Surgery

Before the surgery

Medication

  • In some circumstances, you may have to take antibiotics before the procedure to reduce the risk of post-operative infection. It is very important to take them as they have been prescribed.
  • Given that the surgeon knows the list of medication you are taking and that none of them pose problem for surgery, you must take them at the usual time on the day of your surgery. Bring a list of medication you have taken in the last 24 hours to inform your surgeon.
  • If you take drugs like aspirin, products containing aspirin, vitamin E, or anticoagulants, it is important to inform your surgeon before the procedure. He or she will determine how many days in advance you need to stop taking them. A consultation with your treating physician may be required to assess risks associated with the discontinuation of medication before your surgery. These types of drugs have a blood thinning effect and inhibit clotting, which causes perioperative complications (more abundant or uncontrollable bleeding during and after surgery).
  • With the agreement of the surgeon, you can take a sedative if you are anxious to ensure you a good night’s sleep before the surgical procedure. This medication may be prescribed by your surgeon or by your doctor.  A patient who undergoes surgery and who is well rested will respond better to the surgery and the postoperative period.

Preoperative advice

  • Eat a light and nutritious meal on the day of your surgery.
  • Brush and floss your teeth carefully after eating and before the surgery so that your mouth is as clean as possible. A clean mouth will decrease the risk of post-operative infection.
  • Wear comfortable and loose clothing with roll-up sleeves in order to maximize your comfort and to facilitate the administration of intravenous medication during the procedure.
  • If you smoke, you should stop smoking at least a week before your surgery to increase the chances of success of the operation. Alternatives to tobacco, such as patches or nicotine gum, can be a good alternative during this period. It is also advisable to stop smoking completely after your surgery.

The surgeon will provide you written preoperative and postoperative instructions to familiarize yourself with the surgery.

Immediately after the surgery

Arrange for someone to accompany you and drive you home after the procedure, especially if you have taken a sedative. You should not drive a car because you might be drowsy for several hours. It is also recommended to have someone with you upon your return at home to assist you when needed.

It is strongly suggested to get the drugs that have been prescribed to you right after your surgical appointment in order to have them at home if some pain appears or if you must take antibiotics. It is very important to take the medication considered essential by your surgeon and to use it according to the prescription.

Back at home, you will need to follow the instructions provided by your surgeon in order to avoid post-operative complications.

Bleeding

Light bleeding may occur a few hours after surgery. A small amount of blood, mixed with abundant saliva, may seem impressive, but in fact, chances are that this is only a small amount of blood. To stop the bleeding in the mouth, you can apply a gauze or a moist tea bag on the bleeding site and bite into it or apply firm pressure for 20 consecutive minutes. Bleeding should stop by itself.

We recommend that you put a towel on your pillow when you sleep in order to avoid staining the pillow with the small amount of blood that could ooze out of your mouth.

In case of doubt or abundant bleeding, it is always recommended to contact your surgeon.

Swelling

It is normal to see some swelling (oedema) in the face after surgery. For the first 48 hours after surgery, lie with your head more elevated than the rest of the body and apply ice on your face for 15 minutes at a time followed by a period without ice of 15 minutes.  You can use ice cubes in a plastic bag, an “ice pack” or a bag of frozen peas. This will not prevent swelling to appear, but it will be less important. The maximum of swelling usually occurs between two and three days after surgery and disappears after 7 to 10 days.

After 48 hours, the ice will not reduce swelling. You can then apply moist heat, with a wet washcloth or a bottle filled with hot water.  The heat can be applied directly on your face, where the oedema is present.

Pain and inflammation

Postoperative pain can be controlled by over-the-counter analgesics such as acetaminophen or ibuprofen or medication prescribed by the surgeon. It is recommended to take a first dose of pain medication before you feel any soreness. This will ensure your comfort when the effect of local anesthesia will fade out a few hours after surgery.

Healing time

The recovery time after dental implant surgery varies from one patient to another and depends on the general health of the patient, the number of implants, whether or not a gingival or bone graft was required, and the motivation to follow the surgeon’s post-op instructions.

Remember that rest is essential to healing. During the first three first days after your surgery, only plan on doing non-strenuous activities (such as reading or watching television). Your surgeon will tell you when you can resume your normal routine.

Diet and oral hygiene

A soft diet is recommended for a few days after the surgery to allow the wound to heal properly. In fact, biting into hard food could undermine the success of the procedure.

A normal diet can usually be introduced from 7 to 10 days after surgery, according to the surgeon’s recommendations.  In some cases, the surgeon may recommend to extend the period of soft diet, but this extension is rather rare.

It is important to keep an excellent oral hygiene during the healing of the wound. Keeping your mouth clean will reduce the risk of developing an infection during the healing period. You will, however, have to adapt your tooth brushing in order to not disturb the wound unnecessarily.

Risks and complications

Despite the skills of the surgeon and the precautions taken before and during the procedure, any surgery presents some risks and a potential for complications.

Complications in implantology can be avoided in large part through pre-op X-rays to assess the position of the important structures such as the inferior alveolar nerve and the maxillary sinuses.

Keep in mind that the following complications are rare if good precautions are taken to prevent them. Implantology treatments have a very high success rate.

Here are a few possible complications:

  • Postoperative infection: Symptoms of infection include redness, pus oozing from the wound, severe pain that cannot be controlled by analgesics, as well as fever. In this case, taking antibiotics is necessary to stop the infection and prevent a relapse.  You should then consult your surgeon to evaluate your condition. However, it is very rare that the solution to infection is the removal of the implant.
  • Premature loss of stitches: This complication usually causes no problem if the surgical site is kept clean and if you take care not to disturb it during the recovery. If in doubt, you can contact your surgeon about precautions to take.
  • Altered sensation (paresthesia or numbness) in various parts of the face, like the lower lip and chin, as a result of inferior alveolar nerve damage during the procedure. In most cases, this loss of sensitivity will be temporary and will resorb during the healing process, but for a few, it may be permanent.
  • Maxillary sinus perforation: This can occur during the installation of implants in the upper jaw. In this case, the insertion of the implant may be delayed depending on the damage to the sinuses. To ensure a good osseointegration, it is important that the implant is in contact with the bone. If the sinus is perforated, osseointegration may not fully occur. A bone graft or sinus elevation could therefore be required before installing the implant again.
  • Weakening or fracture of the abutment screwed to the implant, which will support the crown, prosthesis or artificial bridge: It is relatively easy to replace a damaged abutment and this complication usually has no adverse consequences on the success of the surgery.
  • Fracture of the implant: This happens only very rarely. In this case, the implant should be replaced because it would be too complicated to repair it.
  • Osseointegration failure (inability of the bone of the jaw to fuse with the dental implant in a timely manner): In this case, surgery must be repeated with a new implant. Causes of this complication can be multiple.

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