling. A case report. Journal of maxillofacial surgery 1986;14(6):329-31. 1986: Mannai C; Leake D; Pizzoferrato A; Ciapetti G; Sangiorgi C Histologic evaluation of purified bovine tendon collagen sponge in tooth extraction sites in dogs. Oral surgery, oral medicine, and oral pathology 1986;61(4):315-23.

DDS,Ph.D Fellow and Diplomate American Board of Oral & Maxillofacial Surgery Residency training:Harbor-UCLA MedicalCenter 1982-1985 Fellow OMFS Parkland Memorial Hospital Dallas Texas with William H.BELL

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