[Surgery]  bone wax?

Hi guys


Had an interesting surgery last week, I removed remaining lower teeth, reduced/levelled bone, and placed two implants for future locator attachment. 


Anyways, as I reduced bone, there was excessive bleeding from the bone in one area in particular (33/32 area), it was actually spurting out of the bone!  Anyways, I was able to control with pressure eventually, but took a while.


I have always heard to have some bone wax on hand in case you need it, I did have at one point when I first set up my implant supplies, but nonetheless have never needed it and couldn't find it during the appt last week.


Anyways, I've got some in now for use the future. 


Is it as simple to use as wiping it over the area?  I would assume it is a last resort type of thing, if not clotting with pressure?


My question is, do you leave the bone wax over the area once clotted or do you wipe it away?  Could that not start the bleed again?  It says it is non-absorbable, which would be a concern if left? 


If I was placing an implant in the 32 site, would I not want to use bone wax there?


Just curious your thoughts.


As always, thanks!



by Sean Bicknell at Tue, Jan 29, 2013 12:24 AM

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Sean Bicknell Replied at Tue, Jan 29, 2013 4:06 PM

Thanks Bernard! Epi and pressure eventually settled it down, just took a little while! Nice to know how you'd use bone wax if needed. Take care! Sean

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Bernard Jin Replied at Tue, Jan 29, 2013 6:02 AM

Good question Sean. Yes - bone wax is non-resorbable. If you place a very small amount to contain the bleed (as in 2mmx2mmx2mm), it should probably be fine. Ideally, you would have to return to retrieve it if the body is unable to heal around it. Note: I said heal 'around' it & not 'heal into' it - as in regeneration. It is afterall a foreign body. The squirter you encountered was likely an accessory vessel to the lingual perimandibular vessels that can traverse into the anterior mandible. The 'squirt' can be surprising - especially if it was unexpected. My course of action is obviously suction, local anesthetic (for the epi effect), and possibly collapse of the vessel (through crushing the adjacent bone onto the vessel) or implant placement into the site (if applicable). If all fails - then i'd go to bone wax. As for the application of the bone wax i pick a 'dab' of it with my periosteal and spread it into the site with an apical motion so as to lodge the wax there.