Bone augmentation a4 aug 2012

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 dependant 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 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 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 Voltoral
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. 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 sinus lift 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 tap, wring without 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 teeth. If there is further bleeding, repeat with a new pack. (If a temporary bridge exists over your graft
apply pressure from the sides by pinching the gum between the fore finger and thumb for 10 minutes). It is also common to
have occasional nosebleeds for 3 days after the procedure. Again, this is normal and will be self-limiting. Sit with your head
between your knees whilst pinching the mid-portion of your nose until the bleeding stops. Take care not to exhale against a
pinched nose and thus raise pressure in the sinus. If you feel that there is persistent bleeding beyond your
control, or persisting into the night, please call the surgery.
6. Swelling: There may be considerable swelling depending on how much the soft tissues have needed to be manipulated
during the procedure. Moderate swelling and skin bruising are normal relatively common and usually reach a peak at the end
of day 3.
Occasionally severe facial swelling may occur. Bruising extending under the eye or down the neck towards the chest may also
occur especially elderly. There is no need for any concern and this will clear slowly. Please inform me immediately if
swelling extends down the neck, causes breathing difficulties, causes the eyes(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 10days after the sinus
augmentation. From the morning of the following day ( or at least 8hours 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. 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 ( 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 pro-biotic drinks available on the market

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