Oral Surgery Q & A
Some people do not have enough healthy natural bone to support dental implants. Natural bone insufficiency can be caused by:
- Gum disease
- Tooth development defects
- Wearing dentures long term
- An injury to the face or trauma
- Spaces left empty in the mouth after teeth are removed
- Dental procedures where efforts were not made to restore natural bone
Several techniques are used to rebuild bone, restore your natural jaw line and smile, and provide a strong and sturdy foundation for implant-supported teeth. Most patients proceed with everyday life and work often by the next day and continue throughout the months in between dentist appointments. A dental implant expert can tell you if you need bone augmentation.
Below is an overview of some of the more common techniques to augment bone.
Bone grafting is a safe and highly successful procedure that involves the “building up” or adding bone to the jaw by using your own natural bone from another location and/or by using donor, processed or synthetic bone materials. Often the new bone can be obtained from inside the mouth. Ask your dental implant dentist about the advantages of different bone grafting methods and materials so that, together, you can make an informed decision.
Bone grafts are often performed in the implant dentist’s office using local anesthesia to numb the areas that will be involved, sometimes along with intravenous sedation to remove anxiety.
After the procedure, you will usually be given antibiotics, pain medication if needed, and an antibacterial mouthwash, and instructed to avoid eating certain foods and putting pressure on the bone graft. You will return home in between dentist appointments while the bone graft heals and should be able to work and go about your everyday life.
Your implants will be placed after the grafted bone has fused or become a strong, integrated part of the existing bone. The amount of time the integration takes varies depending on the location of the graft and the density of the bone. It may take three or more months.
Sinus Lift (Sinus Augmentation or Sinus Elevation).
Missing upper back teeth are among the most difficult to restore. When the back teeth in the upper jaw are missing the sinus cavity becomes larger as the natural bone deteriorates over time. A sinus lift, also called sinus augmentation or sinus elevation, is a bone-augmentation procedure for patients who have insufficient natural bone in this area for dental implant placement. The procedure involves adding bone below the sinus so that one or more implants can be placed. The procedure does not affect speech, intonation or cause sinus problems.
After the bone has been given time to develop, usually for approximately four to 12 months, dental implants can be placed. Sinus augmentation, which many patients say causes only minimal discomfort, is designed to help ensure that your implants are long-lasting, with ample, strong and sturdy bone that will allow your new teeth to fit and function like healthy, natural teeth.
Ridge Expansion (Ridge Modification).
If the jaw isn’t wide enough to support dental implants, bone graft material can be added to a small ridge, or space, that is created along the top of the jaw. In some situations implants can be placed right after a ridge expansion. Other situations require approximately four to 12 months to ensure that the ridge has fully healed first. Like all bone grafting techniques, ridge expansion helps ensure a strong foundation and long lifespan for your new teeth. It also can be used to correct an unattractive and difficult-to-clean indentation that can occur in the jawline near missing teeth.
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night’s sleep.
The main types of sleep apnea are:
- Obstructive sleep apnea, the more common form that occurs when throat muscles relax.
- Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing.
- Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea.
If you think you might have any form of sleep apnea, see your doctor. Treatment can ease your symptoms and may help prevent heart problems and other complications.
Wisdom Tooth Extraction
During the procedure
Your dentist or oral surgeon may use one of three types of anesthesia, depending on the expected complexity of the wisdom tooth extraction and your comfort level. Options include:
- Local anesthesia. Your dentist or oral surgeon administers local anesthesia with one or more injections near the site of each extraction. Before you receive an injection, your dentist or surgeon will likely apply a substance to your gums to numb them. You’re awake during the tooth extraction. Although you’ll feel some pressure and movement, you shouldn’t experience pain.
- Sedation anesthesia. Your dentist or oral surgeon gives you sedation anesthesia through an intravenous (IV) line in your arm. Sedation anesthesia suppresses your consciousness during the procedure. You don’t feel any pain and will have limited memory of the procedure. You’ll also receive local anesthesia to numb your gums.
- General anesthesia. In special situations, you may be offered general anesthesia. You may inhale medication through your nose or have an IV line in your arm, or both. Then you lose consciousness. Your surgical team closely monitors your medication, breathing, temperature, fluids and blood pressure. You’ll experience no pain and have no memory of the procedure. Local anesthesia is also given to help with postoperative discomfort.
During wisdom tooth extraction, your dentist or oral surgeon:
- Makes an incision in the gum tissue to expose the tooth and bone
- Removes bone that blocks access to the tooth root
- Divides the tooth into sections if it’s easier to remove in pieces
- Removes the tooth
- Cleans the site of the removed tooth of any debris from the tooth or bone
- Stitches the wound closed to promote healing, though this isn’t always necessary
- Places gauze over the extraction site to control bleeding and to help a blood clot form
After the procedure
If you receive sedation anesthesia or general anesthesia, you’re taken to a recovery room after the procedure. If you have local anesthesia, your brief recovery time is likely in the dental chair.
As you heal from your surgery, follow your dentist’s instructions on:
Bleeding. Some oozing of blood may occur the first day after wisdom tooth removal. Try to avoid excessive spitting so that you don’t dislodge the blood clot from the socket. Replace gauze over the extraction site as directed by your dentist or oral surgeon.
Pain management. You may be able to manage pain with an over-the-counter pain reliever, such as acetaminophen (Tylenol, others), or a prescription pain medication from your dentist or oral surgeon. Prescription pain medication may be especially helpful if bone has been removed during the procedure. Holding a cold pack against your jaw also may relieve pain.
Swelling and bruising. Use an ice pack as directed by your dentist or surgeon. Any swelling of your cheeks usually improves in two or three days. Bruising may take several more days to resolve.
Activity. After your surgery, plan to rest for the remainder of the day. Resume normal activities the next day, but for at least a week, avoid strenuous activity that might result in losing the blood clot from the socket.
Beverages. Drink lots of water after the surgery. Don’t drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don’t drink with a straw for at least a week because the sucking action can dislodge the blood clot from the socket.
Food. Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
Cleaning your mouth. Don’t brush your teeth, rinse your mouth, spit or use mouthwash during the first 24 hours after surgery. Typically you’ll be told to resume brushing your teeth after the first 24 hours. Be particularly gentle near the surgical wound when brushing and gently rinse your mouth with warm salt water every two hours and after meals for a week.
Tobacco use. If you smoke, don’t do so for at least 72 hours after surgery — and wait longer than that if possible. If you chew tobacco, don’t use it for at least a week. Using tobacco products after oral surgery can delay healing and increase the risk of complications.
Stitches. You may have stitches that dissolve within a few weeks or no stitches at all. If your stitches need to be removed, schedule an appointment to have them taken out.