POST-OP INSTRUCTIONS Socket Preservation Bone Grafting

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NOTE: Where conflicting information may be noted, these instructions supersede all other instructions.

Hey, where’s the gauze?!

There is no gauze! We intentionally did NOT place gauze over your graft site. This was very intentional and not a mistake or oversight. We do NOT want you to use gauze on your bone graft site. Why? Because your graft site is delicate and can be irreparably harmed by gauze going on and off of the site. DO NOT PUT GAUZE ON YOUR GRAFT SITE!

So what do I do if it’s bleeding?

If it is oozing blood, please do the following: (a) Sit and relax; keep your heart rate low. (b) Use iced compresses to your face. (c) Sip icy-cool liquids. (d) Minimize talking as motion at the surgery site may prolong oozing. If the oozing doesn’t slow to a small trickle after 1 hour of following the above instructions, please contact our office.

I have this bad taste coming from my graft. What is that?

We have infused your graft with antibiotics. We do this so that any bacteria left in the site prior to the graft, or any bacteria that may try to get in to the site, will encounter the antibiotic and die. This is done as a preventative measure to help keep your graft from becoming infected. The antibiotic may slowly leach out and give you a bad taste. If this happens, gently rinse your mouth with salt water.

What is this weird thing I just pulled out of my mouth? Is this a graft particle? Is my graft failing?

Your graft is comprised of hundreds and hundreds (possibly thousands) of very small bone graft particles. They are condensed tightly into the surgery site. The particles closest to the surface of the graft are the least tightly packed (they have nothing above them but membrane!). It is common, NORMAL, and even expected that your graft may exfoliate 2, 3, or 4 particles here and there. These are particles that have not been incorporated into the main, clotted body of the graft. If they did not exfoliate, they would become trapped in the gum tissue as it heals. So it is actually desirable for those loose particles to come out. If you notice a significant number of graft particles all at once (i.e. “it feels like there’s a pile of sand in my mouth…”) please contact our office.

What do I do with the rinses that I have?

For the first 48 hours after your graft has been placed, please rinse with salt water only! Rinses should be done after meals and before bed. Do not use the prescription rinses for the first 48 hours. AFTER the first 48 hours, please resume (or start) using your prescription rinses. Remember, always do the blue rinse first.

What about brushing?

Wait 24 hours after surgery to brush your teeth (yes, all of them)! After the first 24 hours, you may brush your teeth, but DO NOT BRUSH near your surgery site until 48 hours after the surgery. When you do brush your teeth near the surgery site, stay on the tops of the nearby teeth and DO NOT BRUSH YOUR actual surgery site. Let the mouth rinses accomplish the cleansing of the site.

What about flossing?

Don’t floss the site. Don’t WaterPik the site.

I have an irrigating syringe. Should I use it on my graft site?

NO. Do NOT use an irrigating syringe on your graft site. Let the mouth rinses accomplish the cleansing of the site.

How do I know if my graft is infected?

It is very rare for these grafts to actually become infected. Signs of infection include REDDISH swelling of the tissues beyond normal post-operative swelling ACCOMPANIED BY NEW PAIN. If you’re experiencing these symptoms (especially if it’s post-operative day 5 or later), please call our office.

These stitches are annoying.

Yes, they can be annoying. But the stitches are important to providing initial integrity to your graft. Please be careful with them.

What if I think the stitches are loose?

Minor loosening of the stitches is normal as the initial post-operative swelling in the tissues subsides. Big loops of stitch flopping around in your mouth should be trimmed. If you are experiencing this, please contact our office.

What is the best thing I can do to take care of my graft?

BE VERY CAREFUL AND GENTLE WITH YOUR GRAFT! These bone grafts take several weeks to heal to a point where they are resilient. Until that time, the grafts are fragile and delicate! It’s very important that you try as much as possible to give your graft TLC. This means try not to eat on the side of your graft. Also, try to stick to “soft” foods (i.e. anything you can easily squish through tines of a fork) so that if you do happen to chew near the site it won’t be damaged by the soft food. Remember! All of the hard work can be undone by an errant vein of salad or wayward tortilla chip!

What is the follow-up for my graft?

1) Follow-up at 2 weeks for suture removal. We’ll discuss next steps in home care.
(2) Follow-up at 6 weeks for a gingival healing check. At this appointment, your gums should be mostly healed over the graft site and it is generally safe to resume normal diet and cleansing without worry of damaging the graft.
(3) Follow-up at 3 months. At this appointment we’ll verify that the graft has taken using x-rays. If your treatment plan includes an implant(s), we will plan out your implant(s) and review timing, healing, costs, etc.

What is the purpose of the graft again?

(1) Grafts prevent atrophy! Without the graft, the body realizes that there is no more tooth to support and the body begins taking away any remaining bone that held the tooth. This results in bone loss (i.e. atrophy) at the extraction site. The bone loss occurs both in the vertical direction AND in the horizontal direction. This bone loss makes any future restoration attempts (implants, bridges, etc.) significantly more difficult! The presence of a bone graft prevents this natural atrophy process from occurring.

(2) Grafts provide a solid foundation. By grafting a site, we effectively are providing a solid foundation for any future restorative attempt. Implants that are placed in an extracted socket are much more predictably successful, both at the time of surgery and for the long-term health of the implant.

(3) Grafts “hold your place in line.” With a successful bone graft, you are in control of when you decide to replace a missing tooth with an implant. Typically, implants can be placed as early as 3 months after a graft. However, if it fits your situation better, you can wait with confidence because the bone graft will stay stable in place. Then you can choose to place an implant 9 months later, or 2 years later, or never, if you so choose. And you won’t have to worry about atrophy occurring at the site.

(4) Grafts prevent tipping of nearby teeth into the space of the missing tooth.

(5) An ancillary benefit of a bone graft is that they convert an “open” wound (i.e. tooth socket) into a “closed” wound system, which typically makes extraction sites much more comfortable during healing. Although this is not a main reason for having a graft, it is a nice benefit.