Ridge Bone Graft Augmentation

Your bone graft augmentation is designed to reconstruct the horizontal or vertical aspect of the external aspect of your jawbone.  These grafts vary in their complexity.  These grafts are easily subject to be disrupted by surface pressure from eating on or touching the external surface of the graft site.  Surface disruption could cause the graft to fail.  To prevent problems with the graft healing properly, the patient must not eat on the graft area or touch the area with his finger or tongue for the entire healing period.

These grafts can easily get infected as they represent a opportune place for bacteria to grow.  This infection can be prevented by taking your antibiotics as indicated and by following our hygiene directions.  You may notice a “bump” on the outside or inside surface where the graft was placed.  This is normal and does not necessarily indicate the presence of infection.  Please do not play with or feel the bump- leave it alone. Do not sleep on this area as this could mechanically disturb the graft.

EARLY CARE AFTER SURGERY

On the Day of surgery, patients tend to do well if they follow this sequence:

  1. Control Bleeding First.
    1. Have the patient sit up and follow the directions given to you by our staff as to the proper technique if needed to stop bleeding.  Do not spit.  Apply ice packs immediately.
  2. Get something in your Stomach.
    1. A milkshake is suggested.
  3. Start Medications.
    1. If you have pain, start taking your pain medicine first and wait one hour to start the antibiotics.
    2. If you have no pain, start taking your antibiotic first and wait to start the pain medicine until pain is just starting to occur.

BLEEDING

You need to follow the specific directions you were given in the office to stop bleeding. Typically patients having this procedure do not bleed much but they do experience swelling. If you do not see blood coming out of the gum in the graft site do not use pressure gauzes as it will disturb the graft.

It is best if someone other than the patient can check for bleeding.   Use a flashlight and a spoon handle to gently retract the lip or cheek to see the area directly.  Please ignore bloodstain on the gauze as a sign of bleeding as it is likely to stain all day.  Do not be surprised if the patient cannot open very wide.  You only need partial opening to see if it is bleeding. You will only apply a gauze using the technique shown to you in the office if you can directly visualize blood coming from the wound.  If you are uncertain, leave the gauze out for an hour and then check again to see if no active bleeding into the area is occurring.  If there is no change in the amount of blood in the area, leave the gauze out.  If you are uncertain, please call our office.

A variable amount of bleeding is to be expected following surgery.  Slight bleeding, oozing, or redness in the saliva is not uncommon. To minimize further bleeding, sleep with your head elevated and do not sleep on the graft side.   If bleeding does not subside, call for further instructions.

It may be useful to place a towel on your pillow the night of surgery, as minor oozing may occur from the wound at night.

PAIN

Discomfort is usually strongest during the first 12-24 hours.  For severe pain, use the prescribed medication should be taken as directed.  For moderate pain, use Ibuprofen (Advil or Motrin -200mg. tablets).  Take 1-2 Ibuprofen every 3-4 hours.  Tylenol can be use as well as listed on the package. Most pain medications can upset the stomach, especially the prescription pain medicine and especially if the stomach is empty.  If general anesthesia was used and the stomach is empty, you can prevent an upset stomach by drinking a milkshake and taking the first dose of pain medication 30 minutes later.  What is even more effective is to eat bulky foods of some thickness (mashed potatoes, oatmeal, ground meats) at least one half hour before taking your medication
CAUTION – Do not drive, work or operate mechanical equipment after taking the prescription pain medication.  Also, do not mix alcohol and any pain medication (or antibiotic).
Please remember to:

  • Space different medicines at least one hour apart from each other
  • Eat food of some thickness one half hour before taking any medicine
  • Follow the frequency that is prescribed on each bottle
  • Pain medicines take the edge out of strong pain; they do not eliminate all pain sensation.
  • Avoid alcohol with any pain medication or antibiotics
  • You should not drive any vehicle or work if taking narcotic medications.  This does not apply with the anti-inflammatory pain pills.

The post-operative pain can vary considerably in different patients.  It is often worst in the first 72 hours, but occasionally it can become worse after this period.  The overall pattern to one’s pain should be that it tapers off as a general trend over 5-6 days, though the pain can vary some in any one day.  Exertional activities, exercise, and a “busy” lifestyle will tend to make the wounds “throb,” so please use common sense and minimize activities that irritate the area.

ANTIBIOTICS

Take your first dose of antibiotic one hour after taking the pain pills.  Continue to take this medication as prescribed and complete the entire dosage.
Please be aware that antibiotics may decrease the effectiveness of birth control pills.  Please ask your obstetrician if and how long after stopping the antibiotic you should use alternative birth control measures

SWELLING

Drs. Blecha and Jandali tries to use surgical techniques that prevent swelling.  Swelling of the jaw will occur after this surgery.  The swelling that occurs will be proportional to the surgery involved.  Swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon.  This is the body’s normal reaction to surgery and is a part of normal healing.  Swelling usually peaks by 72 hours.  The swelling that develops by 72 hours then takes one week or more to go down.

Your swelling can be reduced with the immediate use of ice packs.   Either ice packs or a Ziploc bag filled with ice and placed in a washcloth should be applied to the sides of the face where surgery was performed.  Use the ice in one half hour intervals (one half hour on, on half hour off) on the day of surgery and up to 72 hours.  After 96 hours, you can use warm, moist heat applications to the side of the face to help bring swelling down.

SMOKING

You should not smoke after surgery for 72 hours.  Smoking will hinder the wound and bone graft healing.  Thus you are best to not smoke at all.

DIET

There is real value in re-establishing your diet after oral surgery. You must not eat on the bone graft area.  This is best accomplished by taking one half of the normal bite size so that you can control where the food goes.

Once the bleeding is stopped we usually suggest a milk shake.  After that we recommend that our patients eat “bulky” food, as this consistency is important in preventing nausea and vomiting from out postoperative medications. If your jaw is stiff to open after your surgery, such stiffness may last for 5-6 days and chewing could be difficult.  Simply cut up bulky nutritious foods so you do not have to chew them. You must remember to not eat food in the surgical areas for the entire bone graft healing period as it can ruin the graft.

Examples of bulky foods include mashed potatoes, oatmeal, and ground-up meats.  Be creative.  Ask a family member to take bulky foods and chop them up so that you can feed yourself these foods with a spoon and swallow them without chewing.  You can eat bulky foods without having to chew them if you cut them up very finely.  You should also have 5-6 glasses of liquids per day to supplement the “bulky” foods.

Your jaw may be sore and stiff, but you must eat bulky foods to tolerate your medications and avoid nausea and vomiting.

NAUSEA AND VOMITING

The cause of postoperative nausea and vomiting tends to occur if the patient is not eating well and is taking postoperative medications, especially pain medications.

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke or seven-up. You should sip slowly until you finish the entire can. When the nausea subsides you can try to resume eating “bulky” foods.  If you can tolerate these “bulky foods”, you can slowly resume taking your medications.  It is often the narcotic pain medication that causes nausea.  Thus, you should minimize use of narcotic pain medications.  Should they be needed, please be slow to resume taking the narcotic pain medication and you should use a low dose to try to prevent further nausea.

ORAL HYGIENE

Do not rinse or spit for 24 hours.This tends to disturb the blood clot, open the wound and can prolong bleeding and slow healing. You may have a small amount of blood seepage in your mouth.    Saliva should be swallowed, even if slightly blood tinged.

Keeping your mouth clean after surgery is essential to reduce the risk of infection.  Start Gentle salt water rinses 24 hours following your procedure. Use one-half teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking five minutes to use the entire glassful.  Repeat as often as you like, but at least four to five times daily and always after eating for the next two weeks.
Do not brush the teeth in the area of surgery for 24 hours. When brushing, be very gentle. When expectorating, also be gentle.
REMEMBER: A clean wound heals better and faster.

ACTIVITY

Keep physical activities to a minimum immediately following surgery.  Exercise and active physical activity is not suggested until your swelling has gone down.  This could take several weeks.  Drs. Blecha and Jandali will tell you when exercise is appropriate for your case.   If there are questions, please talk to our staff before attempting to exercise.

DISCOLORATION

Discoloration of the skin often follows this surgery in and around the graft site. The development of black, blue, green, or yellow discoloration is due to blood seeping beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Warm moist heat applied to the area 72 hours after surgery may speed up the removal of the discoloration.

SORE THROAT / CORNERS OF THE MOUTH

A sore throat may develop from either the procedure or IV anesthesia. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.  Gargling with salt water will help this.

The corners of the mouth can be stretched from doing surgery inside the mouth and they may dry out and crack. Please keep the corners of the mouth moist with a lip balm or an ointment such as Vaseline.

WEARING YOUR PROSTHESIS OR NIGHT GUARD

Wearing temporary teeth (partial dentures, flippers, or full dentures) should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question.  Any type of prosthesis or night guard should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the graft.  If you have questions about the fit of your flipper, partial or complete denture, do not wear it until our office can see you.

POST-OPERATIVE PROBLEMS OR COMPLICATION

If you are suspicious that you are having a problem, please call the office to see Drs. Blecha and Jandali.

FINALLY

It is our desire that your recovery be as smooth and pleasant as possible.  Following these instructions will assist you, but if you have questions about your progress, please call the office.

Your bone graft augmentation is designed to reconstruct the horizontal or vertical aspect of the external aspect of your jawbone.  These grafts vary in their complexity.  These grafts are easily subject to be disrupted by surface pressure from eating on or touching the external surface of the graft site.  Surface disruption could cause the graft to fail.  To prevent problems with the graft healing properly, the patient must not eat on the graft area or touch the area with his finger or tongue for the entire healing period.

These grafts can easily get infected as they represent a opportune place for bacteria to grow.  This infection can be prevented by taking your antibiotics as indicated and by following our hygiene directions.  You may notice a “bump” on the outside or inside surface where the graft was placed.  This is normal and does not necessarily indicate the presence of infection.  Please do not play with or feel the bump- leave it alone. Do not sleep on this area as this could mechanically disturb the graft.