Post–operative instructions for: Bone augmentation

(Block augmentation (grafting) involving bone harvesting from another part of your mouth)


1.         General information: The site where a bone graft has been placed and harvested from will be sutured so that there is minimal space left for much bleeding to occur. However, a clot will still need to develop under the gum and trouble-free healing is dependent on this initially fragile clot remaining undisturbed as much as possible. Most augmentation sites heal with minimal trouble. Please keep turbulence in your mouth to a minimum for 24 hours after the surgery. For at least 8 hours after the surgery do not rinse, eat, gargle or touch the wound with your fingers or tongue. There is likely to be considerable swelling and possibly skin bruising both in the areas of the surgery and possibly extending to other areas of the face and neck as well. This is variable but normal and will clear up over the next 7-10 days. You may brush your other teeth normally that evening keeping away from the sutured wounds around the implants, but be aware that some bleeding may follow.


2.       Painkillers: You will benefit from taking an anti-inflammatory painkiller (such as Nurofen 400mg 6 hourly or Voltarol Retard 100mg 12-18 hourly) for the first 48 hours. If you are unable to take such non-steroidal anti-inflammatory drugs for medical reasons (e.g stomach or oesophageal ulcer or moderate to severe asthma), please take 1g of Paracetamol every 6 hours for 48 hours. This can be supplemented with dihydrocodeine 20mg if required (the combination of paracetamol and dihydrocodeine is available as Co-dydramol over the counter). Paracetamol or Co-dydramol can be used in addition to the anti-inflammatory painkillers if necessary for up to three days. You should not need to take this medication for more than 4-5 days. Please inform me if pain increases after 4 days as it may indicate that an infection has occurred and requires attention.


3.       The effect of the local anaesthetic will normally wear off after 2-6 hours depending on the site anaesthetised and the amount used. Occasionally it may persist for longer. Take great care not to bite or otherwise traumatise the numb site during this time. Do not attempt to drink hot fluids for at least 8 hours. The application of heat on the day of surgery will both encourage further bleeding and swelling and can locally scald the site without your being aware of it.

 4.    Please let me know the same evening if numbness persists for over 8 hours without diminishing.


5.       Bleeding: We will check that any bleeding has stopped before you leave the surgery. Be aware that movement, exertion, eating or drinking may re-start bleeding. (A small volume of blood will be present in your saliva as natural washout from the surgical site). You will be provided with sterile gauze when you leave the surgery. Please roll this into a tight bundle to use as a compress, moisten under a cold tap, wring out any excess water then place over the surgery site and press or bite down on the gauze firmly for at least 10 minutes by the clock. Ensure that the gauze is applying pressure to the wound and is not merely trapped between your other teeth. If there is further bleeding, repeat with a new pack. (If a temporary bridge exists over your graft apply firm pressure from the sides by pinching the gum between forefinger and thumb for 10 minutes). If you feel that the wound is bleeding beyond your control, or persisting into the night, please call me on my mobile. I would be grateful if this number is reserved for emergencies only.


6.     Swelling: There will be a variable amount of swelling depending on how much the soft tissues have needed to be manipulated during the procedure. Moderate swelling and skin bruising are normal and relatively common and usually reach a peak at the end of day 3-4. Occasionally, severe facial swelling my occur. Bruising extending to under the eye or down the neck towards the chest may also occur especially in the elderly. There is no need for any concern and this will clear albeit slowly. Please inform me immediately if swelling extends down the neck, causes breathing difficulties, causes the eye(s) to close or is associated with a high temperature over 37.5 degrees Celsius. Swelling can be minimised by keeping the head elevated during the night on an extra pillow or two. Please inform me on the surgery number during surgery hours or on the above mobile number outside surgery hours if the swelling is particularly painful, or has not started to subside by the end of the 5th day following surgery.


7.     Aftercare: I recommend that you do not plan any strenuous activity or swimming for at least 10 days after the bone grafting procedure. From the morning of the following day (or at least 8 hours after the last period of bleeding), start to carry out gentle hot salt-water mouth rinses every 3-4 hours. An antiseptic mouthwash such as Corsodyl will also be of help in limiting any infection and should be used at least twice a day in the morning and last thing at night. Antibiotics will normally be required after grafting surgery until the graft is incorporated into the body. A covering antibiotic will normally have been given to you prior to surgery. Antibiotics will nearly always be prescribed for you to take after a bone augmentation procedure would normally be one or two of the following:

·        Amoxicillin 500mg three times a day (every 8 hours) for 7 days

·        Clindamycin 150mg four times a day (every 6 hours) for 7 days if you are allergic to penicillin.

·        Metronidazole 400mg three times a day (every 8 hours) for 7 days.

It is important that you take and complete the antibiotic course(s) as prescribed. I would recommend daily supplements of “ friendly bacteria” by having a pot of bio yoghurt or one of the proprietary probiotic drinks available on the market


8.    Please inform me immediately if you have any kind of skin rash or swelling, persistent abdominal pain, vomiting, or bloody stools with any of these antibiotics on the surgery number during surgery hours or on the above mobile number outside surgery hours.


9.       Please also remember that a course of antibiotics will reduce the efficacy of the contraceptive pill. Please use an additional form of contraception during and for 3 days after the course of antibiotics


10.    Do not drink alcohol during your course of antibiotics.


11.  If sutures have been placed, they will usually need to be removed after 10-12 days. An appointment will be arranged for you before you leave the surgery. If sutures are left in for too long then they themselves may become a focus for future infection.


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