• Home
• Our Treatment locations
• Patient Information
• Postoperative advice
• Patient testimonials
• Fees / Private health cover
• Clinic Statement
• Contact us

Patient Information

We like to keep our patients fully informed about treatment procedures and after care. Here you will find information regarding treatments we regularly perform at Bath Oral Surgery Clinic.

If your question is NOT answered here or you have any concern regarding your dental treatment then do not hesitate in contacting us. We'll do our very best to help you!

The surgical removal of teeth
For treating infected and fractured teeth

Wisdom teeth
The third molar teeth

Apicectomy
For treating infection around root tips of teeth

The exposure of impacted canines
Prior to orthodontic treatment

Soft tissue procedures
For the removal of lumps and swellings

Intravenous sedation
Especially for anxious patients

Dental Implants
To replace missing teeth

Bone augmentation and grafting procedures
To increase the volume of bone required for implant treatment

Sinus grafting procedures
To increase the volume of bone required for implant treatment

The surgical removal of teeth

Why am I having my tooth removed surgically?

There can be several reasons for having to remove a tooth surgically. Typically, the tooth is extensively decayed or fractured and is causing chronic infection and discomfort. Surgical removal is needed when simple extraction is not possible because of the condition of the tooth.

How long will the operation take?

This depends on the position of your tooth or teeth and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 45 minutes. When intravenous sedation is used, an appointment usually lasts 90 minutes. The longer time allows for the recovery period needed before you can be discharged home.

Will there be any stitches?

Sometimes stitches are needed and they are usually dissolvable.

If non-dissolvable stitches are used, they are quick and easy to remove. An appointment will be arranged for this, usually one week after surgery.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation as the area of surgery will be numb from the local anaesthetic.

As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

Could there be any after-effects?

This depends on the operation. If there are any issues in particular to be aware of, they will be discussed with you beforehand.

There may be swelling and bruising in the area of surgery, as well as some discomfort which might limit jaw opening. Bruising is usually at its most obvious two to three days after surgery and varies between patients. It normally resolves itself after 10 to 14 days.

The removal of buried or impacted teeth or roots may be followed by altered sensation in the area of surgery. This is due to the bruising affecting the nerves that carry sensation from that area. This is usually only a temporary condition although it can take up to six months to fully resolve itself.

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible for you to return to work the next day.

Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

Wisdom teeth

What are wisdom teeth?

They are the third molars and the last teeth to emerge at the back of your mouth. This usually occurs in late teens ('the age of wisdom'). Most people have four, two in the upper jaw and two in the lower jaw.

Infected gum tissue overlying impacted wisdom tooth

Why am I having mine removed?

Surgical removal can be required for several reasons. Often, wisdom teeth get stuck ('impacted') against the adjacent tooth or within the jawbone and are not able to come through fully into the mouth.

A partially exposed wisdom tooth can be difficult to keep clean. This can then cause chronic infection and discomfort in the surrounding gum tissue. Such infections may require treatment with antibiotics.

A wisdom tooth can also become decayed or cause decay in neighbouring teeth. Your dentist may not be able to treat this decay until the wisdom tooth has been removed.

Decay Example

1. Extensive decay affecting upper and lower impacted wisdom tooth

2. Impaction of lower wisdom tooth leading to development of decay in the lower second molar

3. Extensive decay affecting impacted lower wisdom tooth

Impacted Wisdom Teeth

Impacted wisdom teeth can also adversely affect the attachment of adjacent teeth or be associated with cystic lesions.

1. Horizontally impacted wisdom tooth adversely affecting attachment of second molar

2. Extensive cystic development around impacted lower wisdom tooth

Wisdom teeth should only be removed if they are causing problems. We will discuss this with you during your appointment.

How will it be removed?

This depends on the position of your tooth and the way it is impacted. Some can be quite straightforward to remove. More commonly, simple extraction is not possible and surgery is necessary to remove it.

The type of the surgery needed depends on the position of the wisdom tooth. This may influence whether your operation is carried out under local anaesthesia alone or with additional intravenous sedation.

All options can be discussed with you during a consultation appointment.

How long will the operation take?

This again depends on the position of your tooth, and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 45 minutes. When intravenous sedation is used, an appointment usually lasts 90 minutes.

The longer time allows for the recovery period needed before you can be discharged home.

Will there be any stitches?

Sometimes stitches are needed and they are usually dissolvable. If non-dissolvable stitches are used, they are quick and easy to remove. An appointment will be arranged for this, usually one week after surgery.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation, as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

Could there be any after-effects?

This depends on the operation. If there are any issues in particular to be aware of, they will be discussed with you beforehand.

There may be swelling and bruising in the area of surgery as well as some discomfort which might limit jaw opening. Bruising is usually at its most obvious two to three days after surgery and varies between patients. It normally resolves itself after 10 to 14 days.

Occasionally, an impacted lower wisdom tooth can be very close to nerves supplying the lower teeth, lip, chin, cheek and tongue. These can get bruised when the tooth is removed, resulting in the sensation of numbness or tingling in these areas.

This change in sensation only affects 2-5% of patients and is usually temporary. It can take up to six months to fully resolve itself. It only very rarely becomes permanent. If this is a factor for you to be aware of, due to the proximity of your wisdom tooth to the nerves, we will discuss it with you during your appointment.

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible to return to work the next day.

Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

Apicectomy

What is an apicectomy?

This is a surgical procedure to:

• remove an infected tooth root tip
• clean out the surrounding infection
• place a filling to cap and seal off the new end of the tooth.

Why do I need an apicectomy?

The most common reason to consider an apicectomy is persistent infection around a root tip, after conventional root canal work. This infection can cause pain, swelling and discharge over the top of the tooth in the gum and can get quite extensive (see diag.1).

In some cases, it is preferable to repeat the root canal therapy, but this is not always possible or practical. Surgery is then the best option to deal with the infection.

The suitability of apicectomy treatment can only be determined after thorough examination of the tooth's appearance and x-rays.

1. Jaw bone

2. Area of inflammation/infection surrounding tooth root tip

3. Root canal treatment within tooth

4. Healing area around tooth root tip

5. Specialised filling within root tip

How is the apicectomy carried out?

Local anaesthesia is used to numb the area around the tooth. The gum tissue is then gently raised away from the tooth to allow access to the infection and this area is thoroughly cleaned out. The tip of the tooth root is then removed and special cement placed over the new end of the root. This sets very hard and seals off any open channels in the root which could lead to another infection. The gum tissue is then put back into place to allow for healing. (see diag.2).

Apicectomy treatment carried out on an upper central incisor

1. Jaw bone

2. Area of inflammation/infection surrounding tooth root tip

3. Root canal treatment within tooth

4. Healing area around tooth root tip

5. Specialised filling within root tip

Apicectomy treatment carried out on an upper premolar

1. Jaw bone

2. Area of inflammation/infection surrounding tooth root tip

3. Root canal treatment within tooth

4. Healing area around tooth root tip

5. Specialised filling within root tip

How successful are apicectomies?

Success rates for first apicectomies are typically 75-80%, (assessing patients clinically and with x-rays three months after the operation). It is possible that the procedure will not completely resolve the problem and success rates are inevitably reduced for repeat apicectomies.

How long will the operation take?

This depends on the position of your tooth, the treatment required and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 60 minutes. When intravenous sedation is used, an appointment usually lasts 90 minutes. The longer time allows for the recovery period needed before you can be discharged home.

Will there be any stitches?

Stitches are used in the operation to help complete the surgery. A very fine size of thread is used to achieve a good cosmetic result, which is especially important if it is for a tooth at the front of your mouth.

These stitches are dissolvable and so should disappear after about two weeks.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation, as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

Could there be any after-effects?

This depends on the operation. If there are any issues in particular to be aware of, they will be discussed with you beforehand.

There may be swelling and bruising in the area of surgery, with some discomfort. Bruising is usually most obvious after two to three days and varies between patients. It normally resolves itself in 10 to 14 days.

Following an apicectomy, there can be a small amount of recession of the gum margin on the front of your tooth. This is not necessarily a problem in itself, but can affect the tooth's appearance.

The surgical techniques we use are designed to minimize this recession. Any new restorations (such as crowns) planned for your tooth by your dentist should only be placed once the gum margin has settled.

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible to return to work the next day.

Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

The exposure of impacted canines

What does 'impacted' mean?

This means that your tooth has been prevented from coming through correctly by bone, fibrous tissue or another tooth.

Upper canine teeth are some of the last to come through and therefore have more potential to become impacted and fail to reach their correct position within the upper jaw.

How common are impacted canines?

About 2% of the population have an impacted upper canine, usually affecting one side only. Most of these impact towards the roof of the mouth (the 'palate') but some impact towards the cheek.

Why does it happen?

A variety of factors can reduce the space available for a canine to come through, contributing to it becoming impacted. Commonly, there may already be a degree of teeth crowding in the upper jaw due to a shortage of space. In some cases, there is a family history of canines being impacted.

What happens if it is left untreated?

If the canine is left in its impacted position, a cystic lesion can develop around the crown of the tooth, which can become infected and can also cause damage by putting pressure on the roots of adjacent teeth.

Treatment for an impacted canine is usually part of a course of orthodontic therapy and so you should seek the advice of your orthodontist regarding your particular circumstances.

Impacted Upper Canines

Radiographic images of impacted upper canines indicating possible areas of cystic development and root resorption of adjacent teeth.

How will the tooth be exposed?

First, x-ray images are used to locate the position of the canine. The overlying tissues are then surgically raised away from the tooth to allow for sufficient soft tissue and bone removal to expose the tooth adequately.

Stitches are used to put the raised tissue back in place (these are usually dissolvable). A healing pack is then placed over the exposed tooth and non-dissolvable stitches may be used to secure this. The pack and stitches are quick and easy to remove and an appointment will be arranged for this, usually one week after surgery.

How long will the operation take?

This depends on the position of the impacted canine and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 45 minutes. When intravenous sedation is used, an appointment usually lasts 90 minutes. The longer time allows for the recovery period needed before you can be discharged home.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation as the area of surgery will be numb from the local anaesthetic.

As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

Could there be any after-effects?

This depends on the operation. If there are any issues in particular to be aware of, they will be discussed with you beforehand.

There may be swelling and bruising in the area of surgery, as well as some discomfort. Bruising is usually at its most obvious two to three days after surgery and varies between patients. It normally resolves itself after 10 to 14 days.

Once the pack and stitches have been removed and the impacted tooth is exposed in the mouth, healing usually progresses quite quickly. We advise that a review appointment is arranged with your orthodontist a week to 10 days after your operation.

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible for you to return to work the next day.

Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

Soft tissue procedures

What is a soft tissue procedure?

A soft tissue procedure is one that does not involve teeth or bone.

Why am I having a soft tissue procedure?

Typically, such a procedure is required to investigate lesions affecting the lining of the mouth. It might involve the complete removal of a lesion such as a small swelling or alternatively, a representative piece might be taken of a larger or more widespread lesion for the purposes of investigation.

The soft tissue that has been removed will be sent to an appropriate laboratory for examination under a microscope. A report will then be prepared regarding the nature of the lesion.

How long will the operation take?

An appointment for such a procedure under local anaesthesia usually lasts 30 minutes. A further appointment will be organized once the report is available from the laboratory to discuss this and to review the healing at the operation site.

Will there be any stitches?

Sometimes stitches are needed and they are usually dissolvable.
If non-dissolvable stitches are used, they are quick and easy to remove. An appointment will be arranged for this, usually one week after surgery.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

Could there be any after-effects?

This depends on the operation. If there are any issues in particular to be aware of, they will be discussed with you beforehand. There may be swelling and bruising in the area of surgery, as well as some discomfort; the bruising is usually at its most obvious two to three days after surgery.

In the longer term, there may be a small amount of scarring at the operation site once it has healed.

When can I return to work?

This depends on your occupation and how you are after your treatment; it may be possible for you to return to work the next day. We will give you appropriate advice for your particular circumstances.

Intravenous sedation

What is intravenous sedation?

Intravenous sedation is a modern, safe, predictable and effective way to reduce anxiety in patients.

It makes potentially stressful procedures more pleasant for you.

Who will sedate me?

Tim Milton administers all intravenous sedation at the Bath Oral Surgery Clinic. He has extensive experience in providing intravenous sedation, in both hospital and practice environments.

Tim is assisted by a nurse trained in the care and monitoring of patients receiving treatment under intravenous sedation.

What is the sedative?

The sedative used is called midazolam. It is a member of the benzodiazepine group of drugs and is the main agent recommended for use in intravenous sedation in the UK.

Midazolam is well suited for intravenous sedation as it brings about a general state of relaxation. The recovery period is smooth and quite short, with no feelings of nausea.

How does it feel to be sedated?

You will feel very relaxed and possibly sleepy, with a general sense of detachment from what is going on.

During your operation, you stay conscious, so you do not lose vital protective reflexes (such as the ability to cough).

After your operation, you are likely to have little or no recollection of having the treatment carried out.

How is the sedative given?

The sedative is given through a small plastic tube (a 'cannula') put into a vein on the back of your hand or inside your elbow. The insertion of the cannula is very quick and simple.

The sedative is given in small amounts over a period of time until you are sufficiently sedated for the operation to begin.

You will be monitored from the start of the procedure by our nurses who have specific and recognised training in the care of patients receiving treatment under sedation. Medical monitoring equipment is used to record your pulse, blood pressure, blood oxygen levels, breathing rate and end-of-breath carbon dioxide levels throughout your treatment as well as during the recovery period.

What happens after I am sedated?

A local anaesthetic is still needed to numb the area of surgery. This is given slowly and carefully before your operation begins.

After your operation, a recovery period is necessary during which the immediate effects of the sedation start to wear off. Your monitoring will be continued during this time. All relevant postoperative instructions (including any prescribed medicines) will be discussed with your escort.

When we are satisfied that you have recovered enough, you will be discharged home in your escort's care.

How long does the sedation last?

This depends on the operation you need.

We aim to keep the sedation at a satisfactory level for the duration of your operation. You will only be discharged home when you have recovered enough from the sedation.

The effects of the sedative will be present for the next 24 hours, so it is essential that you follow our postoperative instructions.

Are there any risks involved?

The administration of any drug carries some risk. The risks associated with intravenous sedation as described are very small and can be further minimized by following our pre- and postoperative instructions. A very small number of patients are not suitable for treatment under intravenous sedation for medical reasons.

Please discuss any concerns you have by contacting the clinic on 01225 874 444 or click here to use our simple contact form.

How does sedation compare with general anaesthesia?

Intravenous sedation is a form of 'conscious sedation' as, unlike general anaesthesia, the aim is not to bring about a complete loss of consciousness (including loss of protective reflexes). General anaesthesia can now only be administered in a hospital setting.

Intravenous sedation is inherently a more pleasant way of having potentially stressful treatment carried out. It is especially good if you are apprehensive, as the sedative's action actually removes anxiety and so makes treatment much more comfortable.

You're in safe hands

Tim Milton is a member of Society for the Advancement of Anaesthesia in Dentistry and follows the guidelines of good practice set out by this organisation.

Dental implants

What is dental implant?

A dental implant is a tooth-root shaped insert made of commercially pure Titanium which is surgically placed into jawbone once occupied by a tooth root.

The implant can then be used as a foundation for a restoration replacing a missing tooth.

How is implant treatment carried out?

Implant treatment is typically staged as follows:

Phase 1 – Consultation and planning for treatment. This involves a thorough assessment of the mouth as a whole and particularly the area of jaw where it is intended to place the implant(s).

This includes the taking of impressions for models of the jaws and x-ray films. Sometimes, more specialised CT scans might be required, to provide a very accurate image of the area where implants are to be placed.

Phase 2 - All implant-related treatment requires a strict sterile protocol be followed in the surgery by the surgeon and nursing staff.

The gum tissue is temporarily lifted up to expose the bone at the site for the procedure and the implant is placed very carefully into the appropriate position. If it appears that there is insufficient bone to fully envelope the implant, a bone augmentation procedure will be required so as to cover the implant and build up the bone volume for the long-term (see FAQ page on bone augmentation and grafting procedures).

The gum tissue is then carefully placed into position to cover the site.

Implant placement can be carried out under local anaesthesia alone or with additional intravenous sedation if required. This is inherently a more pleasant way of having potentially stressful surgical treatment carried out and is especially good if you are apprehensive as the sedative’s action actually removes anxiety, so making the treatment much more comfortable.

These options can be discussed with you during the consultation appointment.

Implant-Borne Restoration

1. Restoration on implant.

2. Adjacent tooth.

3. Implant within jawbone

4. Jawbone.

Phase 3 - Following placement, bone starts to fuse to the implant surface in a process known as “osseointegration”. This process can involve a period of 3-6 months, after which a special post (called an abutment) can be attached to the implant to help shape the adjacent gum tissue.

Usually, 1-2 weeks after this, impressions can be taken for the construction of a restoration such as a porcelain crown which will be fixed into position to replace the missing tooth.

How long will the operation take?

This depends on the number of implants being placed and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 60 minutes. When intravenous sedation is used, an appointment usually lasts 90 minutes. The longer time allows for the recovery period needed before you can be discharged home.

Will there be any stitches?

Stitches are used in the operation to help complete the surgery. A fine size of thread is used to achieve a good cosmetic result.

These stitches are dissolvable and so should disappear after about two weeks.

Will I be in any pain afterwards?

You should not feel any pain immediately after the operation, as the area of surgery will be numb from the local anaesthetics that have been used.

As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible to return to work the next day.

Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

Could there be any complications or after-effects?

After the procedure, there is likely to be some swelling and bruising in the area of the surgery and possibly some discomfort. The bruising is usually most obvious after two to three days and will vary in amount between patients. It normally resolves itself in 10 to 14 days.

If an augmentation procedure has also been carried out, the operation site will now be of a larger volume. The area is likely to feel quite enlarged even after the bruising has subsided and the overlying gum tissue may feel different to that of the adjacent areas.

These changes in sensation generally tend to become less noticeable over time and gradually resolve as the augmented area integrates with the surrounding bone.

At the time of implant placement, there is a risk of accidental damage occurring to adjacent anatomical structures (eg:, teeth, nerves) although this should be avoidable with accurate planning.

The risk of failure of implants after the first year in function is low as long as general health is maintained and in particular that of the bone and gum around the implant. Regular maintenance appointments for the periodic examination of the implant and the surrounding tissues are an essential requirement towards the long-term success of the treatment.

Could there be any complications or after-effects?

After the procedure, there is likely to be some swelling and bruising in the area of the surgery and possibly some discomfort. The bruising is usually most obvious after two to three days and will vary in amount between patients. It normally resolves itself in 10 to 14 days.

What are the advantages of implant treatments?

The main advantages of dental implant treatment are that it provides a permanent restoration and the adjacent teeth are not involved in any way.

Success rates for implant treatment can be in excess of 95% and so in most cases can be regarded as the ideal substitute and the first choice for the replacement of missing teeth.

The implant system used is that of the Swiss company Straumann (www.straumann.co.uk) whose clinical effectiveness has been extensively studied and verified by multiple independent clinical trials over many years.

A success rate of 95%+ does conversely mean a failure rate of 1-5% and in most circumstances, if an implant should fail, it can be replaced although additional surgical procedures may be required.

What are the alternatives to implant treatment?

The alternatives to dental implant treatment to replace a missing tooth/teeth are removable dentures and fixed bridges.

The removable denture option has the advantages of avoidance of surgery, a relatively short period of time for provision and potentially a lower cost. However, a denture is not a fixed restoration and so can be unstable and consequently difficult to tolerate.

Fixed bridgework can also usually be completed in a short period of time and avoid the need for surgery. However, the adjacent teeth would need to be prepared which might in turn compromise their health and once in place, it can be difficult to keep the bridgework adequately clean.

You're in safe hands

Tim Milton is a member of the Association of Dental Implantology and follows the guidelines of good practice set out by this organisation.

Tim Milton utilises products supplied by Straumann.

Bone Augmentation and Grafting Procedures

What is bone augmentation and grafting?

Bone augmentation and grafting are related procedures, used to correct deficiencies of bone volume in areas of either jaw where the placement of implants is planned for the replacement of missing teeth.

Why would I need this procedure?

Generally, once teeth have been removed, the bone that was supporting them is slowly lost over time and the end result is a reduction in both bone quantity and density. This situation needs to be corrected if the intention is to replace the missing teeth with implant-supported restorations as sufficient bone has to be present to surround the entire length of the implant. Bone augmentation procedures are used where only relatively small amounts of bone need to be replaced and developed. Grafting procedures are used where larger volumes of bone have been lost over time and need to be replaced.

How is the bone augmentation/grafting procedure carried out?

As with all implant-related treatment, the surgeon and nursing staff follow a strict sterile protocol in the surgery. The gum tissue is temporarily lifted up to expose the bony defect at the site for the procedure. In cases where this defect is relatively small, sufficient augmentation material is placed and a special membrane secured over the area to cover the material. The gum tissue is then replaced into position to cover the whole site. Where the bony defect is larger, a grafting procedure is required which involves the placement of a block graft, secured using fixation screws. Augmentation material is then placed around this block graft before the special membrane is secured over the area and the gum tissue replaced into position to cover the whole site.

Implant-Borne Restoration

1. Jaw bone.

2. Proposed position of implant.

3. Border of bony defect for augmentation.

4. Border of bony defect for grafting.

5. Augmentation material.

6. Block graft material (secured with fixation screw).

7. Membrane placed over augmentation / graft area.

Bone augmentation/grafting can be carried out under local anaesthesia alone or with additional intravenous sedation if required. This is inherently a more pleasant way of having potentially stressful surgical treatment carried out and is especially good if you are apprehensive as the sedative's action actually removes anxiety, so making the treatment much more comfortable.

These options can be discussed with you during a consultation appointment.

What materials are used for the bone augmentation/ grafting?

The bone augmentation material ("Bio-Oss") and special membrane ("Bio-Gide") are produced by Geistlich Biomaterials (www.geistlich.co.uk). The augmentation material is a bone substitute of bovine origin; the membrane is a collagen of porcine origin. Both have been thoroughly treated to remove all proteins and sterilised to ensure safety. The bone substitute initially acts as a scaffold but over time, it largely dissolves away to be replaced by your own bone.

"Bio-Oss" and "Bio-Gide" have been comprehensively researched and validated for use in bone augmentation and grafting procedures; detailed patient information booklets regarding these materials are available.

Can implants be placed at the same time?

It is sometimes possible to place an implant at the same time as an augmentation procedure if there is sufficient quantity of jawbone already present at the operation site to stabilize the implant. Following the procedure, the part of the implant covered by the augmentation material becomes surrounded by new bone over time.

If a graft is required, this is usually carried out as a separate procedure; the graft will need to be left to mature for around 10 months before implants are placed. The type of augmentation/grafting procedure required and the likely timescale of treatment will be discussed during a consultation appointment.

How long will the operation take?

This depends on the degree of augmentation/grafting required and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 90 minutes. When intravenous sedation is used, an appointment usually lasts 120 minutes. The longer time allows for the recovery period needed before you can be discharged home.

Will there be any stitches?

Stitches are used in the operation to help complete the surgery. A fine size of thread is used to achieve a good cosmetic result.

These stitches are dissolvable and so should disappear after about two weeks.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation, as the area of surgery will be numb from the local anaesthetics that have been used.

As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about doses.

Could there be any complications or after-effects?

After the procedure, there is likely to be some swelling and bruising in the area of the surgery and possibly some discomfort. The bruising is usually most obvious after two to three days and will vary in amount between patients. It normally resolves itself in 10 to 14 days.

As the operation site will now be of a larger volume, the area is likely to feel quite enlarged even after the bruising has subsided and the overlying gum tissue may feel different to that of the adjacent areas.

These changes in sensation generally tend to become less noticeable over time and gradually resolve as the augmented/grafted area integrates with the surrounding bone.

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible to return to work the next day.

Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

You're in safe hands

Tim Milton utilises products supplied by Geistlich.

Sinus grafting procedures

What is sinus grafting?

Sinus grafting is a particular type of bone grafting procedure used to build up the bony volume at the back of the upper jaw.

It is used to facilitate the placement of implants for the replacement of missing teeth at the back of the upper jaw.

Why would I need this procedure?

Generally, once teeth have been removed, the bone that was supporting them is slowly lost over time and in particular, this loss can be quite marked in the back of the upper jaw.

The air sinuses which are within the cheekbone and a normal anatomical feature may also enlarge slowly over time into the areas where the roots of the upper back teeth were.

The end result is a reduction in both bone quantity and density. This situation needs to be corrected if the intention is to replace the missing teeth with implant-supported restorations as sufficient bone has to be present to surround the entire length of the implant.

How is the sinus graft procedure carried out?

As with all implant-related treatment, the surgeon and nursing staff follow a strict sterile protocol in the surgery.

The gum tissue on the cheek side of the upper jaw is temporarily lifted up to expose the bone for the grafting procedure. A small window is created in the bone to access the sinus lining which can then be gradually raised. This creates a space for the placement of the graft material which will maintain the new raised position of the sinus lining.

Once sufficient graft material has been placed, a special membrane is secured over the window in the jaw bone to provide a seal and then the gum tissue is placed back in its original position.

Sinus Grafting

1. Upper Jaw bone.

2. Sinus air cavity.

3. Raised Sinus lining.

4. Graft material.

5. Implant stabalised in Jawbone and surrounded by graft / developing new bone.

6. Block graft material (secured with fixation screw).

7. Membrane placed over bony window.

Sinus grafting can be carried out under local anaesthesia alone or with additional intravenous sedation if required. This is inherently a more pleasant way of having potentially stressful surgical treatment carried out and is especially good if you are apprehensive as the sedative's action actually removes anxiety, so making the treatment much more comfortable.

These options can be discussed with you during a consultation appointment.

What is the graft material?

The graft material ("Bio-Oss") and special membrane ("Bio-Gide") are produced by Geistlich Biomaterials (www.geistlich.co.uk). The graft material is a bone substitute of bovine origin; the membrane is a collagen of porcine origin. Both have been thoroughly treated to remove all proteins and sterilised to ensure safety. The bone substitute initially acts as a scaffold but over time, it largely dissolves away to be replaced by your own bone.

"Bio-Oss" and "Bio-Gide" have been comprehensively researched and validated for use in this and other bone grafting procedures; detailed patient information booklets regarding these materials are available.

Can implants be placed at the same time?

It is sometimes possible to place an implant at the same time as the grafting procedure if there is sufficient quantity of jawbone already present at the operation site to stabilize the implant. The grafting procedure will lead to the rest of the implant becoming surrounded by new bone over time.

If it is not possible to place the implant(s) during the procedure, the graft will need to be left to mature for around 10 months before the implants are placed as a separate procedure.

Whether one or more procedures are likely to be required will be assessed during a consultation appointment.

How long will the operation take?

This depends on the degree of grafting required and whether the operation is being carried out with local anaesthesia alone or with additional intravenous sedation.

An appointment for surgery under local anaesthesia usually lasts 90 minutes. When intravenous sedation is used, an appointment usually lasts 120 minutes. The longer time allows for the recovery period needed before you can be discharged home.

Will there be any stitches?

Stitches are used in the operation to help complete the surgery. A fine size of thread is used to achieve a good cosmetic result.

These stitches are dissolvable and so should disappear after about two weeks.

Will I be in pain afterwards?

You should not feel any pain immediately after the operation, as the area of surgery will be numb from the local anaesthetics that have been used.

As the numbness wears off, the area might become uncomfortable and then you should take painkillers. We will supply you with these, with information about dosage.

Could there be any complications or after-effects?

At the time of the procedure, if any infection is found around the operation site, it might be necessary to defer the surgery and instigate the appropriate treatment to resolve this infection.

The sinus grafting procedure requires careful management and handling of the lining of the sinus (which is a delicate structure). If the lining develops a small tear during the procedure, this might be repairable prior to the placement of the graft. However, it is possible that the grafting procedure might have to be postponed to allow the tear to repair itself (usually over a 3 month period).

After the procedure, there is likely to be some swelling and bruising in the area of the surgery and possibly some discomfort. The bruising is usually most obvious after two to three days and varies in amount between patients. It normally resolves in 10 to 14 days.

Some minor nose bleeding and congestion may also occur and to reduce the likelihood of the graft becoming displaced, it is very important to avoid all nose blowing for at least 2 weeks. 

When can I return to work?

This depends on your occupation and how you are after your treatment. It may be possible to return to work the next day.

Some people need to take some time off work, especially if the operation has been carried out under intravenous sedation. We will give you appropriate advice for your particular circumstances.

You're in safe hands

Tim Milton utilises products supplied by Geistlich.

©Bath Oral Surgery Clinic Ltd - Reg. No 6127310 - Registered in England & Wales - All rights reserved | Design by Caveware