Bone grafting and/or bone augmentation is a surgical procedure that tries to replace and – or regenerate the missing or lost bone. This procedure utilizes material from the patient’s own bone using a synthetic/artificial substitute, or natural bone substitute. (1)
Implant placement in the maxilary (upper jaw) molar in premolar area may be problematic due to sinus peumatization. A sinus lift or bone graft can be very simple or complicated depending on the circumstances of each individual case. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully for your sinus lift and bone graft aftercare. (2)
Immediate implant placement is when an implant is placed at the same time as the natural tooth is extracted. Implant placement in fresh sockets was first reported by Schulte and Heimke in 1976, termed ‘immediate implant’. (4)
HEALING
Immediately following the surgery:
- Bite on the gauze pad placed over the site of the sinus lift for an hour. After this time, the gauze pad should be removed and discarded and replaced by another gauze pad. Refer to the section on BLEEDING for details.
- Avoid vigorous mouth rinsing or touching the wound area following surgery. This may start bleeding by causing the blood clot that has formed to become dislodged.
- To reduce any swelling, place ice packs to the sides of your face where the bone graft was performed. Refer to the section on SWELLING for explanation.
- You should eat a little something after the dental procedure so that the food can be digested before the local anesthetic has worn off. Having something of substance in the stomach to coat the stomach will help reduce nausea from the pain medications. Refer to the section on PAIN for details.
- Restrict your activities the day of the surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound.
- NO SMOKING UNDER ANY CIRCUMSTANCES. (3)
Bleeding:
- A certain amount of bleeding is to be expected following this type of dental surgery . Slight bleeding or oozing causing redness in the saliva is very common. For this reason, the gauze will always seem red when it is removed. Saliva washes over the blood clots and dyes the gauze red even after bleeding from the sockets has actually stopped.
- Since the wounds are sutured closed, there is generally little bleeding after the first few hours. However, pressure on the gauze should continue to keep the gum pressed tightly over the wound to prevent excessive bleeding under the gums.
- Following a sinus lift procedure you may expect some bleeding out of the nostril on the surgical side. Gently blot the nose but do not vigorously blow the nose as this could blow the blood clot and graft out of the sinus.
- Excessive bleeding may be controlled by first GENTLY rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for sixty minutes. Repeat as necessary.
- If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. This can be repeated several times.
- To reduce further bleeding, sit upright, do not become excited, maintain constant pressure on the gauze (no talking or chewing) and avoid exercise.
Swelling & Bruising:
- The swelling & bruising that is normally expected is usually proportional to the surgery involved. Sinus lifting procedures may involve a wide area of flap elevation so the cheek is usually swollen after this procedure.
- If there was a fair amount of cheek retraction involved with your tooth extraction, then it would be right to apply ice on the outside of the face on the affected side. The swelling will not become noticeable until the day following surgery and will not reach its greatest amount until 2-3 days post-operatively.
- The swelling may be minimized by the immediate use of ice packs. Sealed plastic bags filled with ice, ice packs, or a bag of frozen peas or corn wrapped in a dishcloth should be applied to the side of the face where surgery was performed.
- Ice packs should be applied 20 minutes on/20 minutes off for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect.
- Thirty-six (36) hours following surgery the application of moist heat to the side of the face may help some in reducing the size of any swelling that has formed.
- If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. Soft, puffy swelling that you can indent with your finger after oral surgery is very normal.
- Bright red, rock hard, hot swelling that does not indent with finger pressure which is getting bigger by the hour would suggest infection. This usually would develop around day 3-4 after surgery when you would expect swelling to be going down, not up. If this is your case please contact Daniel by telephone.
Numbness:
Local anesthetic injections are used during your surgery and when you recover you will notice parts of your face are quite numb. This is normal and is done deliberately as a pain control measure. The numbness will take 6-8 hours to wear off and during that time you should avoid contact with hot liquids etc. Bone grafting procedures occasionally cause stretching and injuries to some of the surrounding nerves in the jaw bones and you may notice some prolonged numbness, which can take up to three months to resolve. In severe cases the numbness may take up to 18 months to settle and on occasions there may even be some permanently altered sensation particularly near the area where the bone graft or sinus lift has taken place.
Temperature:
- It is normal to have a slight temperature for 7-10 days following oral surgery. This reflects your immune response to the normal bacteria that are present in your mouth. A high temperature might exist for a 6-8 hours after surgery but no more than that.
- 2-4 Ibuprofen every 4-6 hours will help to moderate a temperature.
- A high temperature several days after surgery, especially if accompanied by rock hard swelling and increased pain, is usually indicative of infection. You should call Daniel for instructions if this should occur.
Pain:
- Pain or discomfort following this type of dental surgery is expected to last 4-5 days. For many of our patients, it seems the third and fourth day may need more pain medicine than the first and second day. Following the fourth day pain should subside more and more every day.
- Many medications for pain can cause nausea or vomiting. It is wise to have eaten something before taking prescription pain medicines and/or over the counter pain medicines (especially aspirin or ibuprofen).
- For moderate pain, one or two tablets of Ibuprofen may be taken every 3-4 hours.
Antibiotics:
If you have been placed on antibiotics take the tablets as directed. You should take them on schedule until they are completely gone.
Diet:
- Drink plenty of fluids. Try to drink 5-6 glasses of water the first day.
- Drink from a glass or cup and don’t use a straw. The sucking motion will suck out the healing blood clot and start the bleeding again.
- Avoid hot liquids or food while you are numb so you don’t burn yourself.
- Soft food and liquids can be eaten on the day of surgery. The act of chewing doesn’t damage anything, but you should avoid chewing sharp or hard objects at the surgical site for several days.
- Return to a normal diet as soon as possible unless otherwise directed. You will find eating multiple small meals is easier than three regular meals for the first few days.
- You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
Oral Hygiene:
- Good oral hygiene is essential to the proper healing of any oral surgery.
- You can brush your teeth the night of surgery but rinse very gently. Vigorous rinsing should be avoided until the day following your dental surgery.
- The day after dental surgery you should begin rinsing at least 5-6 times a day especially after eating. Salt water (cup of warm water mixed with a teaspoon of salt) is ideal but plain water is also OK.
- Mouthwash has an alcohol base to it so it may be pretty “zingy” when it comes in contact with fresh oral wounds. After a few days, dilute the mouthwash in half with tap water and rinse out your mouth. This will make it taste and smell better. You can gradually build up to full strength mouthwash as you feel more comfortable.
Smoking:
- No smoking for 48 hours after surgery. Smoking retards healing dramatically. Nicotine constricts blood vessels which slows the formation and expansion of the healing blood clot in the socket. This leads to the painful complication called a “Dry Socket”.
- After 48 hours, if you feel you need so much as one aspirin to control pain, you should avoid any smoking of any kind. This usually reflects that the clot has not grown enough to cover all the exposed bone in the socket. The exposed bone is filled with raw nerve endings. Until the nerve endings are covered with a healthy blood clot, they will cause pain. Smoking will just slow this process significantly and make the pain even worse.
- Therefore, if there is any question about smoking…..DON’T DO IT.
Activity:
- You should keep physical activities to a minimum for 6-12 hours following surgery.
- If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should stop exercising.
Read latest https://www.dentalholiday.co.uk/bone-graft/
(1) – Dr. Silverstein: https://www.dentistrytoday.com/implants/10375-the-status-of-bone-grafting-for-implant-dentistry
(2) – Bone augmentation in oral implantology Dr.Fouad Khoury, Dr. Haidy Antoun, Dr.Patrick Missika
(3) – Dr.Marek Salka, our surgeon
(4) – Schulte W, Heimke G. The Tübinger immediate implant. Quintessenz 1976; 27(6): 17-23.