Hi Bryanna

Not sure where the proper place to post this is. If this is wrong please forgive me.

My #3 broke off a few months ago and I am now due for extraction and bone grafting. I am horrified. My oral surgeon whom I like very much says he prefers to do a cadaver bone graft and I have met with him 2 times about this. I thought when I walked out of the office last week, I could handle it but there is no way I can do cadaver bone. He is not a fan of using patients bone as there is more healing time because there are now two wounds. But for mental health sake, I have to. He is not aware that I have made my final decision. I just find it totally disgusting even though they say it is nice and safe. I cant do it. I am nervous to call back to telll nurse my decision.

I have allergies and I am reading I shouldnt sneeze or blow nose after this procedure. This makes me nervous. When I met with him, we didnt talk too much about the procedure of using my own bone but he said it would be in lower jaw and healing time alot longer. He said I was a little more squeamish about the cadaver bone from his other patients. Just how odd am I??

What kind and how big is the incision to get my own bone? At least I will have my sanity back. This crown broke off a few months ago and I have crowns on both sides. I am just horrified at not being able to blow my nose. The anniversary of my moms death is just a few days later and I know I will cry and need to blow my nose.

Any words of comfort are much appreciated. I am a nut job over this!

Thank you!

-Suzie

Hi Suzie,

No apologies necessary and you posted your thread perfectly!
You are not being a nut job over this..... not at all You have very valid concerns and perhaps the surgeon should be addressing them a bit better. Some people will not consider using cadaver bone.... but most people tend to not voice too much concern about it.

Regarding bone grafting... it is important for you to understand that the purpose of a bone graft is to encourage new growth of your own bone to integrate with the graft. Without the bone graft, the growth of your own bone will be limited. Irrelevant of what type of bone graft is used, your own bone will grow into the graft and the entire area will become your own bone. So it's not like you would be walking around with cadaver bone or synthetic bone once your own bone became whole again.

I can understand being squeamish about using cadaver bone. That is a personal choice and if you are not comfortable with it... then do not have that done. Just so you know.... cadaver bone is very sterile and the risks of contamination are remarkably low. Surgeons prefer to use this type of bone in most cases because it is very compatible to our own bone and the healing is quicker. But again this is a personal choice.

Using synthetic bone.... this is derived from sea coral or other forms of calcium. Generally the persons own bone integrates well with this type also. Healing is a bit longer by about 3-6 months post op.

Using your own bone from a personal donor site..... the risk with this is that it is two separate surgeries which is always more risky than dealing with just one site. It is quite tedious to keep one area of the mouth sterile during this type of oral surgery.... it is twice as tedious to keep additional sites sterile. It is imperative that both sites be sterile throughout the surgeries.
In case you have not been informed of this.... when the bone is taken from the other side of the mouth it means you are creating a void in that area of bone to replenish lost bone in another area. The bone will not grow back completely at the donor site. Also it is more difficult to place your own bone in the extraction socket as opposed to bone that is already ground up into very small pieces. So both surgical sites may need to be made larger to perform the procedure.

Regarding the timing of this surgery.... If at all possible, I would recommend that you post pone the surgery until after "the anniversary" because you not only will not be able to blow your nose... but you cannot risk all that pressure and inflammation in your face and sinuses from crying. It is also imperative to go into this surgery feeling both physically and emotionally well as your immune system will be dealing with a lot and burdening it with physical and emotional stress is truly not in your best interest.

Is it possible to postpone it for a week?

I would suggest that you discuss synthetic bone graft material options with your surgeon as that may be a viable option for you if you are adamant about not using cadaver bone It would certainly be less traumatic overall compared to having a second surgery to graft your own bone.

I'm also very sorry for your loss. I hope you find some peace and contentment in the good memories that you had with your mom and hold tight to those as you near the anniversary of her passing.

Bryanna

Hi and thank you very much. He is booked solid into the new year. So really, no crying or blowing nose? What do people do that need to blow if they have allergies? I blow every day, many times a day. This is not good news. My oral surgeon does not use synthetic so its either cadaver or my own. He would do it the day of the extraction, not two separate procedures. I thought about a bridge but I am told that in the long run, I would be happier with implants. I have two friends on facebook that are former dental hygeniests.

How long does one have to go without blowing nose and what do you do if you really have to? By the way, I dont smoke so that is good. Can you give me any idea of how large of an incision is made to get my own bone and does the oral surgeon have to do anything to it after he takes it from me?

Thank you very much!

Suzie

Suzie,

Let me clarify..... if you are going to use your own bone.... it requires two separate surgeries. Meaning at the one appointment, he will perform a surgery in one area of your mouth to remove the bone and then perform a second surgery in another area of your mouth to remove your tooth.

Why doesn't the surgeon use synthetic graft material? It is a viable option and one that is usually offered.

Post operatively you should not blow your nose and it's important to avoid crying as it causes inflammation and pressure in various areas of the sinus and face. People with allergies are usually prescribed anti histamines during the first 2 weeks or so post op the extraction to help them avoid blowing their nose. If you had to blow your nose it is recommended to keep your mouth open while blowing your nose to reduce the pressure in the sinus. But continual nose blowing is definitely not recommended.

The size of the incision to remove your own bone depends on the location site, your anatomy and the health of your jaw bone. After the bone is removed from the donor site, the area gets irrigated with copious amounts of saline and then it's sutured closed.

Bryanna

Hi again Bryanna

Gosh I dont think I am a good candidate for implants then. I cant imagine not blowing nose for a couple of weeks. Anti-histamines don't work for me and I have high blood pressure so my doctor has always just told me to blow as needed.

I do now understand what you meant by the two surgeries. Makes sense now. Regarding the synthetic materials, my oral surgeon told me he and his partners dont offer them because while he knows it's an option, it isn't there as they dont believe they are a good choice so they choose not to offer that option. I have done alot of reading on the internet and read it isn't most oral surgeons #1 choice.

So I called my regular dental office and spoke to a dental assistant and I told her my concerns. She told me she had a bridge and while I wouldnt be able to see my dentist again, I went once to discuss bridges, but he was so busy seeing patients, I couldnt focus on my questions because he was so needed. He and wife have a very thriving practice. So this one dental asst. told me she would show me hers and talk to me about it. She told me if she had to do it all over again, she would go with implants but that a bridge might be best option for me since I wont go with cow or cadaver bone and she hadn't heard that you couldnt blow your nose. So......I dunno, maybe I should keep my extraction date of Sept. 10 and just go with a bridge. I am told I dont have to have a bone graft with a bridge.

Do you know much about bridges? Are they really that bad? I've read on the internet that most people wish they had gone with implants. I have crowns on both sides of the #3 that has to go. And root canals on all of them also. Anything you can tell me about bridges is much appreciated as I wonder, emotionally, a bridge might be my best bet. I wish I could wrap my brain around the cadaver thing but that wont ever happen. And even if I could, I cant go 2 weeks without blowing my nose, I cant imagine how that is healthy even.

What is your line of work to know so much? Thank you for all you do for all of us.

Suzie

Hi Suzie,

I've been in the dental profession for 35 yrs... so yes, I can tell you about dental bridgework, etc.

You are now giving more information than you had previously. The fact that both adjacent teeth are root canaled pose some concerns. Root canaled teeth are not healthy teeth which makes them fragile and prone to abscessing. For these reasons root canaled teeth are not good candidates for anchoring a bridge. When one or both of these rc teeth abscess and have to be removed, there will be nothing to hold this bridge in place. Some dentists will use rc teeth for anchor teeth and not inform the patient of what I just did. So if you are not concerned about long term results, then the bridge may be a "temporary" option for you.

Another thing that many dental patients are not informed of is that the bone surrounding root canaled teeth is often not healthy either due to the bacteria that spreads from the tooth into the jaw bone. So it is risky to place a dental implant next to root canaled teeth.

Unfortunately, this is not information that many conventional dentists, hygienists or assistants will share with their patients. In fact, many hygienists and assistants are not well informed about the infection in root canaled teeth because they have been told or taught that a root canal procedure "cures" the tooth. The word cure simply implies "retain".

Regarding the bone grafting issue.....Every dentist will have his own preference. However, I personally do not know of any oral surgeons or implantologists that do not offer synthetic bone grafting. They are used very successfully in various dental applications. Every patient should be given all the options available.

Regarding your regular dentist not willing to sit and discuss your replacement options with you... that is ridiculous. You should not be relying on an assistant to "show you her bridge" and listen to her tell you how she should have opted for the implant. If you are a patient in that office and that dentist is the one who will be doing the replacement work, he needs to sit down and explain your options to you.... irrelevant of how busy he is.

The risks of blowing your nose after a upper tooth extraction is that the pressure will dislodge the clot and/or perforate the sinus membrane. So although no one can stop you from blowing your nose following the tooth extraction .... it is up to you to not do it.

Why do you always have to blow your nose? Do you have chronic allergies and/or sinus problems?

Bryanna