Q: I’ve had a hard time with my teeth since childhood. I’m sure that I am the one to blame because I have just never developed consistent habits of brushing and flossing. I get at my teeth probably three times a week. I brush more often but flossing- I’m not good.
Every time I make an attempt I get frustrated because I’m so uncoordinated, I can’t do it. When I go to the dentist I’ve always got decay and gum problems that have to be fixed. Sometimes it’s a real emergency. A year ago, I had to have the sockets of the pulled teeth filled with bone. I was supposed to stop smoking and I told the dentist it (the smoking) was under control but that lasted for two days. Fortunately, I’m a good healer and the bone took. Then four weeks ago I had to lose a molar. It had a lot of disease and it took the doctor extra effort to get it filled with bone and stitched up. This time I didn’t heal so well and when I went back there was no hiding the smoking. Some of the graft was lost so I need another graft before implants can go in.
None of the grafting I’ve had so far has given me any pain. How will this be different? Will it be more painful? What’s the chance it will work better? I’m not nervous because I get knocked out and when I wake up it’s done. Is this a good thing to do?
A: First of all, a tip on homecare (brushing and flossing). Flossing is all about the technique—once you are shown and then master the technique you won’t feel uncoordinated. Floss while watching T.V. you’ll do a better job.
To your main point, I’ll say this—smokers sometimes get away with healing of bone grafting in sockets. Well done grafting in these sites are generally predictable. When there’s a lot of disease the predictability goes down especially in smokers because blood supply to the graft is compromised.
It will be important that the gum tissue mature over this last surgery before a new graft is attempted. New techniques are making grafting more predictable but the host (you) still must be healthy. Smoking is one of the contraindications to bone grafting. Don’t cheat this time around. Your doctor will use at least two types of membranes to ensure the graft stays in place and your body gets an advantage in healing.
Follow his instructions carefully and you will likely have a very good final result.