Bone Graft Loss After Dental Implant Surgery: What to Expect

Bone graft resorption after augmentation?

My lower left 37th tooth broke while eating at the end of December last year.
The next day, I went to the clinic to have the remaining root extracted and received collagen grafting.
After the stitches were removed, the doctor advised me to return for dental implant placement in three months.
Four days ago, I went to another clinic for simultaneous dental implant placement and bone grafting.
The doctor mentioned that treatment for periodontal disease would be done after the implant has integrated with the bone.
The implant used is Straumann BLX, with a resorbable OSSIX PLUS membrane for regeneration.
I believe the bone grafting technique used was "guided bone regeneration." The doctor provided antibiotics, pain relievers, and gastric medication post-surgery.
My surgery lasted about 30 minutes and seemed successful.
After returning home, I experienced minimal pain, but there was bruising on the skin outside the implant area, and bleeding had stopped.
However, I can see white bone graft material in the extraction site every day.
Yesterday, I had an emergency follow-up appointment for the doctor to check, and he said everything looked normal, and I should return in two weeks to have the stitches removed.
I suspect that the stitches may not have been placed properly or that the regeneration membrane was not adequately covering the area or may have ruptured, causing the bone graft material to leak out.
My question is: Is it normal for bone graft material to be leaking out four days post-surgery? If so, how long might this continue? If it is not normal, what should I do?

Yá bìng rén, 70~79 year old female. Ask Date: 2023/06/25

Dr. Zeng Guanghui reply Dentistry

After guided bone regeneration surgery, there has been a loss of bone graft material.
It is recommended to return for a follow-up appointment for the dentist to evaluate and perform an examination, checking the condition of the wound sutures and whether the membrane coverage is intact.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/06/25

More Info

After undergoing dental implant surgery, particularly when combined with bone grafting, it is not uncommon for patients to have concerns about the healing process and the integrity of the graft material. Based on your description, it seems you are experiencing some visible bone graft material at the surgical site four days post-operation. Let’s break down your concerns and provide some clarity on what to expect during the healing phase.

Understanding Bone Graft Loss
1. Normal Post-Operative Expectations: After a dental implant and bone grafting procedure, it is typical for patients to experience some degree of swelling, bruising, and discomfort. The presence of white material at the surgical site can often be attributed to the bone graft material, which may be visible as the soft tissue begins to heal. In your case, the OSSIX PLUS membrane is designed to facilitate guided bone regeneration, and it is biodegradable, meaning it will gradually dissolve as the bone heals.

2. Bone Graft Material Visibility: Seeing bone graft material at the surgical site is not necessarily a cause for alarm. It can occur if the graft material is not fully integrated into the surrounding bone or if the soft tissue has not completely closed over the graft. However, if the graft material is excessively exposed or if you notice significant amounts of it leaking out, this could indicate a problem with the closure of the surgical site or the integrity of the membrane.

3. Duration of Bone Graft Visibility: The visibility of bone graft material can vary from patient to patient. In many cases, as healing progresses, the graft material will become less visible as it integrates with the surrounding bone and is covered by new tissue. This process can take several weeks to months, depending on individual healing rates and the complexity of the procedure.

When to Be Concerned
- Signs of Infection: If you notice any signs of infection, such as increased pain, swelling, redness, or discharge that is foul-smelling, you should contact your dentist immediately. Infection can compromise the success of the implant and the graft.

- Excessive Graft Loss: If you are losing a significant amount of graft material or if the area appears to be deteriorating rather than healing, this warrants a follow-up with your dentist. They may need to assess the site to ensure that the graft is integrating properly and that there are no complications.

- Follow-Up Appointments: It is crucial to attend all scheduled follow-up appointments. Your dentist will monitor the healing process and can address any concerns you may have. They will also determine when it is appropriate to proceed with further treatments for periodontal disease, as you mentioned.

Recommendations
- Maintain Oral Hygiene: Continue to follow your dentist’s instructions regarding oral hygiene. Keeping the area clean is vital to prevent infection and promote healing.

- Monitor Symptoms: Keep track of any changes in your symptoms. If you experience increased discomfort or any unusual signs, do not hesitate to reach out to your dental provider.

- Communicate with Your Dentist: If you have concerns about the appearance of the graft material or the healing process, discuss these with your dentist during your next visit. They can provide reassurance or take necessary actions if there are issues.

In summary, while it is not uncommon to see some bone graft material post-surgery, it is essential to monitor the healing process closely. If you have any doubts or if the situation changes, do not hesitate to consult with your dental professional for guidance. Your proactive approach to your dental health is commendable, and staying informed will help ensure the best possible outcome for your implant and overall oral health.

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