After Placement of Dental Implants
Dental implant surgeries all have one thing in common: a dental implant is placed in the jaw for one reason or another. However, the situation for each patient and the purpose and position of the implant varies widely depending on what is trying to be accomplished. Therefore, our dental implant instructions will discuss a specific set of general dental implant instructions and then break down each clinical scenario. This should help you know how to care for your specific situation and minimize any confusion.
Typically, pain is not too severe in dental implant patients. Front upper jaw implants typically hurt very little; however, lower jaw implants sometimes hurt worse in the molar area. Occasionally, the pain will persist in lower implants longer than a week, and additional treatment such as steroids might be needed. If you have pain that is severe and persists longer than a week, please contact our office. The good news is that many patients require very little pain medicine after surgery, and they find the procedure to be less painful than they expected.
Many implant patients report very little bleeding after surgery because the implant will help close off a socket, or the gums will be tightly closed around the implant. Bleeding can occur and should be managed with gauze pressure as shown to you before and after surgery. If bleeding is more severe than expected, please apply firm pressure on the area by biting down on the gauze for a straight 45 minutes without removing the gauze. If the bleeding continues, then reapply the gauze with firm pressure. Ice packs are also helpful with bleeding and keeping your head elevated will benefit you as well. Most cases of severe bleeding will subside if these instructions are followed. Being sure that you are taking enough pain medicine and keeping your blood pressure under control can be very important as well. If you are on a blood thinner and bleeding persists after 24–48 hours, then you may want to contact Dr. Collins for further discussion. Severe bleeding is very atypical after dental implant surgery.
Swelling usually peaks about 3 days after surgery. We encourage you to keep your head elevated (in a recliner or on several pillows) for 3–5 days to reduce swelling. Using the cool jaw ice packs are very important and can minimize swelling as well. Make sure you change out the cool jaw ice packs about every 2 hours and watch for excessive redness where the ice is applied. If this is the case, you may need to take periodic breaks using the ice. Many patients will receive a steroid dose pack after surgery for swelling; however, this is not routine for all implant patients. Most of the time, it is the patients that end up having more extensive surgery. If you develop a late swelling (after a week or two), this could be a sign of an infection, and you will need to contact our office.
GENERAL CARE OF YOUR MOUTH
Every implant situation is slightly different. However, it is best not to rinse for the first 24 hours. Unless your specific instructions say otherwise, rinsing with warm, lightly salted water usually starts on the second day after surgery. We recommend saltwater rinses at least 3 times per day. In all situations, the important objective is to keep the implant brushed and as clean as possible to reduce plaque buildup. In some situations, the implant parts are not visible; however, the implant area should still be kept clean with gentle brushing and saltwater rinses. We recommend the universal use of long-term Peridex™ (chlorhexidine) brushing starting 2 weeks after implant surgery. Peridex is not meant to be used as a rinse! Typically, you will use this about every third day with normal hygiene tooth brushing occurring 2–3 times per day otherwise. Specific instructions may be given to you regarding Peridex, and we will discuss these with you during the pre-operative and post-operative time frame. Additional mouth care instructions will be given to you that are specific to the procedure you had done.
DETAILED HYGIENE INSTRUCTIONS
To prolong the life of your new dental implants, maintaining oral hygiene is of utmost importance. Here are some important tips to follow to keep them in tip-top shape!
- Twenty-four (24) hours after surgery, begin using warm, diluted saltwater rinses to promote healing. These should be done at least 3 times per day.
- Starting on the second day after surgery, the implant sites should be brushed with a small, soft (child’s) toothbrush. At first, you can use just warm salt water if desired and eventually advance to toothpaste. Peridex brushing for a new implant or a recently uncovered implant usually is not necessary until around 2 weeks post-surgery or post-uncovering. Peridex brushing should be reviewed with you, and it is just to be performed around every second or third day in most implant cases.
- If good brushing techniques are used, no electric brush is needed. For some patients, a Sonicare toothbrush can be helpful.
- Non-metal proxy brush attachments or soft picks are available for cleaning between teeth.
- We recommend a Waterpik in many situations. For our fixed detachable implant appliances (All-on-4® appliances), we will go over Waterpik instructions in detail. It is very important that it is done properly, and we typically recommend a combination of Peridex and tap water to use under these appliances to keep the areas clean.
Some surgeons will not place implants in people who smoke. We have found that smokers tend to do fairly well early on but will often lose more bone quicker, which can result in the implant failing. There is also a slightly increased risk of early failure in smokers. We encourage you to stop smoking at least 2 weeks before surgery, but stopping a few months before is preferable. If you are a smoker, we will ask you to sign a smoker’s consent, which indicates you understand that you are at an increased risk of implant failure and that our office is not financially responsible for any implant failures in patients that smoke.
A dental implant is a foreign body placed in the jaw. Many years ago, this would be in no way considered possible, but now we know that dental implants are highly successful and have a great track record. Nonetheless, implant problems and/or failures do occur. We want you to understand that implants fail for many reasons. Sometimes, it can have nothing to do with the surgical technique. Experience plays a large role in the success of your implants. Most implant failures occur for unknown reasons. However, in the vast majority of the population, implants work exceptionally well. The location in the mouth affects implant success as well as bone quality. Other medical conditions, such as Vitamin D deficiency, diabetes, chronic steroid use, and many other medical conditions can contribute to implant failure. Following instructions and attending all of your post-operative appointments are very important to your long-term implant success. Even with all our greatest efforts, occasionally we will have unexplained failures and problems that arise. We have a policy of trying to replace failed implants at minimal or no costs to patients. There is not a specific warranty, and there is no time frame as to when this elapses. We stand behind our work and try our best to minimize any expenses if you have any problems in the future. There are some costs that are somewhat out of our control, which includes a need for future bone grafting, facility fees, and anesthesia. We do our best to take care of you and make a commitment to your long-term implant success. Certain situations are unavoidable and not predictable. Unfortunately, we cannot incur the costs of highly unexpected events and certain unexpected situations such as the need for a hospitalization, long-term antibiotics, etc. These types of complications are rare, but we want you to realize this is a cooperative effort, and maximum compliance is important for both parties.
The day of surgery, you should only consume liquids or very soft foods. It is usually best not to consume anything until 2 or 3 hours after surgery with general anesthesia. Pain medication and antibiotics, if needed, can be taken after a small amount of liquid or very soft food has been consumed. It is very important to maintain good nutrition for proper healing.
Newly placed implants have a vulnerable time frame for a few weeks, so extensive chewing forces placed on the implant itself can result in implant failures. If you have had implants placed on one side of your mouth and the other side is normal, then we recommend chewing on the non-surgical side of your mouth until healing is complete. If you have a temporary crown placed on an implant, it should not be in the bite when we finish the procedure. It is very important that you chew in other areas of your mouth and be very conscious of avoiding this tooth when you chew. If you have implants underneath a regular denture, it is very important to be cautious with your chewing for several weeks. If you have a fixed All-on-4® type of appliance, we recommend staying on a very soft, no-chew diet for approximately 4 weeks and then an extremely soft diet for about 3 months after this.
Our long-term goal is to have you chewing normally and functioning better than you were before implant surgery! Please bear with us during the healing phase and understand that excessive forces placed on healing implants can result in problems.
Nausea can occur after general anesthesia or with the use of pain medication. Remember, do not take the pain medication on an empty stomach. If you were given medicine for nausea, you will find this very helpful. Nausea is rare and usually does not last very long.
Occasionally, implant placement or the preparation for implant placement requires supplemental procedures. These procedures require special instructions which may or may not apply to your clinical scenario. If they do apply, we will review these instructions with you. If they do not, you can ignore them. They are as follows:
SINUS LIFT SURGERY
The upper jaw has a very large sinus in it on both sides called the maxillary sinus. Frequently, the sinus dips down relatively low in the back part of the upper jaw and limits the amount of bone available to place implants. Occasionally, a sinus lift is performed to lift the sinus membrane up out of the way so that bone and implants can be placed in this area. When we do a sinus lift, it is important to follow what we call sinus precautions. They are as follows:
- Do not blow your nose for 1–2 weeks after surgery. We recommend using a saline nasal spray to sniff back several times per day to keep your sinuses draining properly and to prevent the need to blow your nose. This is very important and should be strictly followed for approximately 2 weeks.
- If you feel the need to sneeze, please be sure to keep your mouth open so that air can flow out of your mouth and not build up a lot of pressure inside your sinus. We will often suggest that you use Afrin Nasal Spray after a sinus lift. This is a decongestant that can be used twice daily. It is mostly designed to keep the sinus passages open and the nasal cavity open for air transfer. Long-term use of Afrin can be addictive, so we recommend it be used only for the first 2–3 days and longer than this if severe nasal congestion is present. Do not use longer than one week.
- We typically prescribe an antibiotic to be taken for a week following surgery. Please remember to take your probiotic as instructed while you are taking the antibiotic to minimize antibiotic complications.
- It is possible to have a small amount of blood come out of your nose the night of your surgery on the side where the sinus lift was performed. This should not be concerning unless the bleeding persists and is more than a few drops.
All of these instructions are essentially designed to prevent the movement of the bone graft and allow for proper healing from your sinus lift.
If you experience a sinus infection, where you have pain on the side we operated on at any time during the post-operative period (even a few months down the road), please notify us.
Bone grafting can come in many forms when done in association with dental implants. The most common form of bone grafting involves grafting a tooth socket that has experienced bone loss, with or without implant placement. If a tooth has extensive bone loss around it and a dental implant is needed, frequently all the bad tissue in the socket has to be removed and new bone placed. Many times, this can be done at the time of implant placement. But other times, it is done as a separate procedure, and the implant is placed later. The most important thing to remember about the placement of bone graft material is that we want the bone graft material to stay in place. Excessive rinsing in the first 2–4 days after surgery could potentially displace the bone graft material, and use of the syringe to flush out a specific socket that has bone graft material in it would be contraindicated because it could flush out the graft material as well.
Other examples of grafting could be larger bone grafts harvested from the jaw and/or hip area. These types of grafts are placed with screws, and the bone is covered very well by gum tissue. It is important to use saltwater rinses in these situations. Please let us know if you feel like the graft is exposed in your mouth or if any of the screws become exposed as well.
If a partial denture or complete denture is worn on top of a bone grafted area, this should be done very cautiously, and close follow-up is needed. Abnormal pressure placed on a graft can cause graft failure; therefore, we ask that you follow all of our instructions very carefully if you are wearing a partial or complete denture over a bone grafted area. At times, the denture will have to be left out after surgery, but we will discuss these instructions in detail with you if this is your case.
The following post-operative conditions may occur in some patients while healing is progressing normally:
- There may be swelling on one or both sides of the jaw.
- Numbness around the corner of the mouth or tongue may develop. Please notify us if this persists for longer than 5–7 days.
- Mild, occasional bleeding from a healing socket may occur.
- Bruising can occur; however, it is rare.
- You may have difficulty opening your jaw for a few days.
- There may be some tenderness around the IV site in your arm. If this should occur, elevate your arm (on pillows) and apply warm, moist heat. Call our office if this persists for greater than 24 hours.
- After anesthesia, the risk of fainting is higher. Please stand up slowly and ask for assistance immediately following surgery.
- Infections are rare after oral surgery. Usually, swelling within the first week is not related to an infection. The mouth will develop a yellow scab over a healing extraction site. This should not be confused with an infection.
- Small bone fragments can work their way to the surface during the healing process. Generally, these will resolve with time.
Implants that are buried under the gum tissue when placed are typically uncovered in a minor surgical procedure 2 months later in the lower jaw and 4 months later in the upper jaw. After the implants are uncovered, a small healing abutment will be placed on the implant. This healing abutment is left in place while the tissue heals and gets ready for the final crown. During this process, it is very important that the healing abutment be cleaned regularly by brushing and flossing. The tissue is susceptible to inflammation and infection during this time frame, and meticulous hygiene is very important.
Please keep in mind that it is reasonable to expect your normal activities to be disrupted following a surgical procedure.
If any problems arise or if you have any questions, please call. We really do care!