Removal 4. Is it necessary to remove fours for braces? Is it necessary to remove teeth for braces?

Unfortunately, like any surgical procedure, a sinus lift can have complications. In most cases, the treatment is successful, but sometimes unpleasant situations such as swelling, pain, swelling, sinusitis can occur. To avoid complications, you should choose a competent specialist and follow the doctor's recommendations.

Operation

A sinus lift is a surgical procedure for increasing bone in case of its insufficient volume in the region of the lower wall of the maxillary sinus. The procedure can be carried out in open and closed ways. Manipulation steps:

Training.
Anesthesia.
Incision of tissues, imposition of bone material.
Placement of implants if necessary.
Wound suturing.
Recommendations to the patient.

Causes of complications

The causes of diseases in the postoperative period include:

Failure to comply with the principles of asepsis and antisepsis during surgery.
Insufficient qualification of the doctor.
Improper planning of the operation.
Perforation of the sinus mucosa.
Anomalies in the structure of the sinus.
The presence of chronic inflammation in the area of intervention.
Use of poor quality bone material.
Violation of doctor's recommendations.

Possible Complications

Sinusitis after a sinus lift is the most common complication, you can read more about the operation at the link. Sinusitis is called inflammation of the mucous membrane of the maxillary sinus due to a traumatic or infectious lesion. When the disease occurs, heaviness, an unpleasant and painful sensation on one (causal) side of the face. Discharge from the nasal cavity, swelling and general symptoms of intoxication of the body may appear.
Rhinitis - inflammation of the nasal mucosa and the appearance of discharge, which may be mucous or purulent in nature.
Edema and swelling can occur both in normal and pathological conditions. Swelling may be a reaction of the body to tissue injury during surgery and will disappear in a few days. If the swelling does not subside after a week, you should consult a specialist. You can read more about sinus lifting and possible swelling.
Migration of the implant into the sinus during simultaneous implantation. This does not happen often, usually when the rules of eating are not followed and biting on something hard. The sinus lift operation itself implies that there is little bone in the intervention area, so you need to be careful and follow the recommendations of your doctor.

Stick to a diet: eat semi-liquid food at room temperature.
Apply cold compresses for the first 2-3 hours.
Use medications prescribed by a doctor.
To refuse from bad habits.
1-2 weeks you can not blow your nose and sneeze heavily.
Hypothermia and baths should be avoided.
Visit the dentist for a routine checkup.

The sinus lift operation consists in thickening the bone tissue, it is performed in case of bone atrophy before the artificial restoration of the patient's upper jaw teeth. Perform the operation in the presence of indications in one of two existing ways. This surgical intervention is dangerous with possible complications and has a number of contraindications.

What is sinus lifting - description and characteristics

Today's frequent need for the installation of jaw implants is faced with an obstacle in the form of atrophied bone tissue of the patient's jaw.

The return of a bone of sufficient density, the required height and volume is done by holding sinus lift. After strengthening the jaw bones, implants installed in place of missing teeth will be able to withstand significant biomechanical loads that are characteristic of the process of chewing food.

When a person loses a tooth for any reason, the bone in this place begins to gradually atrophy, because it no longer experiences the chewing load that stimulates its development and strengthening. Over time, the bone decreases in volume. This makes implant placement difficult.

If you try to place the implant on a bone base of insufficient width and height, you can damage the shell of the maxillary sinus.

A sinus lift is a complex dental procedure. bone mass increase human upper jaw. This surgical intervention with the help of microsurgical technologies is performed in the absence of a person's lateral teeth. The procedure is performed on the border of the hollow maxillary sinuses and the bone tissue of the upper jaw.

This operation has been performed by dental surgeons around the world for over thirty years. Today, almost all clinics install dental implants only after previous sinus lift.

During the operation, the bottom of the mucous membrane of the maxillary sinus is slightly lifted with surgical instruments, then the resulting space is filled prepared bone material on a natural or synthetic basis.

The result is a solid foundation on which implants longer than 10 mm can be placed.

When a sinus lift is prescribed - indications and contraindications

The main indication for this procedure is the lack of bone thickness in the region of the maxillary alveolar process.

Bone deficiency occurs due to:

Reducing the size of the gingival bone in the area of the tooth removed from the patient.
The specific structure of the jaw.

To date, according to statistics, the operation is indicated for about half of the patients who need the upper jaw!

The remaining 50% of patients have either general or specific contraindications for its implementation.

General contraindications include:

Oncological diseases.
AIDS.
Drug addiction.
Heart failure.
Alcoholism in the chronic stage.
Patient's bleeding disorder.
Current exacerbation of chronic diseases.

Among the specific prohibitions on the operation, the following should be highlighted:

Acute or chronic sinusitis or sinusitis.
The presence of polyps.
Abnormally close location of the maxillary sinuses relative to each other.
Congenital disorders in the form of multiple partitions.
Unsatisfactory condition of the patient's bone tissue.
Previous sinus surgeries.

How is the sinus lift operation of the lower and upper jaw performed?

Sinus lift surgery is performed under local or general anesthesia.

Depending on the indications, it can be done in two different ways:

open.
closed.

Open sinus lift d is shown if the alveolar process of the bone has a thickness of not more than 9 mm. This method of operation allows you to build up a sufficiently large amount of bone tissue.

The first step in open surgery is the incision of a flap of gum tissue over the upper row of teeth.
Then the flap is turned to the side, freeing access to the maxillary sinus.
A hole is drilled into the bone, through which a bone-forming biological material is then introduced into the resulting cavity.
To prevent voids in the cavity, the biomaterial is tightly packed.
In the final phase of the operation, the hole is closed with a flap of gum tissue using a surgical suture.

After an open sinus lift, implantation can only be done a few months later. This time is necessary for the complete healing of the postoperative wound.

With a bone thickness of more than 10 millimeters sinus lift is performed in a closed way which is less traumatic for patients.

Its algorithm is as follows:

Right in the place of the missing tooth, a small hole is drilled leading to the maxillary sinus.
Through it, restoring bone material (synthetic or natural) is placed on the atrophied part of the jawbone.

As a rule, the installation of the implant is done immediately after the completion of the sinus lift of the closed type!

Videos There is a lot of detail on YouTube about this procedure.

Edema and sinusitis after sinus lift surgery

Despite its apparent simplicity, sinus lift is a very complex operation, which often leads to complications.

The most common negative effect is rupture or perforation of Schneider's inner membrane. As a result of such damage, the infection enters the region of the upper jaw.

The patient develops postoperative sinusitis or sinusitis.

In addition, other serious complications also occur:

Excessive implant mobility.
The appearance in the patient, as a result of damage to the sinus, a runny nose of a chronic nature.
Damage to the sinus by an implant that got inside it.
Bleeding.
Fistula formation.

All the complications that have arisen are accompanied by local pain, a possible rise in temperature, and swelling at the site of the manipulation, gradually passing to neighboring tissue areas.

In order for a person to recover safely after a sinus lift and avoid dangerous complications, it is recommended that he carefully follow all medical recommendations in the postoperative period!

What is impossible after a sinus lift - features of the postoperative period

After sinus lifting, swelling may appear in the area of the operated site.

To reduce swelling or even prevent it, you need to apply a cold heating pad wrapped in a towel to the outside of your cheek for the first two days. Ice or very cold water can be placed in a heating pad. Keep the cold near the operated area for five to ten minutes, taking half-hour breaks between manipulations.

After a sinus lift, the patient should refrain from:

Cheek puffing.
Intense blowing nose.
Sneezing with closed mouth.
Air travel by plane.
Swimming and diving.
Any physical activity.
Overheating or hypothermia of the body.
Situations associated with possible differences in pneumatic pressure.

You should also not drink water or other liquids with a straw.

You need to blow your nose or sneeze with your mouth open very carefully, it is better to simply remove the mucus from the sinuses with a tissue or handkerchief.

No food should be taken immediately after the operation for two hours!

Important! Do not rinse your mouth! For effective recovery in the postoperative period, baths are required!

When a patient has slight bleeding, fever, pain at the suturing site, runny nose after a sinus lift, symptomatic treatment is necessary.

If soreness, bleeding and fever do not go away during the first three postoperative days, you should definitely seek medical help.

Removable dentures should not be used for two weeks after the operation!

After 14 days, you do not need to try to put on the prosthesis yourself. It is necessary to go with him to the clinic so that the doctor can correct the prosthesis, taking into account the changes that have occurred in the jaw.

You can brush your teeth on the second day after the operation, but only with a soft brush and without toothpaste!

After a sinus lift, patients return to their normal lifestyle after 3-4 weeks.

The price of open and closed sinus lift

The cost of a sinus lift consists of:

The examination is carried out to identify or exclude congenital or acquired anomalies in the operated area.

The price of the operation depends on the method of its implementation:

Cost of an open sinus lift is approximately 35-60 thousand rubles. Such a wide range of prices depends on the number of implants that will subsequently be installed.
closed type operation costs less - from fifteen to thirty-five thousand rubles.

The cost of this operation is largely determined by the bone-forming material used.

Sinus lifting is a surgical intervention, a type of bone grafting, designed to increase the volume of the bone tissue of the upper jaw in order to further install a full-fledged tooth implant. The procedure itself should be completely painless due to the combo or conduction anesthesia used, but all sorts of uncomfortable sensations can develop after the anesthetic wears off.

They can be both a variant of the norm (due to the surgical impact, and not a violation of the integrity of the bone tissue during the operation), and they can signal the complications that have appeared.

Normal condition after surgery

After a sinus lift, as after any other surgical intervention, there may be slight swelling, pain, and a general or local increase in temperature. This condition is considered a variant of the norm, lasts for the first 3-5 or 7 days and resolves on its own or with the use of small doses of NSAIDs, local drugs or antiseptics. Such manifestations are not necessary, they may not occur at all, making the postoperative period absolutely painless.

To alleviate the condition, the following medicines can be used:

- Ibuprofen 200 mg up to 4 times a day, Diclofenac 25 mg up to 3 times a day or Nimesulide 200 mg up to 2 times a day. Do not take drugs for more than 5 days. In the presence of gastritis or gastric ulcer, Ibuprofen and Diclofenac should be abandoned or taken simultaneously with Famotidine 40 mg 1 time per day at night or Omeprazole 20 mg 1 time per day.

- Oflokain ointment. Combined drug that has antibacterial and analgesic effects. It should be applied up to 3 times a day at the site of surgery.

- An aqueous solution of Furacilin or Chlorhexidine. They are used as baths for the oral cavity in order to eliminate blood clots, films after surgery or pieces of food in the first days after the intervention. Both agents have a significant calming, distracting and antiseptic effect.

Important: The post-surgery package contains a second box containing your antibiotic and pain medication. Read the instructions carefully and take the medicines according to our recommendations. Ketanov is not sold without a prescription and if you are prone to severe pain, take an additional pack of Ketanov or Ketorol from the reception.

Possible causes of pain

Any pain for longer than three days may indicate that complications have developed after a sinus lift. They may be associated with the penetration of pathogenic microflora into soft or bone tissues, displacement of bone mass, or damage to the maxillary sinus. In the first days, it can be problematic to distinguish complications from the normal state due to the freshness of the surgical wound and the individual characteristics of pain perception. The presence of complications is determined by the clinical picture during the first 7-14 days or according to additional studies (general blood count, X-ray of the upper jaw and maxillary sinus).

In cases of prolonged pain that is not relieved by the drug for more than two hours, immediately contact our 24-hour Medical Post service by phone from the postoperative recommendation card.

Displacement of bone mass

The bone material is displaced, as a rule, due to a violation of the security regime by the patient in the first week after surgery. This may be due to the following actions of the patient in the postoperative period:

coughing or sneezing, trying to blow your nose;
eating on the operated side;
drinking through a straw, vacuum loading;
blows and injuries in the head area;
sports.

In cases of combined sinus lifting and implantation operations, there is always a risk of implant rejection, which also manifests itself with increased pain in the area of implantation. Such a complication can manifest itself with a wide variety of symptoms, the most common of which is micro-movement of a dental implant with little or no pain. There may be swelling, bleeding. If the displacement of the bone mass is accompanied by a violation of the integrity of the mucous membrane of the maxillary (maxillary) sinus, then bloody discharge from the nose and the development of sinusitis are possible. When performing an open sinus lift, the exposure of the bone material is often combined with the divergence of the sutures, which is easy to detect by the resulting open wound, bleeding.

Diagnosis of this complication is made during a visual examination in the dental office, the study of implant mobility and an emergency x-ray of the upper jaw.

The displacement of the bone mass in most cases will require repeated bone grafting in order to secure the denture. The development of this complication occurs in the first 5-7 days. If it occurred a month or more after the operation, then this may indicate a violation of the processes of ossification and healing, as a result of osteoporosis, age-related changes in bone tissue or calcium deficiency in the body.

Penetration of infection

Infection of the surgical wound is the second most common complication of any intervention after bleeding. It occurs due to changes in aseptic conditions around the incision. It is especially difficult to ensure the absence of pathogenic microflora in the oral cavity, due to its anatomical structure, constant food intake and contact with the environment. Any inflammation leads to pain, fever, swelling, in severe cases - to purulent discharge. After sinus lifting, the development of gingivitis, periodontitis, alveolitis and the most severe complication, osteomyelitis, is possible. Osteomyelitis never causes pain, it is a very insidious condition, masked and painless during which can go on for years and lead to severe changes in the structure of bone tissue.

Gingivitis

Inflammation of the soft tissues of the gums is one of the most frequent infectious and inflammatory processes in the oral cavity, not only after bone grafting, but also in everyday life. Its symptoms are: swelling of the gums, pain even with a slight touch, redness, local or general fever, in some cases, the appearance of purulent discharge.

Usually, gingivitis provokes the sharpest soreness of the gums and the patient instantly returns to the attending physician with a lot of questions. This circumstance does not allow starting the inflammatory process and bringing inflammation of the gums to the next most complex disease - periodontitis.

Diagnosis is made after a visual inspection and assessment of the condition. For treatment, rinses with a solution of Furacilin, Chlorhexidine, chamomile infusion, antibacterial ointments, NSAIDs and, if necessary, broad-spectrum antibiotics (Amoxiclav, Cedex and others) are used.

Periodontitis

It is characterized by a deeper inflammatory process that captures the periodontium - a hard tissue that fixes the roots of the teeth. Left untreated, permanent teeth and dental implants may fall out. The disease can occur in conjunction with gingivitis. Its symptoms include symptoms of gingival inflammation along with sensations of "itching" in the teeth, loosening, discomfort when eating, bleeding. The appearance of purulent discharge is characteristic of severe cases of the disease.

In addition to examination, radiography is used in the diagnosis. For treatment, it is necessary to remove all plaque and stones, caries. Drug treatment consists in the use of the same means as for gingivitis, antibiotics are mandatory. In advanced cases, the implant is removed with periodontal cleaning.

Alveolitis

With an even greater deepening of the infectious process, alveolitis develops in the tissue of the upper jaw. Inflammation of the alveolar process of the upper jaw is accompanied by aching pain, body temperature up to 38-39 ° C, intoxication. The pain can be given to the eye, ear, upper lip, wings of the nose. This unpleasant condition occurs only when implantation, multiple removals are combined with sinus lifting.

Diagnostic methods are similar to those for periodontitis. The main drug for the treatment of alveolitis is an antibiotic. Levofloxacin, Sumamed, Lincomycin, Ceftriaxone are most suitable. Duration of administration and dosage are selected individually. NSAIDs are used, in case of severe symptoms of inflammation - glucocorticosteroids, the use of ointments and rinses remains relevant. In severe cases, it is necessary to carry out surgical cleaning of the alveolar socket.

Usually, in order to prepare for osteoplastic operations in our clinic, it is customary to carry out a preliminary preventive cleaning. If there is a risk of infection from chronic foci from the oral cavity, then without a visit to a periodontist, you will be denied an operation.

Osteomyelitis

Purulent lesion of bone tissue is the most severe complication of any dental intervention. It is characterized by severe pain, severe intoxication, swelling can spread to the cheek, zygomatic arch, the temperature reaches 40 ° C, in severe cases - sepsis. Often observed purulent or putrid discharge from the surgical wound, from under the gums, bad breath.

In order to determine the prevalence of the process, MRI is possible. For medical treatment, it is necessary to use not only the latest generation of cephalosporin or penicillin antibiotics, but also detoxification therapy in the form of intravenous drip of colloidal and crystalloid solutions, glucose with ascorbic acid. Surgical treatment, unfortunately, consists in removing the implant, cleaning the bone tissue from pus and setting up drains. It is unpleasant that osteomyelitis is very rarely accompanied by sharp pains, osteomyelitis behaves very quietly.

This complication, which causes a lot of unpleasant inconvenience, is possible in cases where the operation is performed on an underexamined patient prone to inflammation, or in cases of non-compliance with the recommendations of the postoperative period and the impossibility of showing up to the attending physician on time.

This is the saddest circumstance, often leading to repeated operations. Violation of the integrity of the mucous membrane of the maxillary sinus is possible both during osteoplasty and in the first week after it, due to displacement of the bone mass and / or temporary denture.

In the absence of infection, the complication does not require significant attention and may not be accompanied by pain, bloody discharge from the nasal passage for the first three days. But when an infection is attached, acute sinusitis develops, which requires immediate treatment using NSAIDs, antibiotics from the category of macrolides or semi-synthetic penicillins and Polydex or Isofra nasal sprays. In some cases, a puncture of the maxillary sinus is possible and welcome.

Pain after sinus lift and bone grafting associated with sinusitis are dangerous because the infection from the maxillary sinus can pass to the newly installed implant, which will lead to a number of other complications. Among other things, the presence of sinusitis can contribute to the development of frontal sinusitis, otitis media and other inflammatory processes in the region of the facial skull.

Important: To be honest, perforation of the maxillary sinus membrane is the rarest complication in the practice of an adequate maxillofacial surgeon. If the operation is performed by a specialized specialist, then the patient is always safe, a dental surgeon with straight arms may also have the necessary skills, but the risk is minimal precisely in the performance of specialists who have exactly expert competence in this area, combining ENT surgery and maxillofacial surgery.

Prevention of complications

We must take care of ourselves in the postoperative period. Lifestyle in the first week after the operation includes the following features:

1. Teeth cleaning is carried out twice a day (in the morning and before bedtime) using a special dental paste. Solcoseryl, Lacalut, Sensodin have proven themselves well. You should choose a remedy with anti-inflammatory and antimicrobial effects.

Eating should be carried out exclusively with chewing on the healthy side in order to avoid disturbing the location of the bone mass and the implant.
In the first 10-14 days, any sports and physical activity should be abandoned, especially running, cycling, swimming, extreme activities. From practicing any kind of martial arts should be abandoned for 1 month. This may cause bleeding, which may frighten you.
During sleep, stress on the operated side should be avoided.
Sneezing, coughing, drinking through a straw is also prohibited.

Medical prevention

It consists in the use of drugs of various forms and groups in order to prevent the development of infectious complications in the early days.

Oral baths with Chlorhexidine solution are carried out up to 5 times a day, both with and without pain. Proper rinsing after a sinus lift is to move the fluid to the operated side by tilting the head. Active movements of the tongue and cheeks in order to create fluid vibrations are contraindicated.
The use of ointments of the type of Oflokain is necessary to eliminate pathogenic microflora. The ointment is applied up to 3 times a day.
The use of analgesics and NSAIDs is aimed at eliminating pain and relieving swelling. Their dosages and uses have been discussed above.

In order to prevent the development of all kinds of complications, a number of rules of conduct after the intervention should be followed. In the presence of pain after sinus lift and bone grafting that fit the description of the normal variant, prophylactic drug treatment should be performed.

Important: All pains require mandatory correction, all drugs for the postoperative period are already included in your postoperative recommendations package. Carefully study the instructions and boxes with drugs from the postoperative box, put aside some in a travel bag if you need to travel, the pain cannot be tolerated.

10.11.2017

Reminder after sinus lift

A common surgical operation in dentistry that helps increase the height of the jawbone, which is often required before dental prosthetics. A sinus lift is a rather serious operation that threatens with a number of complications if the wound is not properly cared for, which is why a reminder after a sinus lift is so important.

Thanks to her, the patient receives detailed recommendations on caring for a wound after a sinus lift, learns about how long the rehabilitation lasts and what undesirable consequences are possible in this period, how long the gums heal and what to do to speed up this process.

In this article, we will tell you in detail what a reminder after a sinus lift is, about what you can and what you absolutely cannot do after the operation.

Recommendations after a sinus lift, features of the rehabilitation period after surgery are the main points that the memo includes. The duration and severity of the rehabilitation period and the healing time of the gums depend on whether the patient observes or does not follow the recommendations after the sinus lift.

The patient must strictly adhere to all the recommendations indicated in the memo, take antibiotics strictly according to the scheme. We will tell you more about what is possible and what is not possible after a sinus lift a little further, and now we will figure out how long the rehabilitation after a sinus lift lasts and what symptoms can normally develop in this period.

So, rehabilitation after a sinus lift lasts an average of 4-9 months - it all depends on the individual characteristics of the patient's body, the thoroughness of following the recommendations. The doctor should warn the patient about the possibility of developing in the early postoperative period symptoms such as edema, hematoma, pain, nasal congestion, bloody discharge from the nose, or slight bleeding, blood taste in the mouth.

All these symptoms are directly related to injury to hard and soft tissues and should normally disappear within 3-4 days. Pain may persist a little longer - in some cases even up to 14 days after the sinus lift has been performed. Rehabilitation is normally not accompanied by an increase in body temperature - such a symptom may indicate the addition of an infection.

How long does the gum heal after a sinus lift

One of the most worrying questions for patients is how long the gum heals after a sinus lift. There is no single question for this answer, since how long the gum heals after a sinus lift depends on many factors - the state of the patient's immunity, the state of the blood coagulation system, the volume and type of operation, the presence or absence of complications, the patient's compliance with the doctor's prescriptions.

In most cases, after a sinus lift has been performed, gum healing takes about 5-7 days. If there are any disorders on the part of the patient, or if complications develop after the sinus lift has been performed, the healing of the gums can take from two weeks to two months.

The rate of gum healing for an open sinus lift is 3-7 days, and after a closed one - even faster.

Do's and Don'ts After a Sinus Lift

In addition to handing the memo, the doctor should always verbally explain to the patient in detail what is possible after a sinus lift and what is absolutely impossible. Only by following the recommendations, the patient can speed up the recovery period and avoid unwanted complications.

What can be done after a sinus lift

The operated patient can only take warm, soft food, preferably on the side opposite to the one where the procedure was performed. After eating, it is recommended to take baths with antiseptic solutions (Chlorhexidine, Miramistin). You can brush your teeth only on the second day without using toothpaste. To do this, use a soft toothbrush, avoid the area of operation.

Also, the patient is advised to sleep with their head up, and cold (through a towel) can be applied to the cheek on the side of the operation to reduce swelling. The memo should also include a list of medications to be taken after surgery.

What can not be done after a sinus lift?
In order for the rehabilitation period to pass quickly and without complications, the patient must adhere to some restrictions indicated in the memo. So, after a sinus lift, you can’t do the following:

eat hard, hot, spicy food;
go in for sports, visit saunas, swimming pools, solariums;
sneeze, blow your nose, puff out your cheeks;
carry out air travel, dive;
drink alcohol, smoke;
use a straw when taking liquids.

After a sinus lift, you should also not sleep on the side on which the operation was performed, or lean forward.

After the procedure, a lot depends on the patient: he must strictly follow the doctor's recommendations, otherwise dangerous complications may occur after the sinus lift. If the patient strictly adhered to the prescriptions, and still there were problems during the post-implantation care, then this means that he did not undergo an insufficiently detailed examination, or the doctor deliberately took some risks. Therefore, the assertion that sinus lifting is necessarily accompanied by any complications is a myth. They arise either through the fault of the doctor, or as a result of the negligent attitude of the patient.

Sinusitis after sinus lift

One of the main complications of a sinus lift is damage to the Schneider's membrane, which is located in the area of the maxillary sinuses. Especially if the procedure is carried out not with the help of ultrasonic instruments, but with the use of traumatic manual elevators. Damage to the membrane leads to infection in the maxillary region and causes a disease such as sinusitis, or sinusitis. In the acute stage of sinusitis, as well as any infectious disease, in no case should a sinus lift be performed. Therefore, before performing bone grafting on the upper jaw of such a patient, we will definitely prescribe him a two-week course of treatment, which helps to cleanse the maxillary sinus from bacteria.

What does pain, bleeding and fever indicate?

In the first few days after the operation, all patients are under the supervision of a specialist, the first visit to which should take place three days later. During the examination, a highly qualified doctor immediately understands whether the patient followed all the instructions or not, and fixes the problem on the spot. However, there are times when a patient gets to an unprofessional doctor who pays little attention to his well-being. In this case, it is important to independently identify signs of possible complications, which are characterized by the appearance of temperature, impaired nasal breathing and heavy bleeding.

In fact, after the rehabilitation period, there should be no pain and complications. Therefore, any abnormal condition, whether it be pain or feeling unwell, is the first signal that it is time to consult a specialist.