After Sinus Lift
The following information applies when you have had bone added to the area between your sinus and your upper teeth to increase your upper jaw bone height or width, usually in preparation for implant replacement of a missing tooth or teeth.
This procedure regains lost bone height in the area of your first and second molar and occasionally first or second premolar. It is an important procedure as it allows implant placement in an area that could not be implanted otherwise because of insufficient bone height due to an enlarged sinus.
The bone that has been grafted is most-commonly a combination of donated bone, bovine (cow) bone, artificial/synthetic bone and your own bone. Because of this you may have two post-surgical wounds: the donor site and the recipient site.
DO NOT UNDER ANY CIRCUMSTANCES BLOW YOUR NOSE FOR THE NEXT FOUR (4) WEEKS.
Do not smoke, blow your nose or sneeze holding your nose. Sneeze with your mouth open. Do not sniffle, drink with straws, spit, blow up balloons, play musical instruments that require a blowing action, “bear down” to lift heavy objects, or perform any other activity that increases nasal or oral pressure . Scuba diving and flying in pressurized aircraft should also be avoided. Decongestants, such as Drixoral, Dimetapp, or Sudafed, will help reduce pressure in the sinuses. You may also be given a prescription for a nasal spray. Please take these as directed.
A small amount of bleeding is to be expected for a short period of time following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing with cold waster and wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty (30) to sixty (60) minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty (30) to sixty (60) minutes. The tannic acid in the tea bag helps to form a clots by contracting bleeding vessels. To minimize further bleeding, do not become excited or sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
Occasionally, you may have a nosebleed or some drainage from your sinus over the few days following your procedure. This will stop when adequate healing has occurred.
It is not uncommon to pass dried blood mixed with mucous from your nose or mouth over the next two weeks.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling may not become apparent until the day following surgery and will not reach is maximum until two (2) to three (3) days after surgery. However, the swelling may be minimized by the immediate use of ice packs and keeping your head elevated above your heart.
A plastic bag filled with ice then wrapped in a towel, or an ice pack may be applied to the side(s) of the face where surgery was performed. For the first twenty-four (24) hours, ice packs should be utilized ever 20 minutes (20 minutes on, 20 minutes off) while you are awake.
Good nutrition is extremely important for healing. start off with clear liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass. Once you are able, you may eat anything soft by chewing away from the surgical site(s). You may want to confine the first day’s intake to bland liquids or pureed foods (soup, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc, which may become lodged in the surgical site(s).
Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first dose before the anesthesia as worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. For moderate discomfort, one (1) or two (2) Tylenol or one (1) Extra Strength Tylenol may be taken every four (4) hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol, unless you are on Coumadin/warfarin. Ibuprofen bought over the counter comes in 200mg tablets. Two (2) to three (3) 200mg tablets (400 – 600mg total) of Ibuprofen may be taken every four (4) hours as needed for discomfort.
For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. If you do not achieve adequate relief from your prescription, you may supplement your prescription with two (2) to three (3) 200mg tablets of Ibuprofen every four (4) hours, if you are NOT also on Coumadin/warfarin. Some people may even require two (2) of the prescription tablets at a time during the early stages, but that may add to the risk of upset stomach. The more severe discomfort is usually experienced within the first three (3) days after the surgery. Pain or discomfort following surgery usually subsides more and more each day after that, and your need for medicine should lessen as well. Sometimes, the pain increases as the swelling increases over the next two (2) to three (3) days. If significant pain persists for more than three (3) days, if may require attention and you should call the office. Do not take any of the above medications if you are allergic, or have been instructed by your doctor not to take it.
Mouth cleanliness is essential to good healing. Do not rinse or spit on the day of your surgery, as it may disturb the blood clot, open the surgery site, prolong bleeding and slow healing. You may have a small amount of blood in your mouth. Saliva can be swallowed, even if slightly tinged with blood. Avoid brushing the teeth and/or gums in the area of surgery for one (1) week. The day after surgery, you should begin gently rinsing after meals and additionally, for a total of four (4) to six (6) times a day, with an 8 oz glass of warm water mixed with one-half teaspoon of salt. Continue this procedure until the gums fill in over the surgical site(s).
In some cases, discoloration of the skin follows swelling. The development of black, blue, green or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur two (2) to three (3) days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Antibiotics will be given to help prevent infection. Take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Antibiotics make birth control pills ineffective. Women who take birth control pills should use another form of contraception for one complete cycle after the course of antibiotics has been used. Call the office if you have any questions.
Do not smoke for at least two (2) weeks after surgery, as smoking dramatically increases the risk of bone graft and sinus augmentation failure.
Nausea & Vomiting
Nausea may occur after surgery, and is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each tablet with a small amount of food, then taking the tablet with a large volume of water. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on tea or ginger ale (after stirring out carbonation). You should sip slowly over a 15-minute period. If you are not on Coumadin/warfarin, you may also try Alka-Seltzer or Pepto Bismol. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If nausea persists for more than four (4) hours, call the office.
Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. In most cases, sutures will dissolve unnoticed within a week. Occasionally, sutures require removal after one week. The removal of sutures is a quick procedure that requires no anesthesia or needles and is usually associated with minimal to no discomfort.
Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake my be reduced. Exercise may weaken you. If you get light-headed, stop exercising.
Wearing Your Prosthesis or Nightguard
Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise. Please contact the office if there is any question. If you have a temporary “flipper” to wear do not place it until the numbness in the area is gone. When it is placed it should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. This can lead to loss of the graft. If you have questions about the fit of your flipper, partial or complete denture, do not wear it until your general dentist or our office can see you.
Post-Operative Problems or Complications
As with any procedure, unexpected post-operative healing can occur. If you notice the unexpected flow of air or liquids between your mouth and nose, please let us know.
- If you are aware of several small particles of graft material being discharged from your nose, let us know as well.
- If you experience sinus or nasal congestion on the side on which your surgery was performed, let us know.
- If there is an increase in swelling in your mouth, cheek or under your eye after 3 days, let us know.
- A slight elevation of temperature immediately following surgery is not uncommon. Tylenol my be taken to reduce the fever. If a temperature of 101 degrees Fahrenheit persists for longer than a day after surgery, let us know
- You should be careful going from the lying-down position to standing. Since you may not have been able to eat or drink prior to surgery, and it may be difficult to take fluids after surgery, your body may be low on fluid. Because of this, you could get light-headed if you stand up suddenly. Taking pain medications can also make you dizzy. Before standing up, you should slit for one minuted and then get up slowly.
- If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with lip balm or Vaseline.
Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the people best-able to effectively help you: Dr. Burns or your general dentist.
It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office. Please try to call during office hours to obtain a quicker result. A 24-hour answering service is available if necessary. The after-hours telephone numbers are 317-823-4260 or 866-823-4260.