These FAQs answer some of the most frequently asked questions about surgery at Clinique de Chirurgie Maxillo-Faciale du Grand Montréal.
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- How do I prepare for an orthognathic surgery?
Orthognathic surgery requires rigorous preparation. This preparation can influence the outcome of the procedure.
Preparation begins more than a year before surgical intervention, with orthodontic treatment to align the dental arches. To be able to put the maxillary (upper and lower jaws) one on top of the other, the teeth must be properly aligned so that the two jaws close one onto the other, with good occlusion.
This alignment is achieved using orthodontic appliances and may take 1 to 2 years before surgery can be done. In the months before surgery, the orthodontist will assess the quality of the alignment between teeth, and make any necessary corrections.
Two weeks before surgery, surgical posts (small extensions of orthodontic appliances) will be placed by the orthodontist in preparation for the procedure. These posts will be useful during surgical intervention and in the following weeks to place the elastic, to stabilize the jaw in its new position.
Wisdom Teeth Extraction
Mandibular wisdom teeth (and in some cases, maxillary teeth) are placed behind the second molars, where osteotomy surgery is performed. It is therefore difficult to extract these teeth at the same time as the orthognathic surgery. To promote good healing of the gums and bone so that it fully recovers in time for surgery, wisdom teeth should be extracted at least 6 to 12 months before orthognathic surgery.
Some patients will meet with a nutritionist before or after surgery to ensure that the nutrient ratio is sufficient despite a soft or liquid diet during the first few days or weeks. Patients usually plan their meals at least in part before orthognathic surgery.
Softer food (pureed or liquid) can be cooked in advance to ensure good nutrition and a healthy, varied diet.
At your appointment prior to the surgery, your maxillofacial surgeon will take photos, mouth molds and radiographs to plan the surgery. This will provide a surgical simulation, which can be performed by conventional method with a mouth mold montage on an articulator, or by using a 3D technique.
A scan of your facial skeleton is also taken at this appointment and will be used for the 3D planning system. The surgeon's planning will help determine how the jaw should be moved during intervention and prepare the surgical guides that will accurately recreate these movements during surgery.
- I had my surgery yesterday. When can I brush my teeth?
Avoid brushing or rinsing vigourously the day of the surgery. You may brush your teeth gently the following day. Prepare a mouth rinse of warm salted water by adding a teaspoon of salt in a large glass of water. Rinse your mouth 4 times per day after eating and at bedtime for a week following the surgery.
- Are there risks involved in a procedure?
The maxillofacial surgeon will review the risks of the procedure during your consultation visit. The main risk is that the surgery may not work and the tooth may need to be extracted. Depending on where the tooth is located, there may be other risks.
- I just had my surgery. What can I eat?
For the first 2 days, eat a soft diet. This may include yogurt, soup, Jell-O, and other liquid foods. Starting the next day, you may gradually increase the consistency of the foods you eat if you feel able to. Avoid very hot foods and drinking with a straw as it can increase bleeding.
- I had my surgery four days ago and my cheek is still swollen. Is that normal?
If swelling does not go down, it may be a sign of infection. Other signs of infection include painful, firm swelling of the cheek, a bad taste in your mouth and the presence of a yellowish secretions (pus) in the wound.
- I had my surgery 4 days ago. On one side the swelling went down but the other side is not improving. Should I be concerned?
If swelling persists, you may have an infection. Other signs of infection include painful, firm swelling of the cheek, a bad taste in your mouth and the presence of a yellowish secretions (puss) in the wound.
- Who actually performs the dental implant placement?
Dental implants are a team effort between a maxillofacial surgeon and a restorative dentist. While our doctors perform the actual dental implant surgery, and initial tooth extractions and bone grafting if necessary, the restorative dentist (your dentist) fits and makes the permanent prosthesis. Your dentist will also make any temporary prosthesis needed during the dental implant healing process.
- What happens after a dental extraction?
Following extraction of a tooth, a blood clot forms in the socket, usually within an hour. The raw open wound overlying the dental socket takes about 1 week to heal. Thereafter, the socket will gradually fill in with soft gum tissue over a period of about 1 to 2 months. For more information on wound care after a surgery, see Post-Op Instructions.
- When I rinse my mouth with the water and the salt it burns. Is that normal?
Yes and No. If you have a burning sensation it may be that the amount of salt in the mixture is too high. Use a teaspoon of salt in a big glass of water. If the burning is still there, reduce the amount of salt even more.
- I have a bad taste in my mouth. Do I have an infection?
A bad taste does not necessarily mean you have an infection. In fact, most people have to some degree a bad taste and bad breath for the first 2 or 3 days after surgery. You may have an infection if other signs are present like a painful, firm swelling of the cheek, the presence of a yellowish secretions (pus) in the wound or swelling that does not improve.
- I had my surgery 4 days ago. For the first 2 days the pain was not too bad, but since last night the pain is really intense. What is going on?
You may have a dry socket. This condition occurs when the blood clot that forms in the socket of the tooth gets displaced or dissolves prematurely. This leaves the wound exposed to oral debris and saliva and the pain comes back. Pain may be intense and irritate other teeth and the ear. Even if the pain is worse, the healing process is not affected. If the medication you were given relieves the pain reasonably well, no other treatment is necessary. If not, you may contact your maxillofacial surgeon or the maxillofacial surgeon on call.
- I had my surgery earlier today and I took the medication, but it still hurts. What should I do?
Make sure you took all your medications as prescribed. If pain persists, a change in the medication or dosage might be necessary. Call your maxillofacial surgeon or the maxillofacial surgeon on call.
- How long will it be before I can go back to work and engage in daily activities after a dental implant surgery?
Discomfort after dental implant placement is usually minimal. Mild to moderate pain and swelling can occur but are limited to the first 24 to 48 hours. Most patients return to work without any problem the following day after placement of a single dental implant. Placement of multiple dental implants may require a resting period of up to 3 days.
- Is bone grafting painful?
On the day of your bone grafting procedure, you will take medications to help minimize post-operative pain and swelling. When you leave the office you will be comfortable. Most patients prefer to go home and rest with no other physical or scholastic activities planned for the first day. Pain and discomfort will vary depending on the type and size of the bone graft. In most cases, pain is limited and will subside within 5 to 7 days. The medication you will be given is strong enough so you will feel minimal or no pain after the procedure.