Post Operation Patient Care Instructions

Pre-Op: Dental Implants

A dental implant is the foundation for a tooth that will replace what was lost.  Implant dentistry is a state of the art method for tooth replacement.  We believe you will be very happy with the outcome of your upcoming surgery and especially with the final restoration you should receive a few months from now.

Every surgical procedure comes with risks, the possibility for complications, the occasional need for additional steps, and of course, rewards.  Implant Dentistry is no different.

Risks and possible complications in implant placement may include:

1. Infection - it could be associated with the implant site or areas near the implant such as the sinus or nasal area for upper implants or the floor of the mouth or neck for the lower implants. 
2. Excess pain not completely controlled with our pain control protocol.
3. Non integration with the bone resulting in loss of the implant or partial uncovering of the implant during the initial two month healing phase that leads to implant loss.
4. Post operative paresthesia - meaning you could feel numb or have altered sensation either temporarily or permanently associated with the area of the surgery.
5. Excess swelling and/or possible hematoma (black and blue mark) associated with the site of the surgery or anesthesia.
6. Uncontrolled bleeding that starts after you are released from the office.
7. Additional bone grafting may be needed along with the implant placement to idealize the site.
8. Or we may find that even with the best planning, the site where we want to place the implant turns out not to be ideal and is in need of further treatment before we can actually place the implant.  This could mean upon starting the surgery we find the quality of the bone is not adequate for implant placement, or the width, height, or angulation of the bone is not adequate, or the sinus is closer to the ridge than it appeared and an entry into the sinus needs to be treated before implants can be placed. 

It would be disappointing to come away without being able to place the implant as planned, but we are committed to the best long term result for you and that may mean further development of the implant site prior to placement.  It would certainly delay us getting you to a final restoration and while we don't anticipate this happening, we repeat it here as it is important that you understand all the possibilities.

With that said, we typically expect a very straight forward treatment scenario where the total appointment time from seating to dismissal, including placement of the implant, is about 60 minutes.  If we are able to place the implant with no need for further grafting and find the implant is stable, we will place a healing cap that peeks slightly out of the tissue.  If we need to graft the site and/or find the implant goes to place but is not tightened to ideal parameters, we will place a cover screw and cover the implant with your gum tissue. This gives the implant the best chance to integrate into the bone, but requires a small amount of tissue removal to uncover the top of the implant later on versus simply removing the healing cap with a small screw driver.

If you choose to grant us permission to place a dental implant for you as described, you should know and accept these risks, possible complications, and possible additional procedures.  The reality is that these risks and complications are rare and your doctor will discuss with you what is specific for your treatment.

So going forward - The most likely post operative scenario for our patients is:

1. Slight swelling in the area of the surgery that will be most noticeable the second morning after the surgery and then resolve very quickly.
2. Discomfort/minor pain that will peak during the first 12 -18 hours after the surgery, and last two to three days after the surgery.  This pain is usually very well controlled if not avoided using ice and our pain control protocol as directed in the post op instructions.  If a bone graft had to be placed, the pain could be more severe and last up to a week, but again, following our pain control protocol will keep you comfortable almost every time.
3. You will notice the sutures and they will be present about a week.  Most of the time we use sutures that dissolve on their own, but if we use sutures that need to be removed, we will let you know and remove them at a future appointment.
4. If a bone graft and/or membrane are placed to augment the site around the implant you will be informed and any special care instructions will be reviewed.

One last and very important concept you should understand about dental implant supported teeth is that the biggest cause of implant and implant prostheses failure after the first year is overloading of the implant system, not infection, but too much unbalanced force. 

It is our responsibility to design as much load protection into your treatment plan as we can by being sure the implant is the right type and size, the crown is adjusted to your bite properly and is of the correct size, shape and material…

And

It is your responsibility to keep regular maintenance appointments and especially to let us know if anything feels out of the ordinary or out of balance immediately upon discovery.  We emphasize the word immediately!!!

If you ever notice you are hitting on the tooth supported by the implant first, or something seems to have changed, please call our office.

On the morning of the surgery:

1. Eat breakfast, and be sure you are hydrated by drinking plenty of water, starting a few days before your surgery.  Continue to take your normal medications as directed by your physician.

2. Follow the instructions in your implant package about what medications you should take the day of your surgery before coming to our office.

3. Just before leaving home, you should brush your teeth and then, using a ½ ounce of the Peridex oral rinse, rinse your mouth vigorously, especially where the implant is going… You should spit the rinse out after you are done. You do not swallow it.

At the office - Day of surgery:

Under local anesthesia, we will attempt to place the implant in the pre selected site as we discussed.  Nothing will hurt, but you will feel pressure as we work.  We use a drill with water and suction, and you will feel vibration as we use this instrument.

During the procedure, we may have you get up to take an x-ray, so please do not wear any earrings or jewelry on your head or neck.

We can tell you what is happening as we work if you like to follow along, or you can bring your own music, close your eyes and mentally leave the room if that is your preference!  It's your choice; just let us know as we get started.

After the implant has been placed, we will suture the area and go over any more questions you may have and any specific instructions.  We will then see at your follow up appointment.

If you have any questions or concerns, please do not hesitate to call our Binghamton office at 724-1389, or our Vestal office at 748-3349.