What's more fun than the words 'bone graft'?
October 29, 2014 11:45 AM   Subscribe

Tell me about the awesomeness of pre-dental implant bone graft procedures.

I have to have a bone graft following an extraction for an upper molar.

I had anesthesia for the extraction (Vercid?) and it was pointless - I was awake the whole time, just kind of high, but I remember everything. My heart rate was monitored, it was highly surgical etc. It seemed like an awfully big deal for something I could have done with a local.

This is my second implant/extraction extravaganza but I haven't had to deal with the bone graft before. How bad is the bone graft? How long does it take? Can I get away with a local and some Xanax (in consult with my GP and oral surgeon, obviously)?

I would still be having someone drive me home as I'd be waggling around afterwards, but I'm not really feeling inclined to do general anesthesia again. For my first extraction I had a pure local and nothing else (I was pregnant, I got to have the entire awesome experience). I've had versions to turn a breech baby, D and Cs with locals, five root canals....I'm kind of a veteran of pure bummer medical procedures. On the other hand, I'm not interested in suffering needlessly.

What was your experience? General anesthesia or a local and some anti-anxiety meds? (To be clear, I asked for general for this extraction--I really wanted a cake walk of an experience, but it really did not seem to improve matters all that much, the tooth was brittle and hard to get out and the dentist seemed like he was having to work exceptionally hard, which I'd just as soon not know, and it cost me several hundred extra dollars for improvement in the overall experience.)
posted by A Terrible Llama to Health & Fitness (22 answers total) 2 users marked this as a favorite
Response by poster: Damn: for no improvement in the overall experience.
posted by A Terrible Llama at 11:46 AM on October 29, 2014

No firsthand personal experience, but I think it might help if you let folks know where the donor bone is coming from. Is it coming from your chin? Your hip? A different person? Because my general understanding is that each of those sources has significantly different implications for how serious the surgery is.
posted by Michele in California at 11:52 AM on October 29, 2014

I had a bone graft in conjunction with an implant. (They found a surprise hole in my jaw when placing the implant) The graft itself, as I remember it, was basically just the insertion of bone (& cement?) paste...nothing to it, really. The drilling portion of the implant was really unpleasant with just a local...I wouldn't recommend that. But I think you can manage the graft.
posted by another zebra at 11:52 AM on October 29, 2014

Oh, my bone graft was from some other person, if that colors the answer at all.
posted by another zebra at 11:54 AM on October 29, 2014

Response by poster: donor bone is coming from. Is it coming from your chin? Your hip? A different person?

I'm 99% certain that the word 'cadaver' was used.

I did not choose to follow up.
posted by A Terrible Llama at 11:54 AM on October 29, 2014

It kinda sounds like you didn't actually have a general anesthetic. Sounds like you had Versed (a benzo, anti-anxiety and mild sedative) and a local anesthetic, which is pretty common for dental procedures. General anesthesia should put you out completely and leave you completely unaware of anything going on.
posted by erst at 12:00 PM on October 29, 2014

Response by poster: They kept specifically and clearly referring to it as general anesthesia, and I was hooked up to oxygen (mask over my nose)and an EKG. They mentioned Versed, but they also mentioned a slew of other things I didn't recognize in cocktail of what I was getting in the IV. They referred to it as 'general anesthesia' and 'anesthesia' indiscriminately.

All I had been really after in the first place was a nice relaxing IV sedative.

I got the feeling most people don't ask the questions I was asking.
posted by A Terrible Llama at 12:04 PM on October 29, 2014

I was knocked out for mine (I think it was considered sedation rather than general anesthesia), which was about ten years ago. The recovery was uneventful, though prolonged — the bone graft has to heal before the implant goes in, which in turn has to heal before a crown can be installed. The implant has been trouble-free but the porcelain crown finally chipped a few months ago. Should have gone with gold.
posted by exogenous at 12:07 PM on October 29, 2014

My friend had this procedure on both sides of her jaw at once and she said it was fine with just a sedative and a LOT of local anesthesia. She said her dentist had to give her Novocaine several times during the procedure. She also got cadaver bone, which is from cadavers (obviously), but it is ground up and then re-formed into bone, apparently. At least that's what her doctor told her when she got cadaver bone put into her spine.
posted by bedhead at 12:08 PM on October 29, 2014

The bone graft is just ground up dead people powder that they pack into the existing hole in your jaw. It takes like 2, maybe 3 minutes. They pack it in carefully and then maybe drop a stitch or two in the gum above. The worst part is that sometimes tiny little bone slivers will work out of your gums when you eat.

I had three separate bone grafts of dead people and one from my own jaw and all of them plus the extremely traumatic initial extraction were done with only novocain. I have never been offered anything more than that for any of the extensive dental surgery I've had.

I will be having another graft in february with bits of my own shin, yikes, and idk what kind of drugs I'll be getting but they better be good.
posted by poffin boffin at 12:10 PM on October 29, 2014 [2 favorites]

I had this exact same procedure yesterday. (And also 14 years ago, but that eventually failed, requiring replacement.) The most recent time, there was only local anesthetic. I'd had a bone graft (?) several months ago to prepare & rebuild the area. It consisted of my own red blood cells mixed with a "bone slurry" from cow bone. With local anesthetic and a few Advil afterwards, my pain has been in the "negligible" to "manageable" range since the procedure. No sedatives other than a nice mellow Pandora channel.
posted by jeffjon at 12:10 PM on October 29, 2014 [1 favorite]

Best answer: the best part is that afterwards you can say, in a dramatic hushed whisper, "i taste dead people"
posted by poffin boffin at 12:13 PM on October 29, 2014 [6 favorites]

Best answer: I worked in insurance. A) Medical people are sometimes sloppy with terminology and B) sometimes they are carefully using a specific thing with a specific definition because of what the insurance specifically covers, and that may be where some of the confusion is coming from with regards to what they meant by "anesthesia."

Also, from what I have read, yeah, the "I taste dead people" procedure is not significantly more invasive than something like a root canal. When they take it from your hip, that is very invasive and requires hospitalization, etc. From the chin, it is somewhere in between cadaver bone and your own hip bone in terms of how mega serious the surgery is.
posted by Michele in California at 12:46 PM on October 29, 2014 [1 favorite]

I had a bone graft done simultaneously with teeth extraction (for a dental implant) about a month ago; it wasn't bad at all. No drugs aside from novocaine, and I went home taking only ibuprofen for a few days. I do have a high pain tolerance, but even without that I felt like it wasn't terrible. Though I did bleed a fair bit when I slept; a dark towel on your pillow might be a good idea.

I also had to be pretty careful for a week or two afterwards when I ate, because the gum there felt pretty soft and fragile; I don't know if that was exacerbated by it being a bone graft (in addition to an extraction) or not.
posted by spaceman_spiff at 12:49 PM on October 29, 2014 [1 favorite]

I have gone through this in the past year-ish. I had a premolar that was cracking at the base and had an abscess underneath.

I went to the periodontist, they removed the tooth, cleaned up the area of the jawbone that had been affected by decay, then packed the hole with bone graft material. I believe it was the cow stuff, but I also remember the word allograft so maybe it was human. I looked at it beforehand (I like to see all parts of procedures being done to my body; they fascinate me) and it just looked like wet spongy cloth, maybe like gauze bandage but a bit thicker. They put a little cap of some sort there to hold it in place, maybe a stitch in the gum, and that was it.

A few months later my body had formed bone strong enough to support the endosteal implant (aka the screw) and the procedure for that - drilling, insertion - was short and sweet.

I had only local anesthesia on both the tooth removal + allograft material placement as well as the implant insertion. Both were no problem whatsoever, with quick recovery times, and little-to-no pain after the injected anesthetic wore off.
posted by komara at 1:02 PM on October 29, 2014

Best answer: I've had this - upper molar extraction, bone graft and sinus lift. The procedure itself takes quite some time, but if anesthetized, it's not painful - just a lot of packing and pushing. It's an upper molar - you don't say, or perhaps don't know, if you're having a simultaneous sinus lift, which happens not infrequently with upper molars and bone grafts. If you do have a sinus lift, there are complications - I don't want to write a book here, but the bottom line is that for a period of about a 1-3 weeks, you are advised never to blow your nose, exert yourself (so as not to put pressure on the delicate membrane), and worst of all, not to sneeze (in an emergency, if you cannot control a sneeze, do it with your mouth wide open)... there is no time in your life you want to sneeze as badly and as often as when you're not allowed to. But again, those last few instructions is only in case you are having a simultaneous sinus lift.

Post-op pain. You'll get something to take down the swelling, like hi-dose ibuprofen (600-800mg at a pop), an antihistamine to prevent sneezing and congestion due to allergies (if you have a sinus lift) and a vicodin or something of equal strength. Individual pain tolerances will differ, but I only took vicodin twice in the first 12 hours post op - and honestly didn't really even need it. After that, the ibuprofen which was for the swelling also took care of the minor pain. You will bleed on the pillow at night, so make sure you have a towel under your head. Try not to lie on the side of the operation - another hassle if you are a side sleeper with a preference for that side.

You most likely will have some facial swelling for anywhere between 1-5 days, and even some bruising (more rarely).

For the first 24 hours or so, you may be asked to keep a small piece of dressing over the wound, gently, and keep changing it as it fills with blood. You must not drink through a straw or make any sucking pressure in your mouth for fear of opening the wound. Avoid hot or spicy food and drink. Avoid small seed type food - poppyseed, strawberries, blueberries etc., those can all get into the wound and cause an infection. Soft foods are preferred, so you are not massively chewing and putting pressure on the gum tissue in your mouth. No brushing in that area - you'll be given a prescription for a wash (perhaps peridex). You should avoid alcohol for 1-2 weeks at least. You'll be given antibiotics for 7-10 days, which might or might not result in gastric issues.

You'll go back a week after the graft, they'll take an X-ray, and the periodontist will look at how the wound is healing. Most likely it'll be fine. Then you'll come back in another 3 weeks for another checkup. At that point you'll be pretty fine and most restrictions will be lifted. And then, depending on the route chosen by the perio, you'll wait up to 3-4 months before there is talk of inserting a screw/post.
posted by VikingSword at 1:14 PM on October 29, 2014 [1 favorite]

If it's just a bone graft (and not a sinus lift), it won't be bad at all with just local anesthesia. I had this done on an upper front tooth lost in an accident and the extraction of the root followed by packing the hole with graft material and some sort of membrane to hold it all in place, then stitching it all up, took no more than ten minutes. No major pain afterwards, just normal post-op swelling and annoying stitches in your mouth. I think I waited 4-6 months before placing the implant, also with just local anesthesia, although I wish I had asked for some Valium and/or nitrous for that part of the process, because I have to admit it was somewhat unpleasant and unnerving. The bone graft part was a piece of cake.
posted by bennett being thrown at 1:41 PM on October 29, 2014

All I had been really after in the first place was a nice relaxing IV sedative.

This is what you got. This, and your description up top, describe Versed pretty well.

Personally, I prefer a general (unconsciousness, not just Versed) for this kind of major dental procedure. I hope this is responsive to your question.
posted by JimN2TAW at 1:50 PM on October 29, 2014

Just Novocaine for my (several) bone grafts. Also had a sinus lift. They were no more annoying and ultimately less painful than other involved dental procedures.
posted by Obscure Reference at 6:36 PM on October 29, 2014

I'm almost done going through the process of two implants with bone grafts. I am a nerd who deals with nervousness about medical procedures by geeking the fuck out over the details. I ask a lot of questions, to the utter bemusement of my oral surgeon.

The bone graft is, indeed, pulverized cadaver bone (or cow or pig, though pig has largely replaced cow due to concern over mad cow.) It's not a solid bone being implanted. It's more like super-sanitized and throughly processed bone-derived dust. The point (as I understand it) is that it holds the space and stimulates your own bone cells to go into mad production mode to fill in where the oral surgeon needs you to have more robust bone to hold the implant.

For me, they had to "tap up" to make a little more space for the bone graft. This is (sorry!) basically a hammer-and-die situation. It gave me a godawful splitting headache for several days afterward. Anyway, after the graft they stitch you up and you heal and the bone cells do their thing for 3-6 months before you come back for them to put the actual metal implant into your newly solid bone.

I did ALL of this under just local anesthetic, totally awake, and honestly, that was absolutely fine. I was Novocained and otherwise numbed to the gills topically and while I could feel some pressure and such, the procedures were not traumatic to experience. It helps that I really, really like my oral surgeon and trusted him.

The healing wasn't fun, but it really wasn't bad. In my experience, there was a strong pervasive jaw ache for a couple of days (plus the aforementioned headache). I used Percocet or Vicodin for that time. Then the worst of it abated and I was able to switch to prescription-strength ibuprofen and go back to work without any issue except a little extra fatigue. I stuck to soft food for a day or so, then just did not-scratchy foods until the stitches were out (one week) and healed (another day or two.)
posted by desuetude at 10:16 PM on October 29, 2014 [1 favorite]

Response by poster: Okay. Thanks everyone. It sounds like I don't really need sedatives or anything other than local anesthesia for this. The sinus lift is a possibility but it's not my understanding they take place at the same time--my understanding is extraction, wait two weeks, bone graft, wait three months, 3D xray thing, implantation of screw thingy, wait three months, final crown.* I guess either at the bone graft or during recovery they make the decision about a sinus lift.

The extraction was not a big deal, btw, recovery went fine, no swelling (I was pretty religious about keeping ice on my face--I wonder if it also helped that I was on the Vicodin + Ibuprofen combo instead of Vicodin + Acetaminophen), at work the day after. I took Vicodin twice on the first day but hated it and went to plain Advil on day two, and now it's day three and I'm not inclined to take anything. I'm pretty much eating normal people food today except for things as mentioned above, like maybe no poppy seeds for a while.
posted by A Terrible Llama at 3:32 AM on October 30, 2014

Response by poster: In case anyone comes rooting around for bone graft info, this went fine, I took a few xanax and had a local. I wouldn't go so far as to say it was fun, but it was interesting and I got to ask questions [IF YOU'RE EASILY GROSSED OUT EXIT NOW] and see things I wouldn't have seen had I been knocked out, like they showed me the bone graft material and the platelets they got from my blood and how they mixed it together to make this paste that forms the scaffolding for the new bone growth. It's nice to be able to nerd out on it a little, it made it a little depersonalized in a soothing way.

See you in a few months when I come asking about the sinus lift. Thanks everyone.
posted by A Terrible Llama at 5:27 AM on November 20, 2014 [3 favorites]

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