Signs of Dental Bone Graft Failure
A dental bone graft is a minor form of dental surgeon designed to stimulate the growth of new bone cells within the jaw. Proper bone density is necessary for overall good oral health, and a dental bone graft is often performed to create a suitable foundation for future dental implants. A dental bone graft is usually recommended if patients do not have proper bone density for dental implants.
After a successful dental bone graft procedure, patients have sufficient bone density to provide a strong foundation for a future dental implant. As with any surgical procedure, there is the possibility of various complications, including bone graft failure. Learning the signs of a bone graft failure and proper post-operative care techniques can help you deliver the best care to your patients.
What Are the Signs of Bone Graft Failure?
Bone grafting treatments are incredibly popular, with over 2 million bone graft procedures performed each year as of 2014. In the United States alone, approximately 500,000 bone grafting procedures are performed annually.
While bone grafting is a safe and effective procedure, there is the possibility of bone graft failure or rejection, as risks and complications are associated with any surgical procedure. Fortunately, bone graft failure is significantly less likely if someone undergoes surgery with an experienced bone grafting surgeon and follows all post-operative care instructions.
While symptoms may vary from patient to patient, some of the most common bone graft rejection symptoms include:
- Pain: Post-operative pain and discomfort are possible even if a bone graft is successful, but these symptoms are often easily managed with over-the-counter or prescription pain medication. While this pain is to be expected, sharp, intense, severe or persistent pain may signify a bone graft failure.
- Inflammation: Mild post-operative swelling is normal after a bone grafting procedure, but the severity of swelling and inflammation may indicate potential bone grafting complications or failure. If inflammation and swelling are severe or persist longer than a few days, you may want to check with your surgeon to see if this may be a potential sign of a bone grafting complication.
- Gum recession: If a patient has gum recession, the gums may become damaged or unhealthy and recede, causing a dental bone graft to fail.
- Leakage: Large-volume leakage or drainage from the surgical site is another possible sign of a bone graft failure. While some level of leakage may be expected, severe or excess leakage is often a cause for concern and a sign to contact your bone graft surgeon.
- Failure to grow bone: There will be no bone growth or development if a bone graft fails. In some cases, a bone graft can fail without any noticeable side effects, meaning a patient may not realize a bone graft has failed until they go to their follow-up appointment.
- Teeth clenching: Some patients may notice they are unconsciously clenching their teeth more often. If they notice they are clenching teeth or experiencing dental stress and strain, they should come back to visit the clinic, as these may be potential signs of a dental bone graft complication.
- Head and neck discomfort: In addition to oral or dental discomfort, some patients may notice head and neck pain after a bone grafting procedure. Ongoing, chronic or severe head and neck discomfort may signify a bone grafting complication or failure.
What Causes Dental Bone Grafts to Fail?
One study found a 12.7% bone graft failure rate among their patients. Fortunately, 30% of the failures could have fixtures placed and a corrective bone grafting procedure to replace lost grafting material.
There are several reasons a dental bone graft may fail, and there are also different stages of bone graft failure, including early and late-stage failure. Early-stage bone graft failure often causes noticeable symptoms within the first few months following surgery — typically the third or fourth month. Late-stage bone graft failure symptoms occur anywhere after four months from your initial surgery.
Possible reasons for a bone graft failure include:
- Lack of experience: One important aspect to consider when placing a dental bone graft is the level of experience you have placing these grafts. The more experience a dental surgeon has often lowers the general risk for complications, as an experienced surgeon is more equipped to deal with potential complications. Because even a minor error during bone grafting can result in bone graft failure, you must understand each procedure step.
- Unsterile equipment: Sterile equipment and bone grafting material are essential to a healthy, safe and effective dental bone graft procedure. If any bacteria are present on even just one piece of surgical equipment or the bone grafting material itself, the risk for a bacterial infection is greatly increased. An infection can lead to various complications, including dental bone graft failure.
- Blood flow: Proper circulation is essential following any surgical procedure. If a patient does not have proper blood flow following a bone grafting procedure, they may be more likely to experience a bone graft failure.
Instructions to Provide Patients After a Bone Grafting Procedure
Proper post-operative care following a bone grafting procedure is one of the most effective ways to minimize the risk of infection and dental bone graft failure in patients. Following a bone grafting procedure, you should provide your patients with detailed instructions to help them promote proper healing.
After completing a bone grafting procedure and placing a gauze pad at the surgical site, it is important to tell your patient to keep the gauze pad in place for 30 minutes to help minimize post-operative bleeding. You should also inform your patients to avoid touching the area with their fingers, as doing so can easily irritate the healing incisions and potentially introduce bacteria.
It is also important to notify patients that while they may take certain pain-relieving medication, they should avoid any form of acetaminophen, including aspirin, because this type of medicine can worsen bleeding. Depending on the aspects of a patient's bone grafting procedure, you can notify them of a potential timeline of when to expect pain to subside.
For general bone grafting surgeries, you can tell patients they may notice pain begin to diminish within a few days following their treatment. You should also let patients know a timeline for how long they need to avoid vigorous activities until you believe their incision has healed properly.
As always, notifying patients that rest and downtime help promote healing is important to minimize potential bone grafting complications. It can be beneficial to provide patients with instructions on how often or long to apply cold compresses and ice packs to numb the side of their face.
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