Bone Grafting

BoneGraftingMuch in the same way that gum tissue can be restored with soft tissue grafts, the same can be said for those patients who suffer from bone loss due to periodontitis. Bone in the jaw is kept strong and healthy when a healthy tooth is in its socket. However, when bone loss occurs, the tooth has less support, can become loose and eventually be lost.

A bone graft may be needed in areas where bone is missing. A surgical procedure, bone grafting replaces missing bone and aids in the re-growth of new bone by placing graft material into the area where bone existed. The new bone growth strengthens the grafted area by forming a bridge between the existing bone and the graft material. Over time, new bone growth will replace much of the grafted material.

For periodontal needs, bone grafts are most commonly used to restore or regenerate bone needed around teeth (Guided Tissue Regeneration, GTR) or to aid in placement of a dental implant (Guided Bone Regeneration, GBR) prior to the placement of bridges or implants.

Bone Grafting Around Teeth

Guided Tissue Regeneration (GTR) attempts to regenerate lost periodontal structures, such as bone, ligaments, and connective tissue attachments that support the teeth. A biocompatible membrane or Emdogain® is sometimes used conjunctively with bone grafts for the regeneration to be successful.

Emdogain® is a grafting product that promotes the regeneration of hard and soft tissues lost through periodontal disease. Emdogain® main ingredient is amelogenin, a protein that aids in the creation of teeth and supporting structures but produced only when our teeth are developing. Emdogain® is applied to the root surface during the bone grafting procedure. By doing so, the body thinks it is forming a natural tooth attachment, which promotes the growth of new bone around your tooth.

Bone Grafting for Dental Implants

If a tooth is lost, a patient may seek dental implants to restore his/her smile. However, even dental implants need a healthy jawbone before they can be placed. Ridge Augmentation or Guided Bone Regeneration (GBR) restores the bone before the placement of implants by increasing the width of your jawbone or by filling in an extraction socket to prevent loss of bone during healing. Biocompatible membranes and bone grafts keep the tissue out, thus allowing the bone to grow.

Sinus augmentation now makes it possible for many patients to have dental implants placed in the upper posterior of the mouth. Years ago, there was no other option other than to wear loose fitting dentures. The sinus augmentation is a graft procedure that replaces bone between the bottom of the sinus cavity and the upper part of the jaw.

When a back tooth is lost in the upper part of the jaw, the floor of the maxillary sinus drops down into the space that was occupied by the root of the missing tooth. For an implant to be placed in that space, the sinus floor must be pushed back up to where it was originally by adding a bone substitute to hold the sinus floor in place. After six months of healing, the bone substitute becomes part of the patient’s jaw and dental implants can then be inserted into the stabilized bone.

Post-Op Instructions for Bone Grafts & Sinus Augmentation

Recovery

Rest with your head elevated when you arrive at home after the procedure. We ask that you please limit your physical activity and keep moving to a minimum for the first 24-hours.

Ice Application

For the first 4-5 hours after the surgery, we recommend placing an ice bag to your face in 20-minute intervals. This will help reduce facial swelling. If needed, you can use an ice bag for 24-hours. Your face will likely swell after surgery, so this is no cause for alarm. The ice and NSAID medication will both help alleviate the facial swelling.

Medication Instructions

Please take anti-inflammatory medications (NSAIDs) to prevent inflammation, swelling, and pain. For the next 4-5 days, we suggest taking 400mg-800mg of Ibuprofen every six hours to reduce swelling and pain and quicken healing. DO NOT take more than 2400mg in a 24-hour period. If you experience excessive pain or discomfort, take the narcotic that has been prescribed to you. If you do not have one, please call our office and the doctor will call in a prescription to your pharmacy. Please take as directed along with the NSAID. If you’ve been prescribed an antibiotic, please take as directed. We ask that you finish the entire dosage. If any of the medications are causing you extreme nausea, itching, or a rash; discontinue its use and call our office immediately.

If you had surgery on your sinus, we ask that you please take an antihistamine as directed on the box for the first 4-5 days, especially if you are prone to feeling “stuffy” or sneezing. Be careful, due to the fact that an antihistamine can make you sleepy.

Please take your prescribed antibiotic as directed. We ask that you finish the entire dosage. If you notice that your pain or swelling are only increasing, or that you have a fever, please call our office immediately. We will be able to tell you if you have an infection.

If You Experience Bleeding

Some minor oozing is expected for a few days after surgery and is no cause for alarm. If you see a lot of “red” in your mouth, it is likely a mixture of a little blood with your saliva. Blood can strongly “dye” and will tint your saliva red. You are likely not bleeding nearly as much as it seems. To stop the bleeding, apply pressure on the surgical site with a moistened piece of gauze or a tea bag for 20 minutes. If your bleeding is moderate to heavy and has continued for a few hours without stopping, please call our office immediately.

Sometimes patients have nosebleeds after sinus augmentation surgery. If this happens, lie down with your head elevated and place an ice bag to your nasal area. If your nosebleed continues longer than 30 minutes and will not stop, please call our office immediately.

Eating Guidelines

We ask that you do not try to eat until all the anesthesia has completely worn off. For the first week after surgery, we suggest eating high protein foods and liquids.

You may eat very soft foods, if this can be done easily. Because your mouth will be sensitive, the food that you eat during the first week should be soft. Please DO NOT eat anything that is spicy, salty, acidic, very hot or very cold and please do not eat anything hard or crunchy, such as nuts, popcorn, chips, etc.

If possible, we also advise that you take the following nutritional supplements as they will aid in the healing process. Please take these vitamins for 4-6 weeks after surgery:

  • Multi-vitamin with minerals (1/day)
  • Calcium 500mg (twice/day)
  • Vitamin E 400 iu (1/day)
  • Vitamin C 1000mg (1/day)

Caring for Your Mouth

We strongly request that you continue your regular oral hygiene habits on all other areas of your mouth. Please do not brush or floss the the surgical area during the first week after surgery as this will hinder the healing process. For the next month, please DO NOT use an irrigation tool, such as a WaterPik.

You can use an antiseptic mouthwash at least once in the morning and once at night before bed until your next appointment with our office. You can also gently swab the exposed surgical area with a cotton swab dipped in antiseptic mouthwash every morning, every night before bed and after eating and drinking.

Wearing Your Removable Dental Appliance

If you have a removable appliance that replaces missing teeth and it touches your surgical area, please refrain from using this appliance as much as possible. We do not want any unneeded pressure on the surgical area as this could cause pain and hinder healing.

If you have any questions or concerns, please call our office.

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