After Bone Graft Surgery – Block Graft, Onlay or Veneer Graft, J-Graft, Ridge Split Graft
Block graft, onlay or veneer graft or J grafts done with autologous (your own bone) requires most often a donor site harvest from a site in the mandible such as the ramus or the chin. Most often the site will need care such as in an extraction site with mouth rinses and soft diet. Large block grafts obtained for larger bony defects will often be harvested from the anterior ileum or for very large defects from the posterior ileum (hip) bone. These procedures require a short hospital stay of 23 hours or less and sometimes using a cane, crutch or walker for a short time for walking until the wounds are healed and soreness with gait abates in two to three weeks. Hip harvest donor sites will often need external suction drains that will be removed within the first few days after surgery. Cadaver block graft for ridge augmentation does no create another surgical donor site such as in a split ridge bone graft.
As for all grafted sites the important instructions to follow is to not disturb the grafted site with hard crusty foods, tooth brushes or touching the area. A soft diet for the first one to two weeks post operatively will be advised. Wound dehiscence or wound breakdown by trauma from hard chunky foods, poorly fitted provisional dentures, or tooth brushing will often lead to loss of the grafted bone that was placed.
Antibiotics will always be prescribed for all bone graft cases. You are advised to take the tablets or liquid as directed for the frequency and duration indicated on the prescription. Antibiotics will be given to help prevent infection of the graft. Missing one dose time is usually not a problem if you have been on it for a couple days but take the next dose as soon as possible and in this case doubling the next dose usually is not necessary. Missing more than 24 consecutive hours of antibiotics within the first 3 days of dosing schedule can be a problem and a call to the doctor is recommended to discuss the situation. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Rash, itching or swelling with use could indicate an allergic reaction and you must alert the doctor of these findings immediately. Swelling of the neck and face other than at the surgical site accompanied with difficulty in breathing is a life threatening allergic problem and calling 911 and/or going to the nearest emergency room is advised. Other problems that antibiotics could cause that you may need to advise your doctor of is sudden development of diarrhea as this could signify a antibiotic induced colitis of the bowels that may need treatment.
Call the office if you have any questions.
The area operated on will have swelling reaching a maximum in two to three days so it is advised to use ice packs (externally) on the same side of the face as the operated site to reduce swelling and pain. Apply ice for the first day and no longer than 24 hours. The ice should be applied intermittently 20 minutes on and 20 minutes off on the face to the area of surgery continuously for the first day while you are awake. .After the third day from surgery, the application of a moist warm towel for two to three minutes alternating with cold compress for one to two minutes followed by a warm moist towel again for two to three minutes repeating this cycle six to eight times a day will help to speed the resolution of the discoloration and any swelling that may have occurred. The intermittent hot and cold compresses should be used as much as possible for at least a few days beginning 3 days after surgery (remember ice packs alone are used only for the first 24 hours after surgery). Keeping the head elevated at 30 degrees while resting or asleep will also help minimize swelling from surgery.
Use the pain medication as directed by Dr Chun and his staff at the surgery and or consult appointment. To review, you should begin taking pain medication as soon as you feel the local anesthetic wearing off. For mild to moderate pain, 1 or 2 Tylenol or Extra Strength Tylenol may be taken every 6 hours for patients over the age of 12 years. Ibuprofen (Advil, Motrin) may be taken instead of Tylenol and is often reported to work better. Ibuprofen bought over the counter comes in 200 mg tablets: 2-3 tablets may be taken every six to eight hours for patients over age of 12 years as needed for pain. For severe pain, the prescribed narcotic medication should be taken as directed. You should not drive, operate machinery or make important decisions while on narcotic pain medications. If the medication doesn’t seem to be working then call the office for further instructions. If the pain does not begin to subside in 3 days, or increases after 3 days, or you do not think it is working please call our office for advice.
Wearing your Prosthesis or Nightguards
Partial dentures, flippers, or full dentures should not be used immediately after surgery if they have not been brought to the surgery for adjustment until your post-operative appointment when it can therefore be checked and adjusted for proper fit. Please contact the office if there is any question. If you have a temporary “flipper” or “provisional prosthesis/denture” to wear immediately after the surgery and it causes irritation or soreness to the to the area after the numbness in the area is gone then it should be removed and the doctor called to advised of this problem. The tissue in the area often swells to maximum in 2-3 days after surgery so if it is removed for a long duration in this time period it may be difficult to replace the denture or flipper back into the mouth. A good fit of the flipper will not press significantly on the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins which will lead to loss of the graft. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.
Do not smoke for at least 2 months after surgery, if at all for life. As discussed at your consultation, smoking has proven to dramatically increase the risk of bone graft augmentation failure.
You will need to keep physical activities to a minimum immediately following surgery for the first day. For larger bone grafts we recommend no physical exertion for four to five days after the surgery. If you are considering exercise, you should realize that throbbing or bleeding may occur which may make you discontinue your exercising. Be aware that your normal nourishment intake is reduced and exercise may further weaken you. If you get light headed, stop exercising.