Three weeks ago I had bone graft on "tooth" 11. I had this tooth removed 4 months ago due to fracture and an autologous bone graft (from my chin) was placed for a future implant.

The bone graft got a little exposed on the palate site, I think this is because of exagerated vertical augmentation and poor blood irrigation.

This little piece of exposed bone is dead and I'm afraid of getting an infection, specially because I know ostemyelitis is a severe problem.

I'm washing my mouth and brushin the exposed bone with Chlorhexidine after each meal. I took antibiotics for the first 19 days (amoxicillin 14 and levofloxacin 5). Now im on day 23

How dangerous is my situation? What cares should I take?

Thanks

capsula4,

If I am understanding you correctly, a portion of the grafted bone on the palate side is not covered by palatal tissue. Was it covered initially? Have you been back to the oral surgeon since the grafting was done?

Bryanna

The situation is as you described Bryan, there is a small portion of the bone graft not being covered with soft tissue on the palate.

I cant really tell if it was initially covered since I realised of.it after the 4th day.

The surgeon saw me several times. The first time at the 4th day and he saw there was a fibrin clot right were I have the exposed bone (i dont have fibrin.any longer).

He just told me to have great higiene over that area and now he is on vacations, he doesnt seem to worry much about the exposure. In one month he will make a flap and take out the dead bone, tho Im worried if it gets infected.

Hi capsula,

Chances are the tissue coverage on that portion of the bone graft was inadequate at the onset. It is wise to keep it clean of food debris and plaque, but be careful not to be too aggressive as that could introduce bacteria in to the surrounding tissue. Keep in mind that you do not want to disturb the rest of the graft.

Gentle brushing with a soft bristle toothbrush and salt water rinsing should be adequate at keeping it clean.

Please keep us informed on how things go..

Bryanna

first of all, thanks Bryanna for taking the time not just for reading my post, but also for replying!

I have been using clorhexidine for almost a month but I think using water with sodium bicarbonate may be a better option for not getting my teeth colour affected by CHX.not sure if there is any other effect of abusing of CHX.

As soon as I meet de surgeon I will tell how everything keeps on going!

Here is a picture of the exposed bone graft, next to a crown post. I know is not pretty clear but it may help you.

Btw, I wouldnt like to think the surgeon didnt cover the whole graft with soft tissue, isnt kind of obvius that it will kept exposed? Im thinking he may haven't had enough soft tissue to cover it.

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Capsula,

That is a large piece of exposed bone. Either he didn't have an adequate amount of soft tissue to cover the entire graft or he did cover it but the tissue died and sloughed off early on. The tissue margins around the graft are dark and irritated. Did he tell you to actually brush this piece of bone? Or was that something you decided to do on your own?

I could understand lightly brushing it... as I said with a very soft bristle toothbrush... but definitely gently if at all. Sometimes chlorhexidine can be irritating to the gum tissue when over used... and yes, it definitely will temporarily stain your teeth. If you switch to salt water... do not make the water very salty. Just a pinch of salt in about 2 ounces of warm water is adequate. There is no need to use more than that. As a matter of fact, overuse of salt will also cause irritation and soreness to the oral tissue.

Can I ask ... are you in the medical field? You sound quite knowledgeable

Bryanna

Yes, my surgeon definetely told me to brush it gently with CHX. When I asked him how much should I keep brushing it with CHX he told me I should decide my own. This answer was not clear at all to me.

He said it was a small piece of bone, I think he said that way for not making me worry.about it. Still I think the graft is large. If you see it from the front side, the gum tissue is larger than the gum on the surrounding teeth.

Im not into the medical field, im computimg engineer but I love reading and reseaeching. Before posting here I read everything I found on the subject.

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Here is a better front view picture of the graft (right next to the crown post).

Another last question. My crown on 11 has attached a false teeth to it to fill the grafted side. Wearing it should be a matter of risk for the graft? I dont use them for eating though.

ps: English is my second language so excuse me if I dont use the exact words or if I have too many grammar mistakes.

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capsula,

Yes, the grafted tissue is quite large on the front (facial) side. I have to admit, I have never seen this done this way. May I ask.... What country are you in?

Also, this appears to be your right front tooth which is actually tooth #8, not #11. Correct? You have a temporary 2 unit bridge that you take in and out that fills the space and fits onto the other front tooth #9... is that correct? I know #9 has been shaved down for a crown but has that tooth also been root canaled? I ask because it gives the dark appearance of a non vital tooth.

Ideally nothing should be worn against the bone graft site, especially if tissue was grafted, until it has healed for several weeks or so. Does your temporary bridge rub against the palate side of the graft? Could that be why the bone is exposed?

Could you post a picture with the temporary in place? By the way, these pictures help a lot with your description.

Bryanna