Bone Grafting

Periodontist in St. Louis, Missouri

The Procedure

A dental bone graft adds volume and density to your jaw in areas where bone loss has occurred. The bone graft material may be taken from your own body (autogenous), or it may be purchased from a human tissue bank (allograft) or an animal tissue bank (xenograft). Once the bone graft has been placed, it holds space for your own body to do the repair work. In other words, a dental bone graft is like a scaffold on which your own bone tissue can grow and regenerate.

Presurgical Instructions

Please arrive at the office at least 20 minutes prior to your surgical appointment to make any final arrangements prior to the procedure.

Please don’t apply makeup and lipstick around the mouth. If a cleaning is due, it is ideal to have it done within a week prior to the procedure and brush your teeth immediately prior to the appointment is advised.

Take your medications as advised. If taking blood thinners, some aspirins, or fish oil prescriptions, we will contact your Prescribing Doctor for their recommendation on modification. We will inform you of their recommendations before surgery. If you have any questions about your prescriptions, please contact us.

Bone Grafting

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If advised, begin taking pain reliever about 24 hours in advance (600-800mg of Ibuprofen or 1000 mg of Tylenol typically for an adult and 200-400mg of Ibuprofen for a child; this was discussed in your pre-surgical appointment).

The over-the-counter ibuprofen comes in 200mg tablets and over the counter extra strength Tylenol comes in 500mg tablets, so please take the appropriate number as listed above for them to be effective.

For patients who require antibiotic prophylaxis for previous joint replacement, or heart conditions, please take your premed 1-hour prior to the dental surgery.

If you are having IV sedation, please take 2 hours prior to your surgery with the 2 glasses of water we advocate taking. DO NOT CONTINUE TO DRINK WATER UP UNTIL YOUR SURGERY.

If you are having IV sedation, please take the Ibuprofen and antibiotic right after the surgery.

If Sinecch TM/Arnica Montana was recommended/prescribed for those who bruise easily or are having a more extensive procedure done. Please begin taking Sinecch TM as it’s recommended, 1-24 hours prior to the procedure.

No alcohol 24 hours prior to procedure.

It is strongly advised to abstain from smoking ideally 3 months prior and at least 3 weeks after a bone grafting procedure. This helps to greatly reduce post-surgical infections and delay in soft tissue healing.

Continued abstinence of smoking throughout the months afterwards is likely to assist in bone formation.

Periodontal Post-Surgical Instructions

Wearing Nightguard

If there isn’t any surgical dressing obstructing the use of wearing your

nightguard please do so starting day one after your procedure.

Care of The Mouth

Normal brushing and flossing following the procedure should be followed throughout the mouth except in the area where surgery was performed. It is important to maintain a high level of oral hygiene care after periodontal surgery. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.

Oral Hygiene at the Surgical Site

• Do not brush, floss, or otherwise disturb the surgical area during the first week or longer if instructed.

● Beginning 24 hours after surgery, rinse GENTLY with the prescribed mouth rinse (Chlorohexidine/Peridex/ClosysTM) 2 times a day (after breakfast and before bed) for at least 30 seconds. No eating, drinking or rinsing should be done for 30 minutes after the oral rinse is used. This rinse is continued for at least the following 10 days after the procedure. You may also consider using throughout the day a warm salt-water mixture (1/2 teaspoon of salt into 6-8 oz. of warm water) 3-4 times per day for the first couple of weeks.

Pain

It is normal for there to be varying amounts of discomfort for 1-6 days after surgery. How much pain and how long it lasts depends on the extensiveness of surgery done, how long it took, and your unique response to it. Everyone differs in his or her perception of, and response to pain; the pain medication may not eliminate all pain but should make you reasonably comfortable. It is not routine to require narcotics.

• For mild discomfort, alternate 600-800mg of Ibuprofen and 1000mg of Tylenol every 3 hours.

For severe discomfort, take 800mg of Ibuprofen and 1000mg of Tylenol at the same time, every 6 hours. If this regiment isn’t managing your pain control, please give us a call.

Bleeding

It is normal to have some oozing for 2-3 days. To prevent excessive bleeding follow these steps: If advised, Ceasing/modifying your blood thinner/aspirin/fish oil at the recommended time prior

to surgery should have occurred. (If you have any questions concerning this, please call the office).

Don’t spit, rinse, or use a straw for at least 24 hours after the surgery.

• Avoid strenuous activity for 2 days.

• It is recommended to place a towel over your pillow and keep your head slightly elevated for the first 3 days.

• If you notice continued heavy bleeding, apply biting/thumb pressure with a clean, dampened, rolled-up gauze/tea bag/paper towel directly to the area for 40 continuous minutes.

• If these attempts are unsuccessful and the bleeding is excessive, please call us.

Swelling

• Gently apply an ice pack to the side(s) of your face over the surgical area for 10-15 minutes per hour during the first 24-48 hours after surgery.

• Keep your head elevated at night to reduce the swelling.

• Bruising may occur depending on the type and extent of surgery that was performed.

• Minimize the heat of your food for the next 24-48 hours to slightly warm to help with swelling.

• After 48 hours, if still swollen, a moist heated washcloth or heating pad applied to the site will then be effective.

• Swelling typically peaks on the third day and then slowly begins to reduce from there forward. This is also why Ibuprofen/ anti inflammatory is advised to continue to be taken for the first 4-5

days after the surgery.

• Depending on the area and the extensiveness of the procedure, a short length prescription of steroids may have been given. Please take these to completion.

• Sineech TM/Arnica Montana is recommended for those that are expected to bruise easily or are having a more extensive procedure done. Please begin the Sineech TM as its recommended to begin 1-24 hours prior to the procedure.

Diet

For the first 24 hours, restrict your diet to cool soft foods and liquids(ie. milk shakes, ice cream, instant breakfast drinks, junior baby food, Ensure, yogurt, cottage cheese, pudding, jello, applesauce, etc.)

• For the first 3-4 days, avoid Spicy foods, citrus, alcohol.

• After 24 hours warm, soft foods can be introduced.

• Then for the 2-4 weeks, continue with warm softer foods (ie. Pastas, soups, well cooked chicken, fish, omelets, mashed/baked potatoes, tuna noodle casseroles, meat loaf and well-cooked vegetables, etc.) and continue to avoid chewing on the surgical side.

• Avoid eating crunchy, chewy foods, along with popcorn and peanuts for at least 3-4 weeks after surgery.

• No tobacco products (cigarettes, chewing tobacco, snuff, etc.) for at least 3 weeks after.

By four weeks, unless otherwise advised, you are usually able to eat without any restrictions.

Medications

Take your medications for blood pressure, heart, anxiety asthma/lung the day of your procedure. If you are having iv conscious sedation, then take them with enough water to get the medication down (less than 3oz.) Bring your inhalers with you. If you are diabetic and having iv sedation, do not take oral diabetic medication or insulin the morning of your procedure. If there are any issues regarding the interruption of your medication, contact your prescribing physician.

Blood thinner medications: (Our office will be consulting your cardiologist. Unless otherwise told, the following recommendations for temporarily discontinuing your blood thinner/s is listed below.)

Dabigatran (Pradaxa)- hold off 48 hours and wait to begin 48 hours after treatment.

Rivaroxaban (Xarelto)- hold off 48 hours prior to the procedure and begin 48hrs after treatment.

Apixaban (Eliquis)- hold off 48 hours prior to the procedure and begin 72 hours after treatment.

Edoxaban (Savaysa, Lixiana)- hold off 48 hours prior to the procedure and begin 48 hours after treatment.

Warfarin (Coumadin, Jantoven)- If instructed, hold off 3 days prior and begin 48 hours after treatment.

*Ticagrelor (Brilinta)- hold off 5 days prior to the procedure and begin 48 hours after treatment.

*Ticlopidine (Ticlid)- hold off 5 days prior to the procedure and begin 48 hours after treatment.

*Clopidogrel (Plavix)- If instructed, hold off 5 days prior to the surgery and begin 48 hours after treatment.

*Prasugrel (Effient)- hold off 5 days prior to the procedure and begin 72 hours after treatment.

*Cilostazol (Pletal)- hold off 3 days prior to the procedure and begin 4 days after treatment.

*Aspirin 325mg or greater- hold off 1 week prior to the procedure and begin 48 hours after treatment.

*Dipyridamole (Aggrenox)- hold off 5 days prior to the procedure and begin 48 hours after treatment.

(*) anti-platelet meds

***Patients with mechanical artificial heart valves cannot stop their anticoagulant medications (blood thinners) without discussion with their cardiologist and the periodontist!!

Supplements are non-prescribed medications. If you are taking any of the supplements listed below, please stop 1 week prior to your surgical procedure.

● Dong Quai (Angelica sinensis)

● Feverfew (Tanacetum parthenium)

● Fish oil, Garlic

● Ginkgo Biloba

● Ginseng (Panax quinquefolium/Panax ginseng)

● Licorice Root (Giycyrrhiza glabra)

● Red Clover (Trifolium pretense)

● Vitamin E

Commonly prescribed/recommended medications for this procedure:

__ Ibuprofen (ie. Motrin, Advil): This is usually over the counter. (if can be taken, 600-800mg for adult and 200-400 for a child, every 6-8 hours for at least 4-5 days after the surgery.) This is an over-the-counter medication. It is used to control mild to moderate pain. The medication also has an anti-inflammatory result at surgical sites. It works best when taken before surgery followed by consistent dosing times afterwards. The major side effect of Motrin is an upset stomach. To avoid this issue, take ibuprofen gel caplets with meals, milk, or 2 full glasses of water to lessen this complication. If you are prone to stomach ulcers, take this medication cautiously and discontinue if you have any stomach pain, nausea, or vomiting. Do not take ibuprofen if you have had any allergic type of reactions (itching, swelling, rash, difficulty breathing, etc.). Ibuprofen has been reported to make some people drowsy (1 in 100)

___ Amoxicillin: This is a common antibiotic that is prescribed for bone grafting or implant procedures. Please take the prescription 3 times a day until gone. Amoxicillin may upset your stomach. To decrease this side effect, take the medication with a full glass of water after eating. Esophageal

irritation and ulceration have been reported if Amoxicillin is not taken with adequate amounts of water.

Antibiotics, may decrease the effectiveness of oral contraceptives. An alternative form of birth control is recommended while taking the antibiotic and throughout the complete mensural cycle. If you begin developing a rash or itchiness, discontinue its use and immediately give us a call.

___ Clindamycin: This is a common antibiotic that is prescribed for bone grafting or implant procedures. Please take the prescription 4 times a day until gone. Clindamycin may upset your stomach. To decrease this side effect, take the medication with a full glass of water after eating. Esophageal irritation and ulceration have been reported if Clindamycin is not taken with adequate amounts of water. If blood in stools begins to occur, immediately stop and give us a call. Antibiotics may decrease the effectiveness of oral contraceptives. An alternative form of birth control is recommended while taking the antibiotic and throughout the complete mensural cycle. If you begin developing a rash or itchiness, discontinue its use and immediately give us a call.

___ Doxycycline: This is an antibiotic often prescribed after a bone grafting or implant procedure. This medication can concentrate the fluid around the teeth and is effective against the bacteria in these areas. Doxycycline may upset your stomach. To decrease this side effect, take the medication with a full glass of water after eating. Avoid taking with dairy products for 2 hours afterwards. Esophageal irritation and ulceration have been reported if Doxycycline is not taken with adequate amounts of water. Sensitivity to sunlight or ultraviolet light has been observed in some patients, which can result in a sever sunburn type response. If you are pregnant, you should not take doxycycline or other tetracyclines because it may cause tooth discoloration. Doxycycline, in addition to other antibiotics, may decrease the effectiveness of oral contraceptives. An alternative form of birth control is recommended while taking Doxycycline and throughout the complete mensural cycle. If you begin developing a rash or itchiness, discontinue its use and immediately give us a call.

__ Tylenol (Acetaminophen): (Can be taken 325mg-650mg every 4-6 hours) This is an over-the-counter pain reliever that can be taken while breast-feeding. It is contraindicated to those that are allergic to acetaminophen, or those who have a known G-6PD deficiency.

__ Peridex (chlorohexidine Gluconate): This is a mouthwash used to kill the bacteria in the surgical area. Take ½ oz. of mouth rinse, swish for a full 30 seconds, or swab the teeth with a Q-tip in the area, 2 times a day, no eating or drinking for 30 minutes afterwards. If instructed, begin this medication 24 hours after the surgery is completed and continue for at least 3 weeks or longer, even if brushing and flossing has been implemented again. Staining of the teeth can occur, which can be polished off. Avoiding tannin containing food products during its use will reduce staining tendencies (ie, red wine, tea, coffee)

___ Closys®: This is a post-surgical rinse that is initiated 24 hours after a surgery. Gently rinse for at least 30 seconds with ½ oz (2 full caps), then spit it out. It should be used 2-3 times a day. This is a non-staining, killing 99.9% germs in the external part of the surgical site. The rinse is used specifically for the surgical site, generally until all the sutures are removed. Brushing and flossing should occur throughout the rest of the mouth.

___ Sinecch TM/Arnica Montana: This medication is used to reduce bruising and swelling that may occur after your surgery. Use as directed on the packaging and you should ideally start the medication 1-24 hours prior to the surgery and finished up 4 days after the surgery. If you are breast feeding, or pregnant, please inform your doctor. Don’t use if you are taking other medications that contain pentazocine (such as Talwin), if you are sensitive to any of the

ingredients in Sinecch.

___ Medrol Dose Pack (Methylprednisolone): The primary use of this medication is to diminish swelling. This is a day regiment and can be started the day of the surgery and taken as directed, until gone. This shouldn’t be taken if you have a sensitivity to Methylprednisolone, have fungal infection, diabetic. Caution should be used if you have Thyroid disease, liver/kidney/cardiovascular disease, or pregnant please inform your doctor of this.

Office (314)842-6151

Dr. Scott Schlueter (636)492-1756

Dr. Trinity Boszko (314)221-6832

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