Sinus Bone Graft Augmentation

A sinus bone graft augmentation is designed to regain bone height that has been lost in the area of your first or second molar (and occasional second premolar). This procedure is just as important as the placement of the implant. Without the bone graft, the area could not hold the implant due to insufficient bone height. When the bone shrinks and the sinus enlarges, there is not enough foundation to hold the implant in place.

The graft usually consists of a combination of different grafting materials and growth factors. It is important to understand that the graft is very delicate. Great care needs to be taken during the recovery time to avoid disturbing the graft.

DO NOT, UNDER ANY CIRCUMSTANCES: FOR THE NEXT 8 WEEKS, YOU SHOULD NOT BLOW YOUR NOSE OR DRINK THROUGH A STRAW.

This time frame might be longer, as indicated by the doctor. If anything causes suction or pressure in the mouth or nose, it can disrupt the graft. Avoid “bearing down,” which is common when lifting heavy objects, blowing up balloons, playing wind instruments, or any other activity that increases oral or nasal pressure.

If you need to sneeze, keep the mouth open while sneezing. Do not spit. Flying in an airplane and scuba diving can increase sinus pressure, so these activities should be avoided.

The use of a decongestant, such as Zyrtec-D, might be recommended by your doctor to reduce sinus pressure. You might also need to use nasal saline drops: 2–3 drops per nostril, 4 times per day.

Do not smoke because it will ruin the result of this treatment. Stop smoking at least 30 days before the surgery, and do not resume during the recovery time. If needed, talk to the doctor for assistance with programs and medications to help with smoking cessation.

Early Care After Surgery

On the day of the surgery, patients have the best results when following this sequence:

  • Control Bleeding First: The patient should stay in a sitting position and bite on gauze until the bleeding stops. Do not spit. Apply ice packs to the affected areas immediately.
  • Eat Something: Getting something in the stomach is important. A milkshake is suggested.
  • Start Medications: If the patient is experiencing pain, then the pain medication should be taken first, followed by the antibiotic an hour later. If the patient is not experiencing pain, then the antibiotic should be taken first, with the use of pain medication when the pain is starting to occur.

Bleeding

Apply moistened sterile gauze (a thumb-size roll) between your molar teeth and the cheek near the surgical area. Then, place an icepack on the outside of the cheek and apply consistent, moderate-light pressure. Do not move the ice pack or talk, because the movement might provoke bleeding.

Even when the above techniques are used properly, it may take as long as 3 to 4 hours for the bleeding to stop.

Ignore bloodstain on the gauze as a sign of bleeding. Ideally, someone other than the patient should check for bleeding and help with the gauze application. At the end of each hour, the gauze should be removed and the wound needs to be checked for further bleeding. Look at the wound directly for 20–30 seconds, using a flashlight and spoon handle (as a retractor) if needed. Don’t be surprised if the patient can’t open wide. A partial opening should be sufficient for you to see if it is bleeding.

If you see “jelly clots” (blood clots) on adjacent teeth, then they should be wiped off. This might stimulate some bleeding but is the correct care for the wound. These clots form when the gauze does not seal off the gum opening. Blood seeps outside of the wound and clots on nearby teeth and tissues.

If you see blood coming from the wound directly, then a new pressure gauze should be placed as described above with light ice pack pressure. Check the wound again after an hour to see if the bleeding has improved.

Variable bleeding is expected after oral surgery, with blood in the mouth or even the nose. The nose can be wiped, but you should not blow the nose. It is not uncommon to experience oozing, slight bleeding, or redness in the saliva. If the bleeding doesn’t stop, then please call our office.

For best results, sleep with the head elevated and avoid exercise for at least 10 days. Consider placing a towel to cover your pillow the night of the surgery. Minor oozing and drooling might occur while sleeping.

Pain

The first 12–24 hours are usually when the most discomfort is experienced. Severe pain can be treated using the prescribed medications, taken as directed. Moderate pain can be treated using ibuprofen (Advil or Motrin: 200mg tablets, taken every 3–4 hours). Tylenol can be used as well, following the dosage recommendations as listed on the package.

Keep in mind that most pain medications can cause an upset stomach. The risk of stomach discomfort is highest when medication is taken on an empty stomach and prescription pain medication is used. If general anesthesia was used and the stomach is empty, then it is best to drink a milkshake followed by the first dose of medication 30 minutes later. A more effective option is to eat something soft and bulky (mashed potatoes, oatmeal, ground meat, etc.) 30 minutes before the medication.

Important Medication Reminders

CAUTION: Patients should not drive or operate mechanical equipment when using prescription pain medication. Also, alcohol should not be mixed with any type of pain medication (over-the-counter or prescription). Do not mix alcohol with antibiotics.

  • Different medications should be spaced at least an hour apart from each other
  • Eat food with some thickness 30 minutes before taking medication
  • Always follow the dosage and frequency prescribed on each bottle
  • Pain medications are beneficial to take the edge off of strong pain, but they do not eliminate all pain
  • Avoid alcohol when using pain medication and/or antibiotics This does not apply if you are using anti-inflammatory pills.
  • If taking narcotic medications, you should not work or drive a vehicle

Postoperative pain varies between patients. The worst pain is usually experienced in the first 72 hours, but some people experience a worsening of pain after the first few days. The overall trend is that pain should taper off within 5–6 days, although it is common to experience pain variations from one day to the next.

Exercise, strenuous activities, or following a “busy” lifestyle tends to cause a throbbing sensation in the wound. Use common sense and minimize activities if you find the pain or discomfort intensifies.

Antibiotics

If you have been prescribed antibiotics, then the first dosage should be taken 1 hour after taking pain medication. Continue using this medication as prescribed until the entire prescription has been finished.

Be aware that antibiotics might decrease the effectiveness of other medications, such as birth control pills. Talk to your obstetrician to know how long alternative birth control methods should be used after stopping the antibiotic.

Other Medications

The doctor might recommend that you use Zyrtec or Zyrtec D on the evening of the surgery, and continue the use of this medication for two weeks (following dosage and frequency recommendations on the package).

Nasal saline drops can be used, starting 24 hours after surgery. Place 2 – 3 drops in each nostril, 4 times per day. For example, use the drops after meals and again at bedtime.

Swelling

Drs. Blecha and Jandali use the best surgical techniques to minimize and prevent swelling whenever possible. But the swelling that occurs will be proportional to the procedure. It is common for patients to experience swelling around the cheeks, mouth, eyes, and sides of the face. This reaction is expected and a normal part of the healing process. Usually, the swelling peaks within 72 hours, then will take 5–6 days to subside.

Ice packs can be used for swelling reduction. If you don’t have ice packs, homemade packs can be created using a Ziploc bag filled with ice. All ice packs should be wrapped in a dry washcloth or hand towel before applying the pack on the sides of the face.

Ice can be used in 30-minute intervals: 30 minutes on, 30 minutes off. Start the ice pack treatment on the day of the surgery and continue as needed – up to 72 hours after the surgery. After 72 hours, you can bring the swelling down by placing moist, warm, heat applications on the sides of the face.

Smoking

Smoking will ruin the result of this surgery, so it is strictly forbidden. Do no smoke during the recovery time. If needed, contact our office for medications and resources to help with smoking cessation.

Diet

Reestablishing your diet after oral surgery is beneficial to promote healing. Chewing might be difficult in the first 5–6 days if your jaw is stiff and difficult to open.

When the bleeding stops, we recommend a milkshake. Next, patients can move on to soft, bulky foods, such as oatmeal, mashed potatoes, and ground meat. These ingredients are important in preventing vomiting and nausea from the use of medications.

Ask a family member to chop up the foods into small enough pieces so you can eat them with a spoon and swallow without chewing. Drink 5–6 glasses of liquid per day to supplement the bulky foods.

Even if your jaw is stiff and sore, you must be consistent with eating bulky foods so your stomach can tolerate your medications.

Nausea and Vomiting

The risk of postoperative nausea and vomiting is highest when the patient isn’t eating well and is taking postoperative medications. Pain medications are commonly the cause of stomach upset.

If nausea and/or vomiting is experienced after the surgery, then don’t eat or take anything by mouth for an hour (including prescribed medications). Slowly sip on a Sprite or Coke for 15 minutes.

When the nausea subsides, try to eat bulky foods (as listed above). If these foods are tolerated, then you can try to resume the use of medications once again. Usually, the narcotic pain medication is the cause of nausea. If these prescriptions are needed for pain management, be slow in resuming the use of the prescription and try taking a lower dose to minimize nausea.

Oral Hygiene

Do not rinse the mouth, brush your teeth, or spit for 24 hours after surgery. These activities can disturb the blood clot and cause the wound to re-open, which slows healing and prolongs bleeding. You might notice a small amount of blood seepage from the nose into the mouth. The saliva can be swallowed, even if it is slightly tinged with blood. If you notice blood draining from the nose, wipe the nose (don’t blow the nose).

After 24 hours, you can start using salt-water rinses. Mix 1/2 teaspoon salt in a glass of warm water, then gently “swish” to clean the mouth. For the next two weeks, repeat at least 4 – 5 times per day, or as often as you would like.

The teeth near the surgical area should not be brushed for 24 hours. Then be careful to avoid the wound; gently brush the surrounding teeth. Also be careful to avoid pressure and movement of the wound when spitting.

REMEMBER: A clean wound heals better and faster.

Activity

Immediately following surgery, physical activities should be kept to a minimum. Avoid exercise for 5–6 days. Strenuous activities can result in throbbing or bleeding. If these problems occur, then you should discontinue the activity.

During this recovery time, your normal caloric intake may be reduced because it is difficult to eat. As a result, exercise may weaken you. If you are feeling light-headed, then stop exercising. Be careful to ease your way back into an exercise routine to avoid complications for your recovery.

Discoloration

Some patients experience skin discoloration after surgery. When the blood spreads beneath the tissues, it can cause the development of green, blue, black, or yellow discoloration. This postoperative discoloration is normal, and usually shows up 2 or 3 days after surgery. Moist heat can be applied to the area to speed up the healing and fade the discoloration.

Sore Throat & Corners of the Mouth

The IV anesthesia or extractions can cause the development of a sore throat. The throat muscles are near the surgical site, and it can cause pain when these muscles swell. This pain is normal and should subside in 2–3 days. Saltwater gargling can help to reduce the pain.

During the surgery, the corners of the mouth can be stretched – causing them to crack and dry out. This discomfort can be managed by applying lip balm or an ointment (such as Vaseline) to keep the corners of the mouth moist.

Wearing Your Prosthesis

Unless instructed otherwise, partial dentures, flippers, or full dentures should not be used between the surgery and your post-operative appointment. If you have questions about using your prosthesis, please contact our office.

Any type of night guard or prosthesis should not touch the gums in the surgical area. If this contact occurs, it can result in ulceration of the wound edges, which can break down the suture margins – and ultimately lead to the loss of the graft. Use caution and talk to the doctor if you have any concerns about the fit of the prosthesis or night guard.

Post-Operative Complications

As with any surgical procedure, there is a risk of postoperative complications or problems. Please contact our office immediately if you notice:

  • An unexpected flow of liquid or air between your nose and mouth
  • Small particles of graft material that are discharged from the mouth or nose
  • Severe nasal or sinus congestion on the surgical side
  • Increased swelling in the cheek, mouth, or under the eye. Swelling usually peaks 72 hours after surgery, then will start to subside. Contact us if the swelling increases after 5 or 6 days.

We want to help you with a smooth, comfortable recovery. These instructions are designed to support your healing and minimize the risk of complications. If you have questions about your progress, then you shouldn’t hesitate to contact our office for information.