Bone Grafting Surgery

Postsurgical Instructions Bone Augmentation with General Anesthesia

Care of your mouth after surgery has an important effect on healing. Swelling, discomfort, restricted jaw function, and skin discoloration is to be expected. However, following these instructions closely will help to insure a rapid and uneventful recovery.

Sedation slows reflexes for 24 hours

The effect of the general anesthetic can make you lightheaded, dizzy, or faint if you get up too quickly. Sit for 1 minute before standing up. Move slowly and be aware that you may need to sit down immediately. Do not drive or operate machinery for 24 hours after sedation.

Pain Management Overview

Baseline Pain Control Regimen

• 650 mg Tylenol (Acetaminophen) 2 x 325 mg tablets 4 times per day. Breakfast, lunch, dinner, and right before bed. (Avoid Tylenol if you have been told not to take this medication or have liver failure)
• 200-600 mg Advil (Ibuprofen) 1-3 x 200mg tablets 4 times per day. Breakfast lunch, dinner, and right before bed. (Avoid ibuprofen if you have been told not to take this medication or if you have a history of stomach ulcers, kidney disease, or take a blood thinning medication)

If Additional Pain Control is Needed

• 2.5 – 5 mg Oxycodone ½ – 1 x tablet up to 4 times per day if needed for additional pain control.
• Do not stop taking the baseline pain control regimen if you need the oxycodone

Pain Management Philosophy and Science

• Postoperative pain control is of paramount importance to us and our patients after surgery. We want you to be as comfortable as possible as you recover from your surgery. When you return home and the local anesthesia (numbing medicine) wears off, you will transition to oral pain medications to assist in pain control. The goal of postoperative pain management is to use oral pain medications to reduce pain to a tolerable level while the body heals and reduces pain naturally overtime. This may result in a maximal oral medication regimen which can be progressively decreased over the recovery process.
• Modern medicine uses three common classes of medications to achieve this goal, Acetaminophen (e.g. Tylenol), Non-Steroidal Anti-Inflammatory Drugs (NSAID e.g. Ibuprofen/Advil), and opiates (e.g. Oxycodone). Each act on different pain pathways within the body which allows them to all work synergistically at the same time. Using different classes of pain medications allows us to maximize the potential benefits of any one class while minimizing their respective side effects. During the postoperative period we want to maximize your pain control while minimizing any potential side effects.
• All pain medicine should be used in an “as needed” fashion. If you are not in pain, you do not need to take pain medicine. However, the baseline pain control regimen outlined above can be more effective if taken on a “scheduled” basis, regularly spaced time intervals, during the postoperative period where significant pain is anticipated. The baseline pain control regimen is more effective if taken on a “scheduled” basis rather than waiting for significant pain before taking the pain medicine. This “scheduled” strategy allows you to maintain a constant level of pain control in your blood which ultimately results in more effective pain control. If you would like to take the baseline pain control regimen on a “scheduled” basis to maximize its effectiveness we recommend taking these medications ~ 4 times per day, convenient times for most patients are breakfast, lunch, dinner, and right before you go to bed. The baseline pain control regimen can be taken together as instructed above for up to 1 week without concern for significant side effects in a healthy patient. However, if you find yourself continuing to need a “scheduled” baseline pain control regimen after 1 week, please let us know so we can make sure that you are healing appropriately.
• Opiate derived pain medications, like oxycodone, have rightfully received a lot of attention in the media recently due to their addictive potential. While this class of medication can be addictive it is important to note that addiction occurs when these medications are used for prolonged durations for chronic pain, not for acute postoperative pain. As such, these medications are safe to use as prescribed for a short duration after your surgery. However, they have other side-effects as well such as nausea, constipation, and drowsiness which are undesirable. As a result, we still reserve this class of medication for as needed additional pain control if the baseline pain control regimen above is insufficient.
• We hope all our patients recover as painlessly as possible. However, recovering from surgery is typically uncomfortable. The strategies and philosophies outlined above will not make the recovery from surgery painless, but they should serve to reduce the pain to a tolerable level while the body heals and subsequently reduces pain naturally. If you ever feel that the pain is unbearable despite these medications, please let us know so we can make sure that you are healing appropriately.

Swelling

• First 72 hours with Limit Swelling Accumulation
  • Apply ice to limit accumulation of swelling. Change the ice every 60 minutes while awake. Do NOT sleep with ice on your face. (e.g. ice packs and head wrap provided, frozen peas/corn)
  • Take NSAIDs (Ibuprofen/Advil) if instructed as part of the baseline pain control regimen above
• After 72 hours with Promote Resolution of Swelling
  • Apply moist heat to promote drainage of swelling which has accumulated during initial healing phase. (e.g. clay heat packs sold in drug store, moist towel heated in microwave)
  • Elevate your head while sleeping and resting by using several pillows such that your head is above your heart.
• Bone Morphogenic Protein (BMP)
  • BMP signals your body to grow bone and is necessary in some difficult cases to achieve more predictable graft success. BMP also causes significant swelling. Ice can help, but it will not eliminate this swelling. Swelling from BMP does not peak until day 5 to 7 and may not resolve for 10 to 14 days. Do not be alarmed if your swelling persists for a longer period if BMP was used.

Swelling Management Philosophy And Science

• Swelling is a natural part of your body’s healing process. During the early phases of recovery from surgery tiny vessels called capillaries become increasingly porous resulting in fluid escaping and accumulating in your tissues. This accumulation of fluid allows for your body’s healing machinery to access the injured area. However, this typically results in undesirable tension and a reduction in range of motion of muscles in the area. Both of these things can contribute to postoperative pain and discomfort which is why we attempt to reduce postoperative swelling, although we will never eliminate it completely.
• Swelling is a natural part of your body’s healing process and typically begins hours after surgery ends and continues to increase over the next 48 to 72 hours. As a result, we expect the average patient to be the most swollen on ~ day 3 after surgery. During this period of increasing swelling we have two methods of reducing swelling, ice and NSAIDs (Ibuprofen/Advil). Ice causes constriction of the small vessels in the area which results in a reduction of the fluid that escapes and thereby reducing the accumulation of swelling. Ice should only be applied when a patient is awake because prolonged application of ice can result in burns. We recommend 20 minutes of ice application to the affected area and a 20 minute period to allow the tissue to recover, repeating this cycle while you are awake. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen/Advil reduce signaling pathways in your body which reduce pain mediators and the accumulation of swelling.
• We expect swelling to peak ~ 72 hours after surgery and then slowly dissipate. Swelling typically takes much longer to dissipate than to accumulate. During this period of swelling resolution we have two methods to reduce swelling, moist heat and elevation. Moist heat promotes dilation of the small vessels in the area and allows the body to recapture accumulated fluid and remove it from the affected area more efficiently. Moist heat should be warm, but not so hot that it causes discomfort. Moist heat can be applied using warmed heating pads available at most pharmacies or with a damp towel heated in the microwave for a short duration. Elevating the surgical area allows gravity to naturally pull swelling from the surgical site. During the day most patients naturally elevate their head, however, sleeping on several pillows such that the head remains elevated at night as well can further expedite the resolution of the swelling.
• Swelling is part of your body’s natural healing process and we cannot eliminate it entirely. Swelling typically peaks ~ 72 hours after surgery and can contribute to postoperative pain and reduced mobility while healing. We can reduce its accumulation and promote is resolution by implementing the strategies outlined above.

Protecting The Graft

Diet: During the first 2 weeks of healing the bone graft is extremely delicate. During this time, you should avoid foods that require chewing. Examples of foods you can eat without chewing include any liquid, smoothies, milkshakes, ice cream, yogurt, creamy soups, and anything you would like to put in a blender. After the first two weeks the graft is still much too weak to withstand chewing forces, but you can safely chew away from the graft, but you should be careful in this area for a full 3 months to give graft the best chance for success. Stay Plates, Flippers, and Temporary Prostheses: It is very important that these temporary devices do not put pressure on the grafted area when worn, or they will quickly destroy the graft. Often, after the grafting procedure the tissue that this prosthesis used to rest on has enlarged because of the underlying graft. If this is the case, the prosthesis will need to be adjusted or remade to use it safely. Do not wear the prosthesis until your surgeon has tried it in to check to make sure it is not impinging on the graft at your postoperative appointment.

Antibiotics

Mouth Rinse: Starting tomorrow you will gentle rinse with a topical antibiotic mouth rinse called Peridex twice a day, after you brush your teeth. Pills: You will also have a prescription for several days of antibiotic pills. After you pick these up at the pharmacy take them as directed on the bottle until they are gone.

Dental Routine

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth twice a day. However, be gentle around the implant site until the soft tissue in that area has healed, typically 2 weeks. The surgical site heals best next to clean teeth.

Sutures

The sutures in your mouth will dissolve on their own. This typically takes 7-14 days, however, if a suture comes out early it is not a problem. Leave the sutures alone if possible and they will take care of themselves. Often, they will come out when you are eating food and you will swallow them, that is not a problem.

Smoking

Smoking has been proven to directly decrease the rate sinus grafting success. You have invested a lot into your graft, avoid smoking to give it the best chance for success.

Activity

Mild activity is fine seven days after your surgery; see how you feel but don’t push yourself.

Allergic Reaction

If you develop hives or a rash, discontinue all medications and immediately contact our office.

Telephone Support 24/7: (650) 342-0213

Post-surgical follow-up is an important part of your care. We want you to have a successful and comfortable recovery. Please call the office if you have any questions or concerns about your procedure or postoperative healing.