Normal to Lose Bone Particles After Bone Graft?

Question:

Alan asks:

I had #30 & 31 extracted with allografts six weeks ago, was not placed on antibiotics (had just completed a course two days prior to surgery for infection in #30) or prescribed Peridex.

I saw the oral surgeon on day 8 due to pain and was told I might have residual infection and/or that it might be due to the stitches coming out too soon. Have been on ibuprofen due to swelling of graft and jaw pain every day.

After 3 weeks, bone particles began to emerge from sockets. Saw the oral surgeon again at 4 weeks - was told that I am healing slowly and that it is OK for bone particles to be coming out. When a piece comes out, it is a huge release of pressure on my jaw. Is it normal to be losing bone particles 6 weeks post graft? Is the pain/swelling in jaw normal at this point. Should I get a 2nd opinion?



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Expert Advice and Comments
drkazemi's picture

Loss of bone particles after grafting

Answered By: Dr. H. Ryan Kazemi - Bethesda , MD

Hi

With loose sutures, the gum tissue flap over the extraction site and graft can become loose and mobilized. In this case, it is certainly possible that the bone particles and the membrane protecting it could become subject to loss- either minor or possibly more. Some small superficial particles may become loosened even after several weeks, but it all depends on how much and where it is coming from. Pain and swelling at 6 weeks may indicate infection and should be addressed.

It sounds like a wound healing issue and certainly some measures can be taken to help it:
1. Antibiotics
2. Local irrigation
3. Debridement if necessary

I hope this is helpful

Dr. Kazemi


Dr. H. Ryan Kazemi
http://www.facialart.com/

tgrossman's picture

Socket Grafting Procedure

Answered By: Dr. Theodore M. Grossman - Aventura , FL

Hi Alan
Surgical sites with a previous or recent infection history present challenges to a successful grafting result.
After the extraction and antibiotic routine I wait 4-6 weeks for inflammation to be reduced at the surgical site.
Pre-medication starts the night before grafting and the antibiotic is prescribed for 10 days. Topical Peridex application (swab) to the graft site is prescibed, rather than rinses, to minimize membrane and particulate graft displacement.
Some discomfort is normally experienced when particles or membranes are displaced, often unavoidably. If the site was infected, and you experienced swelling and a bad taste this would indicate a problem and the graft may be compromised.
Best of Luck.

Theodore M Grossman DMD
www.Fortlauderdaleoralsurgery.com
305-466-1804


Dr. Theodore M. Grossman

ekusek's picture

The only thing I would add to

Answered By: Dr. Edward Kusek - Sioux Falls , SD

The only thing I would add to the above comments is if there is continued pain in the area, and it is not geting better, you may need to think about removing the graft as you may have residual infection present and only way to treat is to remove the graft and allow to heal. Every situation may be different, so that is best guess for what you have told me.
good luck


Dr. Edward Kusek

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