After Socket Bone Grafting
The following information applies when grafting material has been placed into extraction sites to help preserve your jawbone in preparation for possible implant replacement of the extracted tooth.
Your bone graft is made up of many small bone granules. You may find some small granules in your mouth for the first several days. Do not be alarmed by these. It’s normal to have some of them come out of the graft site and into your mouth. There are some things you could do to minimize the amount of particles that become dislodged:
- Do not disturb or touch the wound with your fingers, cotton swabs, tooth brush or irrigation device (Water Pic or Monoject syringe) until advised. This is usually 2 weeks or longer if indicated at the follow up exam.
- Avoid rinsing or spitting for one day to allow blood clot and graft material stabilization.
- Do not apply pressure with your tongue or fingers to the grafted area, as the material is movable during the initial healing.
- Do not lift or pull on the lip to look at the sutures. This can actually cause damage to the wound site and tear the sutures free.
- Do not smoke.
- Avoid hard or crusty fruits, vegetables or bread for the first week or until your follow-up exam appointment, whichever is longest.
Following the second day, gentle rinsing would be allowed but not too vigorously as you can again disturb some of the bone graft granules. If a partial denture or a flipper was placed in your mouth, you may have to see your restorative dentist to have it adjusted and learn how to remove and replace it appropriately.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you to a good recovery, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor. The after hours telephone number is the same as the office number which is 925 833-8516.
After Sinus Lift Bone Grafts – Open Lateral Sinus Wall Approach
The open lateral sinus wall approach sinus lift bone graft is where a lateral access to the maxillary sinus is needed to place bone into the sinus and jaw area. The Sinus Lift Augmentation Procedure or Open Lateral Wall Approach Sinus Lift Bone Graft is done when a large amount of bone augmentation is needed due to severe bone loss. The upper jaw bone height and sometimes width often in the area of the area of your first and second molar and occasionally second premolar will often have bone loss due to an enlarged, pnuematized sinus or disuse atrophy of the alveolar ridge or both. The goal of the Sinus Lift procedure is to place bone graft to help restore your vertical and sometimes horizontal jaw bone volume in preparation for implant replacement of the missing tooth or teeth.
This procedure regains lost bone height allowing implant placement in an area that previously could not be implanted because of insufficient bone height due to an enlarged sinus or atrophied ridge.
The bone that has been grafted is most commonly a combination demineralized freeze-dried bone (DFDB), and your own bone. Because of this you may have two post-surgical wounds: the donor site and the recipient site. Other bone graft donor sources for sinus lifts is using human donor bone with hematopoietic stem cells or using a recombinant derived Bone Morphogenic Protein (BMP) alone or in combination with DFDB. The benefits of the latter two sources of bone regeneration is that there is no second surgery site (donor site) needed and therefore usually faster and less pain in recovery period is often seen.
DO NOT UNDER ANY CIRCUMSTANCES. BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS. This may be longer if indicated. You may sniff but NO BLOWING.
Do not blow your nose or sneeze holding your nose. Sneeze with your mouth open. Do not drink with straws and do not spit. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Oral Decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses. Often Afrin Nasal Spray (oxymetozaline) 2 puffs to each nostril every 12 hours for 2-3 days may be advised as well to reduce congestion and promote drainage of the sinus cavity of collected blood and fluids. You may also be given a prescription for antibiotics. Please take these as directed. Anything that causes pressure in your nasal cavity must be avoided. Avoid “bearing down”—as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Smoking must be stopped as it slows healing and would cause breakdown.
Be sure to take the prescribed antibiotics as directed to help prevent infection. Antibiotics need to be taken as scheduled for the duration indicated to be effective unless advised otherwise by the doctor. Non compliance can result in infections and failed results. 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. 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.
Do not rinse or spit on the day of your surgery. This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You should not have a significant amount of blood in your mouth. Saliva can be swallowed, even if slightly blood tinged.
Keeping your mouth clean after surgery is essential to reduce the risk of infection. Start salt water rinses the day following your procedure. Use one-half teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful. Repeat as often as you like, but at least four to five times daily and always after eating for the next seven days or until your follow-up exam.
Do not brush the teeth in the area of surgery for 48 hours. When brushing, be very gentle. When expectorating, also be gentle.
We may prescribe an antibiotic rinse (Chlorhexadine, Periogard, Peridex) for certain procedures. This rinse should be used in the morning and at bedtime after routine mouth care. Do not eat or drink or rinse your mouth after using the medicated rinse. Using this rinse more than two times a day will cause staining of your teeth which will require a dental cleaning/polishing to remove. If the mouth rinse causes changes of taste or is causing an intolerable burning sensation then you may try a solution of 3 parts water to 1 part hydrogen peroxide for rinsing.
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 and sinus augmentation failure.
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.
Post-Operative Problems or Complications
As with any procedure, unexpected post-operative healing can occur. If you notice the unexpected flow of air or liquids between your mouth and nose, please let us know immediately.
If you are aware of several small particles of graft material being discharged from your nose, let us know as well.
If you experience sinus or nasal congestion on the side your surgery was performed, let us know.
If there is an increase in swelling in your mouth, cheek or under your eye after 3 days, let us know.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours; however a 24-hour answering service is available for after hours contact with a doctor. The after hours telephone number is (925) 833-8516