Pre-Operative Information for Patients Undergoing Dental Implant Surgery

This information has been prepared specifically for our patients who are considering the placement of dental implants. Implants have proven to be successful replacements for natural tooth roots that the general dentist can use to attach dentures, bridges, or crowns, in patients who have lost all or some of their teeth. Fortunately, dental implants can now be used in most patients provided they have enough remaining bone structure to accommodate placement of the implant(s). For those patients with inadequate bone structure, they may become candidates for the placement of dental implant(s) once the bone has been reconstructed (augmented) using standard grafting techniques; in many cases this can be accomplished as an office procedure with a local anesthetic (Novocain) and sedation. Generally, patients should have a sound medical history that allows for good wound healing and all serious systemic diseases should be under control. Finally, and probably most important, patients must have a clean mouth that is free of obvious periodontal (gum) disease or rampant tooth decay. In scientific studies where implants were used to replace all the upper and lower teeth in healthy mouths, greater than 95% of the implants placed in the lower jaw and greater than 80% of implants placed in the upper jaw have remained in function over a ten year period.

The subject of a clean mouth needs special emphasis. Today’s modern techniques and materials have produced an implant that can become firmly healed in bone over a short three to five month time span. However, the gum tissue surrounding the implant does not physically attach to the implant metal like it does around natural teeth. In the adult population, most teeth are lost due to gum disease. Simply put, the bacterial plaque that is always present in the mouth around the teeth creates inflammation that destroys the attachment of the gum tissue to the teeth. It is a slow, silent process but over time the gum tissue and bone shrink away from around the tooth causing it to become loose. Eventually, the gum either gets seriously infected or the tooth becomes so loose it is of no use for chewing and must be removed. The only true means of preventing this process is a constant effort at brushing around and flossing between the teeth. Once implants are placed in the jaw, this may be even more important. With dental implants the gum isn’t attached to the implant to start with so it may be easier for the gum disease process to affect the implant than it is the natural tooth. In contrast, some recent studies indicate that dental implants may be somewhat less prone to common gum disease. Regardless, a casual attitude toward cleaning around your dental implants may result in a substantial decrease in their long term success. Therefore, for dental implants to have the greatest chance for success, the patient must be committed to the highest standards of oral hygiene forever!

The process of placing an implant into the jaw bone involves one or two simple surgical procedures. These procedures are so simple that they are usually performed in the office with local anesthesia (Novocain) and possibly sedation. There are special individual circumstances where this may be handled in the hospital or with general anesthesia and these will be discussed with you if found to be appropriate in your case.

The first procedure involves creating a precision channel in the bone into which the implant is placed followed by two to five months for the jaw bone to heal around the implant (osseointegration). More often than not, you will be able to wear your existing dentures or a temporary crown or bridge over the area until this healing process is complete. At one point in time, the freshly placed implant was buried at this stage and left undisturbed during this time. This is only occasionally necessary today due to improved implant design and techniques used to place them. Most often today, the implant will be visible to the patient as a small metallic stud and/or a white post in the area where the implant was placed. Leaving the top of the implant (abutment) exposed at the time of the initial implant placement typically precludes the need for a second minor surgical procedure to uncover the implant. However, if the implant required being covered or buried at the time of its placement, you will require the aforementioned minor procedure to expose it and a short period of gum healing will be necessary before your general dentist can begin to restore the implant with crowns, bridges or dentures.

In some special circumstances, an implant can be placed immediately into a tooth extraction site, however, in most cases the extraction sockets and gum tissue need to be healed and free from infection. This usually requires a healing period of between two to six months depending on the size of the initial defect following tooth extraction and the surrounding conditions. Your doctor will discuss this timing with you at your consultation appointment.

You can expect some swelling and bruising around areas where implants have been placed. This will last five to seven days and can be minimized by keeping ice packs over the areas involved for the first twenty-four hours after surgery.The same type of swelling can affect the sensory nerves in the jaw bones (especially the lower jaw) causing a numb sensation (paresthesia) in your lips, chin, teeth or tongue following surgery. This numb sensation (as if affected by Novocain) is usually transient (lasting ten to thirty days) and is rarely if ever permanent. Some situations are more prone to producing a paresthesia than others. Your doctor will discuss the specific situation of “paresthesia” when it is applicable to your case. A numb sensation is actually helpful in the early post operative phase because it reduces post operative discomfort. Most patients experience only minor post operative discomfort; similar to having a simple front tooth extracted. You will be given a prescription for pain medication if you need it but for most patients Tylenol or Aspirin is sufficient. You will also be given a prescription for an antibiotic which you must take for a week to ten days, even if you feel great. This helps prevent infection in the early stages of healing.

With regard to risks, there are only a few minor sequelae from routine dental implant surgery that should be discussed.The first involves important anatomy in the jawbones where implants are commonly placed.

The Maxillary Sinus

The maxillary sinus is located in the upper jaw. As long as there is enough usable bone under the sinus, the implant(s) can be placed in the upper jaw without further consideration. However, if there is insufficient bone
in this area it may be necessary to augment or build up the area prior to placing the implant. This procedure is often referred to as a “sinus lift.” While this additional and sometimes required procedure can sound foreboding, it is generally considered to be routine when placing implants in the upper jaw and is a procedure that we perform regularly. For more information, visit our web site topic review on this procedure or ask your doctor about the efficacy of this procedure. Patients with severe sinus problems should discuss this with the surgeon, but in general, placing implants in or near the sinus has not been shown to cause sinus disease.

Sensory Nerves

The sensory nerves in the lower jaw can be aggravated if the implants are placed too closely to them and may result in long term numbness or pain. Care is taken to ensure there is sufficient bone above the nerve by taking a panoramic radiograph prior to surgery. If this persistent numbness or chronic ache should occur, and it bothers the patient more than the security of a well anchored denture or bridge that the implant should be removed.
A final sequela that can occasionally develop following dental implant surgery is an infection and implant failure. If an infection occurs in the early healing phase following surgery, the implant is likely to stay loose and become painful. This situation can usually be prevented with antibiotics and meticulous oral hygiene during the healing phase. However, implants that fail to heal properly need to be removed and replaced. If the implant(s) becomes loose after it has been restored and is in function, it will not provide adequate support for your dental work or dentures and may become infected. Again, loose or painful implants will need to be removed and be replaced at a future surgery. Neither your dentist nor your surgeon alone can prevent gum disease.You must be prepared to brush and floss around each implant on a daily basis. If you follow the oral hygiene protocol designed and monitored by your restorative dentist, dental implants have been shown to remain solid in the bone and provide a long term successful result.

As far as your financial obligations are concerned, the purchases of the implant itself, the placement of the implant, local anesthesia, and all surgical follow-up visits during the first year are covered under the same fee. We do require that your implant fee be paid on the day of your surgery so the implant materials can be purchased and shipped. Generally, the abutment inserted into the implant, the denture, bridge or crown will be covered by the fee charged by your general dentist. We will be happy to help you obtain whatever benefits to which you are entitled from your insurance carrier and/or assist you in arranging financing through the CareCredit lending institution.

We feel that all of this information is important for our implant patients to understand. We have been very pleased with the results over the long term when the dentist, the surgeon, and the patient are all fully committed to success. Should you have questions please feel free to discuss them with your dentist or surgeon so you are comfortable and well informed in making your decision to proceed with dental implants.