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Bone Grafting

General Information

Bone GraftingOver a period of time, the jawbone associated with missing teeth atrophies or is resorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for the placement of dental implants. Without adequate bone, some patients are not candidates for placement of dental implants.

We now have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance. There are different types of bone grafting procedures that can be done. During your consult, your doctor will recommend the best treatment options. Together, you will decide the best approach for you.

Socket Preservation (Ridge Preservation)

For this procedure, artificial bone grafting material is added to the extraction socket immediately after removing the tooth/root. This preserves the pre-extraction bone width and prevents bone atrophy. The placed bone is then covered with gingival tissue (gum tissue) or an artificial membrane to encourage your body’s natural ability to repair the socket. With this method, the socket heals simultaneously while eliminating shrinkage and collapse of the surrounding gum tissue and bone. Once the newly formed bone in the socket has matured, the foundation for an implant is available to replace the tooth.

Sinus Lift Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. These sinuses are empty, air-filled spaces. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in that area. The key to a long successful lasting implant is the quantity and quality of jawbone. Sinus augmentation can raise the sinus floor and allow for new bone formation. The sinus lift procedure is an extremely useful and successful method of grafting. A small window is made into the side of the sinus, the sinus lining is carefully elevated and artificial bone grafting material is placed onto the sinus floor. Once the graft has matured, the implants can be placed. The sinus graft makes it possible for many patients to have dental implants where years ago there was no other option besides wearing loose dentures.

Ridge Augmentation

In severe cases, the ridge (jawbone) has been resorbed (worn down) and a bone graft is placed to increase the ridge width, and to a lesser degree, the height. Typically, this involves, either artificial bone grafting or the patients’ own bone. If the patients’ own bone is used, this is usually removed from the mandibular ramus (behind the lower wisdom teeth) or chin. If indicated, we use resorbable collagen membranes and miniature bone screws to stabilize the grafting material. Although sometimes necessary for successful implant treatment, these procedures will increase the time frame for overall implant completion as the bone grafts take 3 to 6 months to heal.

Extensive Bone Grafts

In more extensive situations, a greater quantity of bone can be obtained from the hip, the outer aspect of the tibia below the knee, the ribs and the skull. These surgeries are done at the hospital under general anesthesia.

Bone Graft Materials

To better serve our patients, we utilize all types of bone grafting materials including:

  1. Autogenous: patients own bone
  2. Allograft: donor or cadaveric freeze dried bone
  3. Xenograft: bone graft from another species (i.e. bovine, porcine)
  4. Alloplast: man-made synthetic bone material

Post-Operative Socket Preservation Instructions

Proper care after surgery has an important effect on healing. Please read the following instructions carefully.

Procedure

After a tooth is removed, the bone around the socket is slowly resorbed. This often causes poor quality or quantity not suitable for a dental implant. The purpose of the socket preservation is to protect the bone surrounding the socket in order to create a future site for implants. After your tooth is extracted, artificial bone will be immediately placed into the extraction socket. The bone is then covered with the gum tissue or an artificial membrane to encourage your body’s natural ability to repair the socket. With this method, the socket heals; eliminating shrinkage and collapse of surrounding gum and bone. After a few months of healing, your doctor will assess if the site is ready for implant placement.

Immediately Following Surgery

  • Bite firmly on the gauze pad covering the grafted site to help stop the bleeding. We will change the gauze before you leave the office. You may need to change the gauze pads once more at home, leaving it in for an additional 30 minutes.
  • You may have difficulty feeling your lips, cheeks or tongue due to numbness. This is a temporary feeling and will wear off within 2-4hrs. Please take care not to bite your lips, cheeks or gums.
  • Apply ice packs to your face to reduce swelling for the first 24 hours after surgery.
  • Take pain the medication as prescribed as soon as possible.
  • Do not rinse or spit the day of surgery, as this may prolong the bleeding.

Special Considerations

  • Do not disturb or touch the wound.
  • Do not apply pressure with your tongue or fingers to the grafted area, as the material is moveable during the initial healing phase.
  • If a corner of the membrane does become exposed, please do not touch or pick at it. Generally, the exposed portion will fall off on its own.
  • Avoid chewing or creating pressure on the graft site.

Bleeding

One of the most common concerns after surgery is bleeding. Surgery causes an increase in salivary flow which in addition to the normal oozing of blood may alarm you unnecessarily. Some oozing is normal for 24 to 48hrs following surgery and should not be a concern. It is common for saliva to be slightly blood tinged for several days following surgery.

  • Use a piece of gauze (or a moist teabag), folded into a small wad, and place it over the surgical site. The idea is to apply gentle pressure on the surgical site. Apply pressure for at least 20-30 minutes after surgery. The gauze can be changed when it feels saturated. One may need to change the gauze and repeat the previous steps a few times to decrease bleeding. If bleeding is controlled, the gauze is no longer necessary.
  • DO NOT rinse your mouth or use a straw for the next 24 hours.
  • DO NOT smoke or consume alcohol for the next 24 hours.
  • DO NOT perform strenuous activities for the next 3 days.

If you are bleeding excessively, apply firm pressure by folding and placing a gauze pad directly over the extraction site and bite firmly on the gauze for one hour. Excessive bleeding is defined as pooling or dripping of blood out of the extraction sites within 15-20seconds of removing the gauze. If excess bleeding continues, apply a gauze pad for an additional 30 minutes. If excessive bleeding persists, contact the 24hr office number.

Pain Management

Some amount of discomfort is to be expected following any surgery. If your doctor thinks that you will benefit from a prescription pain medication, you will receive a prescription following your surgery. Please follow the prescription instructions carefully.

  • Ibuprofen (such as Advil, Motrin) works very well for many patients and can significantly reduce the amount of narcotic pain medicine (Tylenol 3, Percocet) needed. You may find that taking 400-600mg of ibuprofen every 6 hours on a regular schedule for the first 2-3 days is all the pain medicine needed. If needed, you may take both the ibuprofen and the narcotic pain medication as prescribed for maximum pain management. Continue to take the pain medication as directed and as needed for pain relief. You can wean yourself off the pain medications if the pain is controlled. You may or may not need to take all the prescribed pain medications for this reason.
  • Begin taking your pain medications as directed as soon as you get home and before the local anesthetic (freezing) wears off. Your pain medication can be taken with liquids but it is important to get some soft food in your stomach as soon as possible. Take all subsequent doses along with food to minimize nausea.

Infection

If your doctor thinks that you will benefit from antibiotics to prevent infection, you may receive a prescription for one. If prescribed, take as directed. It is important to ensure you finish the full course of the antibiotic.

  • If you are experiencing nausea you may TEMPORARILY stop taking the antibiotic until the nausea subsides, however you must always restart and finish the antibiotics as directed.
  • If any medications cause hives or itching, discontinue them immediately and call the office.

Call our office if you notice any signs of infection including:

  • Increased swelling after 5 days
  • Swelling that is painful, hard or hot
  • A foul taste or odour in your mouth
  • A temperature above 38°C

Swelling

Swelling around the mouth, eyes, and cheeks is a normal reaction to the surgery and usually takes 2-3 days to fully develop. To help prevent swelling:

  • Apply ice packs to the cheeks for 20 minutes on and 20 minutes off. Keep your head elevated for first 48 hours after surgery. Ice serves no purpose after 48 hours and may contribute to jaw stiffness.
  • Use crushed ice in a ziplock bag or a bag of frozen peas bag wrapped in a moist cloth to prevent frost bites.
  • After the first 5 days, you can begin using a heating pad or moist heat for relief of swelling, bruising, and stiffness of the jaw.
  • Apply heat 4 times/day for 30 minutes time intervals.
  • If your doctor thinks that you will benefit from it, you may have receive a prescription for a medication (Dexamethasone) to help with swelling. Take the medication as directed. Occasionally, this medication will cause some people to experience tingling in their hands and feet. If this happens, stop the medication and contact the office.

Diet

Try to resume a normal diet after the first 3 days. Initially you may feel more comfortable with a softer diet. Suggested foods are soups, noodles, scrambled eggs, pasta, pudding, yogurt, ice cream, juices, milkshakes, pancakes, anything soft that you can tolerate. Drink lots of fluids to rehydrate. Avoid hard, crunchy foods such as chips that may disturb surgery site for at least 3 days. No alcoholic beverages should be consumed for at least 24hrs post anesthetic or as long as you are taking narcotic pain medications and antibiotics.

Nausea

You may experience some nausea which is common following a general anesthetic/sedation. Frequent sips of carbonated drinks such as ginger ale, will usually help stop the nausea. Follow this with a clear diet, apple juice, clear tea, broths, and jello. If this is not effective you may use Gravol, an over the counter medication. Take as prescribed on the box. Discontinue your medications TEMPORARILY until the nausea subsides but always restart and finish them as directed.

Wound Care

If prescribed to you, use the Peridex (Chlorohexidine 0.12%) mouth rinse three times a day after brushing. Swish in your mouth for thirty seconds then spit it out. You may also rinse your mouth with a salt-water solution (1/2tsp salt in 1 cup of water) several times daily.

Sutures (Stitches)

Your sutures will dissolve on their own 10-14 days after surgery but they may come out at any time after surgery. You may notice that they loosen after the swelling of your gum tissue decrease. This is completely normal.

Resuming Activities

If you have undergone a general anesthetic, you should go home and rest for the remainder of the day. Do not drive or engage in strenuous activities (sports) for at least 48hrs. On average most patients will take 1-2 days off from normal activity. You may return to work/school when you feel you are recovered.

Wearing Your Prosthesis

Partial dentures, flippers or full dentures may or may not be used immediately after surgery. You will be advised by your doctor.

Smoking

Do not smoke for at least 3 days following surgery.

Brushing & Rinsing

The day of surgery you may brush your teeth, but try to avoid the surgical site for at least 3 days. Avoid rinsing, or spitting the day of surgery.

Straws

Do not use a straw for first 24hrs after surgery.

Temperature

A slight rise in temperature can occur for 24-48hrs after surgery and this is normal. If it continues beyond this time, please call the office (403) 235-0505.

Bone Chips

Occasionally small chips of bone may appear in the surgical site. This can happen anywhere from a few days to several weeks following the surgery. Usually they will eventually fall of by themselves . If they are causing you significant discomfort you can contact our office for an appointment.

Numb Lip and Chin

Lip numbness of the side in which the tooth was extracted may develop. This is known as “paresthesia” . It is most often a temporary condition that will correct itself. It can last a variable length of time. If it lasts greater than 3 weeks please notify the office.

Follow Up Appointments

Generally a follow up is needed 7-10 days after the surgery. The nurse will let you know if a follow up appointment is necessary and it will be scheduled for you. There is no additional charges for follow up visits.

Questions

Your well-being is our primary concern. It is our sincere desire that you experience be the least uncomfortable or anxiety provoking. Should you have any questions regarding your recovery, please do not hesitate to contact our office at (403) 235-0505.

Emergencies

If any unusual symptoms should occur please call our office at (403) 235-0505. If you are calling after our office hours or on the weekend, the answering machine will direct you to the oral surgeon on call. In the event of an unexpected admission to a hospital related to a treatment done at our facility, please make sure you notify us.

Post-Operative Sinus Lift Instructions

Proper care after surgery has an important effect on healing. Please read the following instructions carefully.

Procedure

The maxillary sinuses are behind your cheeks and on top of the upper teeth. Some of the roots of the upper teeth extend into these sinuses. After these teeth are removed, you are often left with only a thin wall of bone separating the maxillary sinus and the mouth. When the sinus wall is thin, it is impossible to place dental implants in this bone. A sinus lift may be necessary to raise the sinus floor and add additional bone to the area for a future implant procedure.

A small window is made into the side of the sinus. The sinus lining is carefully elevated and artificial bone grafting material is placed onto the sinus floor. Once the bone graft has matured, implants can be placed in the upper jaw. The sinus graft makes it possible for patients, that would have not been a candidate in the past, to have the option of having an implant to replace missing maxillary teeth.

Immediately Following After Surgery:

  • Bite firmly on the gauze pad covering the grafted site to help stop the bleeding. We will change the gauze before you leave the office. You may need to change the gauze pads once more at home, leaving it in for an additional 30 minutes.
  • You may have difficulty feeling your lips, cheeks or tongue due to numbness. This is a temporary feeling and will wear off within 2-4hrs. Please take care not to bite your lips, cheeks or gums.
  • Apply ice packs to your face to reduce swelling for the first 24 hours after surgery.
  • Take pain the medication as prescribed as soon as possible.
  • Do not rinse or spit the day of surgery, as this may prolong the bleeding.

Special Precautions

  • Avoid performing activities that cause unnecessary pressure on the sinus for at least 1 week following surgery:
    • Blowing your nose. You may wipe your nose gently with tissues. Take an over the counter decongestant if necessary
    • Sucking on a straw
    • Smoking
    • Rinsing your mouth vigorously
    • Sneezing (if you have to sneeze, sneeze with your mouth open)
    • Air travel (for at least 2 weeks after surgery)
    • Playing wind instruments
  • You may experience some drainage from your sinus after surgery. This is common and will gradually decrease and stop
  • If you feel air flow through the surgical site- please contact the office for a follow up appointment

Bleeding

One of the most common concerns after surgery is bleeding. Surgery causes an increase in salivary flow which in addition to the normal oozing of blood may alarm you unnecessarily. Some oozing is normal for 24 to 48 hours following surgery and should not be a concern. It is common for saliva to be slightly blood tinged for several days following surgery.

  • Use a piece of gauze (or a moist teabag), folded into a small wad, and place it over the surgical site. The idea is to apply gentle pressure on the surgical site. Apply pressure for at least 20-30 minutes after surgery. The gauze can be changed when it feels saturated. One may need to change the gauze and repeat the previous steps a few times to decrease bleeding. If bleeding is controlled, the gauze is no longer necessary
  • DO NOT rinse your mouth or use a straw for the next 24 hours.
  • DO NOT smoke or consume alcohol for the next 24 hours.
  • DO NOT perform strenuous activities for the next 3 days..

If you are bleeding excessively, apply firm pressure by folding and placing a gauze pad directly over the extraction site and bite firmly on the gauze for one hour. Excessive bleeding is defined as pooling or dripping of blood out of the extraction sites within 15-20 seconds of removing the gauze. If excess bleeding continues, apply a gauze pad for an additional 30 minutes. If excessive bleeding persists, contact the 24hr office number.

Pain Management

Some amount of discomfort is to be expected following any surgery. If your doctor thinks that you will benefit from a prescription pain medication, you will receive a prescription following your surgery. Please follow the prescription instructions carefully.

  • Ibuprofen (such as Advil, Motrin) works very well for many patients and can significantly reduce the amount of narcotic pain medicine (Tylenol 3, Percocet) needed. You may find that taking 400-600mg of ibuprofen every 6 hours on a regular schedule for the first 2-3 days is all the pain medicine needed. If needed, you may take both the ibuprofen and the narcotic pain medication as prescribed for maximum pain management. Continue to take the pain medication as directed and as needed for pain relief. You can wean yourself off the pain medications if the pain is controlled. You may or may not need to take all the prescribed pain medications for this reason.
  • Begin taking your pain medications as directed as soon as you get home and before the local anesthetic (freezing) wears off. Your pain medication can be taken with liquids but it is important to get some soft food in your stomach as soon as possible. Take all subsequent doses along with food to minimize nausea.

Infection

If your doctor thinks that you will benefit from antibiotics to prevent infection, you may receive a prescription for one. If prescribed, take as directed. It is important to ensure you finish the full course of the antibiotic.

  • If you are experiencing nausea you may TEMPORARILY stop taking the antibiotic until the nausea subsides, however you must always restart and finish the antibiotics as directed.
  • If any medications cause hives or itching, discontinue them immediately and call the office.

Call our Office if you notice any signs of infection including:

  • Increased swelling after 5 days
  • Swelling that is painful, hard or hot
  • A foul taste or odour in your mouth
  • A temperature above 38°C

Swelling

Swelling around the mouth, eyes, and cheeks is a normal reaction to the surgery and usually takes 2-3 days to fully develop. To help prevent swelling:

  • Apply ice packs to the cheeks for 20 minutes on and 20 minutes off. Keep your head elevated for first 48 hours after surgery. Ice serves no purpose after 48 hours and may contribute to jaw stiffness.
  • Use crushed ice in a ziplock bag or a bag of frozen peas bag wrapped in a moist cloth to prevent frost bites.
  • After the first 5 days, you can begin using a heating pad or moist heat for relief of swelling, bruising, and stiffness of the jaw.
  • Apply heat 4 times/day for 30 minutes time intervals.
  • If your doctor thinks that you will benefit from it, you may have receive a prescription for a medication (Dexamethasone) to help with swelling. Take the medication as directed. Occasionally, this medication will cause some people to experience tingling in their hands and feet. If this happens, stop the medication and contact the office.

Diet

Try to resume a normal diet after the first 3 days. Initially you may feel more comfortable with a softer diet. Suggested foods are soups, noodles, scrambled eggs, pasta, pudding, yogurt, ice cream, juices, milkshakes, pancakes, anything soft that you can tolerate. Drink lots of fluids to rehydrate. Avoid hard, crunchy foods such as chips that may disturb surgery site for at least 3 days. No alcoholic beverages should be consumed for at least 24hrs post anaesthetic or as long as you are taking narcotic pain medications and antibiotics.

Nausea

You may experience some nausea which is common following a general anaesthetic/sedation. Frequent sips of carbonated drinks such as ginger ale, will usually help stop the nausea. Follow this with a clear diet, apple juice, clear tea, broths, and jello. If this is not effective you may use Gravol an over the counter medication and take it as prescribed. Discontinue your medications TEMPORARILY until the nausea subsides but always restart and finish them as directed.

Wound Care

If prescribed to you, use the Peridex (Chlorohexidine 0.12%) mouth rinse three times a day after brushing. Swish in your mouth for thirty seconds then spit it out. You may also rinse your mouth with a salt-water solution (1/2tsp salt in 1 cup of water) several times daily.

Sutures (Stitches)

Your sutures will dissolve on their own 10-14 days after surgery but they may come out at any time after surgery. You may notice that they loosen after the swelling of your gum tissue decrease. This is completely normal.

Resuming Activities

If you have undergone a general anesthetic, you should go home and rest for the remainder of the day. Do not drive or engage in strenuous activities (sports) for at least 48hrs. On average most patients will take 1-2 days off from normal activity. You may return to work/school when you feel you are recovered.

Wearing Your Prosthesis

Partial dentures, flippers or full dentures may or may not be used immediately after surgery. You will be advised by your doctor.

Smoking

Do not smoke for at least 3 days following surgery.

Brushing & Rinsing

The day of surgery you may brush your teeth, but try to avoid the surgical site for at least 3 days. Avoid rinsing, or spitting the day of surgery.

Straws

Do not use a straw for first 24hrs after surgery.

Temperature

A slight rise in temperature can occur for 24-48hrs after surgery and this is normal. If it continues beyond this time, please call the office (403) 235-0505.

Bone Chips

Occasionally small chips of bone may appear in the surgical site. This can happen anywhere from a few days to several weeks following the surgery. Usually they will eventually fall of by themselves . If they are causing you significant discomfort you can contact our office for an appointment.

Numb Lip and Chin

Lip numbness of the side in which the surgery was performed is known as “paresthesia” . It is most often a temporary condition that will correct itself. It can last a variable length of time. If it lasts greater than 3 weeks please notify the office.

Follow Up Appointments

Generally a follow up is needed 7-10 days after the surgery. The nurse will let you know if a follow up appointment is necessary and it will be scheduled for you. There is no additional charges for follow up visits.

Questions

Your well-being is our primary concern. It is our sincere desire that you experience be the least uncomfortable or anxiety provoking. Should you have any questions regarding your recovery, please do not hesitate to contact our office at (403) 235-0505.

Emergencies

If any unusual symptoms should occur please call our office at (403) 235-0505. If you are calling after our office hours or on the weekend, the answering machine will direct you to the oral surgeon on call. In the event of an unexpected admission to a hospital related to a treatment done at our facility, please make sure you notify us.

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