After Bone Grafting

After Bone graft surgery, do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gingival (gum) tissue.

Bleeding

Avoid Vigorous Rinsing: Do not rinse your mouth vigorously or touch the surgical area. This may initiate bleeding by causing the blood clot that has formed to become dislodged. Do NOT SWISH LIQUIDS OR RINSE WITH ANY PRESSURE AT ALL FOR 1 WEEK AFTER SURGERY. Instead, roll warm salt water back & forth with your mouth open and your head tilted back, then lean over the sink to allow the water to fall out of your mouth, then dry your mouth with a towel…do not spit.

Slight bleeding, oozing, or redness in your saliva is to be expected following surgery. If bleeding becomes excessive, rinse or gently wipe away any old clots from your mouth, then place a MOISTENED gauze pad over the area and bite down firmly for 30 minutes. Repeat if necessary. If bleeding continues, bite on a moistened caffeinated black tea bag for 30 minutes. The caffeine &  tannic acid in the tea helps form a clot by constricting blood vessels. To reduce further bleeding, remain calm, sit upright, and avoid any physical activity. If bleeding persists, or continues profusely, please call our office for further instructions. 

Swelling

Swelling is a normal response to surgery and is usually proportional to the extent of the procedure. You can expect swelling around the mouth, cheeks, eyes, and sides of the face. This swelling will typically become noticeable the day after surgery and will peak 2-3 days post-operation. To minimize swelling, apply ice packs or frozen unopened peas or corn immediately after surgery. Ice packs should be placed on the sides of your face where the surgery was performed and should be alternated on for 20 minutes then off for 10 minutes continually while awake for the first 24 hours. After 24 hours, ice no longer provides any benefit. If swelling or jaw stiffness persists for several days, there is no cause for concern—this is a typical part of the healing process. After 24 hours, applying moist heat to the sides of your face can help reduce swelling. Take Pain Medications as prescribed. If you choose to take narcotic pain medication do not operate machinery or drive a vehicle for 8 hours.

Diet

Drink plenty of fluids and avoid hot liquids or foods. Soft foods and liquids should be consumed on the day of surgery. You can return to a normal diet as soon as you are comfortable, unless otherwise directed. DO NOT CHEW ON THE GRAFTED AREAS UNDER ANY CIRCUMSTANCES FOR 4 MONTHS. IF YOU DO, THE GRAFT WILL FAIL AND WILL NEED TO BE REMOVED AND REDONE. 

As bone cells migrate into the bone graft, they attach and calcify. This process must occur without disturbance. If force is applied to the grafted area during this critical healing phase, the bone bonds will break and turn into scar tissue. The more scar tissue that forms, the less effective the graft will be.

To ensure the bone graft heals properly and lasts as long as possible, do not chew, push, touch, tap, or disturb the grafted areas or the surrounding gum tissue in any way. Even gentle pressure can negatively impact the healing process or cause the graft to fail.

If you will be using a temporary prosthetic device during the healing process, do not wear or attempt to try it in until Dr. Gadler has examined it and, if needed, adjusted it to sit passively over the bone graft. Failure to comply with this could almost certainly result in graft failure. 

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol can be taken every 4-6 hours. Alternatively, Ibuprofen (Advil or Motrin) may be used instead of Tylenol. Over-the-counter Ibuprofen typically comes in 200 mg tablets; 2-3 tablets can be taken up to four times daily, with a maximum daily dose of 3200 mg for adults. Please consult our practice for guidance on usage for individuals under 18.

If the pain is significant, you can alternate between Tylenol and Ibuprofen. Start by taking one Extra Strength Tylenol, then wait 3 hours before taking 600 mg of Ibuprofen (Advil or Motrin). After another 3 hours, take another Tylenol, then wait another 3 hours before taking 600 mg of Ibuprofen again. Repeat this cycle until the pain subsides or becomes tolerable without medication.

For severe pain, take the prescribed narcotic medication as directed. Do not take any of the above medications if you are allergic to them or have been instructed by your doctor not to take them. Avoid driving, operating machinery, or consuming alcohol while on medication. Pain or discomfort following surgery should gradually improve each day. If the pain persists, it may require further attention, and you should contact our office.

Antibiotics

If you have been prescribed antibiotics, take the tablets or liquid as directed. Antibiotics are given to help prevent infection. If you develop a rash or experience any other adverse reactions, discontinue antibiotic use and contact our office immediately. If you have any questions, please call the office.

Oral Hygiene

Good oral hygiene is essential for proper healing. On the night of surgery, very gently and without swishing or applying pressure, use the salt water rinse before bed. The day after surgery, use the salt water rinse twice daily: after breakfast and before bed. Be sure to rinse gently for at least 30 seconds, then spit it out. Warm salt water rinses (1 teaspoon of salt in 1 cup of warm water) should be used at least 4-5 times a day, especially after meals.

Brush your teeth as normal, but completely avoid the grafted areas and do not disturb the sutures. Be very gentle when brushing the surgical areas. Excessive pressure on the graft or surrounding areas can cause the bone graft to fail.

Sometimes, very small amounts of bone graft material may come loose, and you might feel small, sand-like gritty pieces in your mouth, especially in the first few weeks after the grafting procedure. A small amount is normal as Dr. Gadler overpacks the sites with graft material to compensate for any minimal loss. However, if you feel a large amount of gritty material, this likely indicates that you are rinsing too vigorously, chewing on the area, or doing something that you should not be doing to the area. Call our office immediately if this occurs.

During the healing process of bone grafts, never use a Waterpik or electric toothbrush on the surgical sites, bone grafts, or anywhere near them. These actions will cause the grafts to fail.

Upper Bone Grafts: Frequently, when teeth are removed, the roots of the upper molar and bicuspid teeth protrude into the sinus floor. If upper molar or bicuspid bone grafts were placed, and the teeth they replaced had roots within the sinus, it’s possible that the bone graft may engage the sinus floor, effectively closing it off from exposure to the mouth.

In cases where upper bone grafts were placed into either healed areas or extracted tooth sites, the grafts may have been placed to raise the bone height by adding graft material to the lower 1/3 of the sinus floor, also known as a Sinus Lift procedure.

If you’ve had upper bone grafting, especially in the back of your mouth, do not blow your nose, travel to high elevations, bend over for extended periods, or cover a sneeze with pressure (instead, sneeze into a jacket, shirt, towel, or the inside of your elbow). Do NOT rinse vigorously, and avoid applying any pressure during rinsing.

For the next 4 months, do not put any air pressure into your mouth as this can create a hole in the sinus and lead to the failure of the entire procedure. DO NOT USE A WaterPik or electric toothbrush around the graft sites—these will cause failure.

Activity

Keep physical activities to a minimum immediately following surgery. Exercise may lead to throbbing or bleeding, in which case you should stop exercising. Also, remember that you are likely not consuming your usual nourishment, which may weaken you and further limit your ability to exercise.

Wearing your Prosthesis

Partial dentures, flippers, or full dentures should NOT be used immediately after surgery for at least 10 days, as discussed during your pre-operative consultation. If you will be using a temporary prosthetic device during bone graft healing, do not wear or attempt to insert it until Dr. Gadler has examined it and, if necessary, made adjustments to ensure it sits passively over the grafted sites. Failure to comply with this instruction will almost always result in the bone graft failing.