Patient Resources

Post-Operative Care Instructions

Post-Operative Care for Implant Care Surgery

A dental implant has just been placed in your mouth.  The implant is located in the bone, under the tissue & usually cannot be seen.  The implant will remain submerged for a period of 4 to 6 months, depending upon your body’s healing properties & the type of implant placed.  NEVER USE A WATER PICK NEAR YOUR IMPLANT, EVEN AFTER WORK IS FINISHED.  IT CAN CAUSE THE IMPLANT TO FAIL.

  • IF I.V. medication has been given to you, you are not allowed to drive a vehicle or operate heavy machinery for 24 hours following. It is advised to have someone with you during that time period, or until your sedation completely wears off
  • 2 weeks following your surgery, you will need to have your sutures out and be examined by the doctor.
  • If you wear a partial, denture, flipper or essay retainer – you may take it out to brush, eat, use the surgical red brush or use salt water rinse.  Keep the appliance as clean as possible at all times, you may soak it in Efferent cleaner, brush it lightly and rinse it regularly.  However, you will need to wear it during the night while you’re sleeping on the very first night of the day you had surgery.  After the very first night of wearing your appliance, you should take it every night after that, it will help the tissue to heal (unless you have been directed otherwise).
    1. No smoking at all!  You can’t be around anyone who does for 3 days. Smoke, nicotine & heat slow down your healing time and can cause the implant(s) to fail.
    2. No alcohol to drink for 30 hours after your surgery.  We also advise not to use rinses with alcohol in it, as it will dry out the tissues and prevent healing.
    3. Salt water – you will do salt water rinses 3 to 4 times daily for two weeks after surgery – 1/2 teaspoon to a 6 ounce glass of warm water (be very gentle when doing so – holdout the side of your mouth and tilt your head side to side vs. rinsing.  Lean over the sink and let the water fall out. Do not spit.
    4. Red Brush – use the red brush on the sutures within 24 hours of the surgery, 3 to 4 times a day for two weeks.  You need to keep sutures clean (no white stuff on sutures). Doing this properly will help stimulate the tissue, promoting tissue to heal.  It will not harm the sutures in any way.  You can also dip the brush into salt water.
    5. Antibiotics: I.V. sedated patients have received an antibiotic through the I.V. line.  You may be given a follow up antibiotic to take.  You will start that antibiotic the day after surgery in the morning.
    6. Antibiotics: If an antibiotic has been prescribed for you today, it is extremely important that it is taken until gone.  Should you develop hives, rash, itching or difficulty breathing, PLEASE STOP THE MEDICATION AND CALL OUR OFFICE, YOUR DOCTOR, AND GO TO THE NEAREST EMERGENCY ROOM.
    7. Please follow prescriptions given to you prior and after your surgery.
    8. Pain: A certain amount of pain is to be expected with all types of surgery.  A pain medication has been prescribed to you, take it as directed.  It is advised that you do not drive or operate heavy machinery while taking the medication.
    9. Motrin/Ibuprofen/Advil: These are all the same type of medication.  Please take 600mg every 4 to 6 hours following your surgery for 3 days. This type of medication is not only for pain but is an anti-inflammatory as well, which will help with swelling.  If you are not able to take this type of medication, take Tylenol Extra Strength 400mg every 4 to 6 hours for 3 days.
    10. Swelling:  Some swelling is to be expected and possible bruising may occur and is not unusual. In most cases swelling can be prevented or controlled.  Please use an ICE PACK – applied to the outside of your face on the side of the surgery for 20 MINUTES ON AND 20 MINUTES OFF FOLLOWING YOUR PROCEDURE.  It is best to use the ice pack for 24 to 48 hours, following your surgery.  If after 3 days you still have swelling or pain, please call our office. IF URGENT and it is after hours, call our office and a doctor will provide you with help. If not, please leave a message and we will return your call promptly.
    11. Bleeding:  You will experience a small amount of bleeding and this is normal.  If it is excessive (blood filling your entire mouth within seconds) please call our office.
    12. NO VIGOROUS RINSING, SPITTING, OR SUCKING THROUGH A STRAW FOR 24 HOURS AFTER YOUR SURGERY.  IT WILL PROLONG THE HEALING TIME.
    13. Diet: Soft cold things are ok right away such as: Jello, pudding, yogurt, milk shake, ice cream, frosty, carnation breakfast or Ensure. Nothing hot the day of surgery, but you may have warm and soft food such as, mashed potatoes, eggs, soup, broth or soft noodles.  Avoid chewing on the implant site until the doctor or staff informs you that it is ok to do so.  You may have other foods days following that are normal, although it is up to you personally can tolerate, just no chips, nuts or anything sharp or chewy lie gum or hard bread.
Post-Operative Care for Sinus Elevation & Bone Grafting

A bone grafting procedure(s) has just been completed for you. Sutures have been placed to hold the tissues together during healing. Two weeks after surgery the sutures will be removed and you will be examined by the doctor.

If I.V. medication has been given, you cannot drive a car for the remainder of the day. It is advised that you have someone remain with you until your sedated condition wears off.

Usually you are able to continue wearing your present partial or flipper. Sometimes it is necessary to leave it in the night of surgery. It is important to keep the appliance as clean as possible during the healing period. You may need to use denture adhesive to hold your partial or denture in place during healing. Avoid placing adhesive directly on the suture line.

Every consideration must be given to keep the surgical site clean and free of food particles. The following are instructions for you mouth care after surgery:

  1. NO SMOKING. Smoking is to be avoided for the time specified by our dentists since it increases the heat in the surgical area and significantly lowers the body’s ability to heal the site.
  2. Avoid alcohol, commercial mouth rinses and very hot fluids and foods for 30 hours after your surgery. Room temperature to cold is adequate. Anything that is cooked must be allowed to cool down.
  3. Rinsing: Gentle rinsing of the mouth should be started the day of surgery.  Frequent gentle rinsing with lukewarm saltwater will aid the healing process and maintain cleanliness. Add 1/2 teaspoon of salt to a 6 ounce glass of water. Avoid use of a Water Pik.
  4. Ultra-Soft Brush: Please begin using the red brush 24 hours after your surgery to cleanse and stimulate the tissue. It will not harm the sutures. Dip the brush into the saltwater rinse and brush directly on the surgical site. Sutures should be brushed at least twice daily.
  5. Antibiotics:
    • I.V. sedated patients have received an appropriate antibiotic through their I.V. line. You may be given a follow-up antibiotic prescription. Please take as directed.
    • Patients who have not had I.V. sedation should follow the directions on the prescription given to them prior to surgery.
    • If an appropriate antibiotic has been prescribed for you today, it is very important that the prescription is filed and taken as directed. PLEASE TAKE THE TABLETS/CAPSULES UNTIL ALL ARE USED. Should you develop hives, itching, skin rash or difficulty breathing, stop the medication and call the doctor immediately or proceed to your nearest hospital emergency room.
  6. Pain: A certain amount of pain must be expected with all types of surgery. An appropriate pain medication has been prescribed for you. Please take it according to the instructions. It is advised that you do not drive while taking the pain prescription. However, if only Motrin is needed, most people are able to drive without any problem.
  7. Use the Neo-Synephrine nose spray as directed. 2-3 sprays per nostril every 12 hours for the next 4 days.
  8. Swelling: Some swelling and possible minimal bruising is to be expected and is not unusual. In most instances, swelling can be prevented or controlled.  Apply the ice pack that has been given to you for a period of 20 minutes on and 20 minutes off during the day for the next two days. The application of the ice to the outside of the face over the surgical area will minimize swelling. If after three days you still have inordinate swelling or pain, please call the office.
  9. Bleeding: A small amount of bleeding following surgery should not alarm you.  If the bleeding is excessive or continuous, please call us at once. Vigorous rinsing of the mouth prolongs bleeding by removing the clotting blood, so when rinsing your mouth, do it gentle. Nose bleeding for 1-2 days following sinus elevation can be expected. Nose bleeding for longer than 2 days would be out of the ordinary and you should call Dr. Heller.
  10. Blowing nose: DO NOT blow your nose, just wipe. If necessary, blow very gently with both nostrils open. If you need to sneeze, do not hold it in, but sneeze with your mouth open.
  11. DO NOT spit, gargle or suck on a straw for 24 hours following your surgery.  This tends to loosen the sutures/blood clots.
Post-Operative Care Instructions following Laser Therapy

While no incisions or sutures/stitches are involved, there are still some important post-operative instructions that you should follow.

If you have any pain or excessive bleeding following your treatment, please contact our office. 

Normally, some discomfort is to be expected, and some slight bleeding is also normal, but should be minimal. Severe pain or excessive bleeding are NOT normal and should be addressed immediately.

  • Do not be alarmed by any color changes or appearance of tissues following laser

therapy. Tissues can be gray, yellow, red, blue, purple or “stringy” and reflect

normal response to laser treatments.

Try to keep your mouth as clean as possible in order to help the healing process. Brush, floss and follow other home-care measures in all the areas of your mouth except for the treated areas for a couple of days. Do not apply excessive tongue or cheek pressure to the treated areas.

  • NO SMOKING. Smoking is to be avoided for the time specified by our dentists since it increases the heat in the surgical area and significantly lowers the body’s ability to heal the site.
  • Avoid alcohol and very hot fluids and foods for 30 hours after your surgery. Room temperature to cold is adequate. Anything that is cooked must be allowed to cool down.
  • It is very important to maintain a good food and fluid intake. Try to eat soft but

nutritious foods, such as eggs, yogurt, cottage cheese, malts, ice cream, etc., until you can comfortably return to a normal diet.

  • Rinsing: Gentle rinsing of the mouth should be started the day of surgery.  Avoid commercial mouth rinses. Frequent gentle rinsing with lukewarm salt water will aid the healing process and maintain cleanliness. Add 1/2 teaspoon of salt to a 6 ounce glass of water.
  • Do not chew on the side of your mouth that has been treated for a couple of days.
The Patient’s Guide to Implant Maintenance

The long-term success of your implant is fundamentally dependent upon both your effective home care routine and on the dental team’s administration of professional procedures in the dental office. You are considered a co-therapist in maintenance therapy and your contribution is indispensable.

As soon as your implants are placed and restored, the immediate care you will be responsible for is:

Thorough at-home oral hygiene

Your first checkup at no more than 6 months

Reports of any discomfort 

Report any:

Tissue Soreness

After the implant supported prosthesis is placed, it takes a little time for the tissues to adapt to the new situation. Therefore, slight pain and light bleeding in the tissues may occur.

Most often, the symptoms gradually disappear after a period of time or after simple adjustments performed by the doctor.

Discomfort When Chewing

Pain or discomfort when biting down on something, most often concludes that the bite needs to be adjusted. The same is true when a part of the restoration is “too high”.  It is important to consult the doctor. It is essential that the restoration/prosthesis fits perfectly in the bite so all chewing forces are evenly distributed on the implants.

It is important to know that adjustments are normal after receiving your dentures, overdentures or prosthesis. It can take a while for your tissues to become used to the new prosthesis. Therefore, it is not uncommon to require a few adjustments within the first couple of weeks. As time goes on, the underlying bone structure will change as well. Because of this, you may require an adjustment every couple of years for maximum fit and comfort.

Adjust Your Diet Accordingly

Once you have your new dentures, overdentures or prosthesis , there are certain foods you will want to avoid, such as hard nuts or corn on the cob. Most patients do quite well with softer foods in the beginning, such as eggs, yogurt, cooked vegetables, fish, potatoes, ice cream, and more. However, it is important to maintain proper nutrition as well, so be sure you are eating well-balanced meals and healthy snacks.

Clean Regularly

You will accumulate plaque and tartar just like your natural teeth. They can also stain. Therefore, it is important to brush your removable prosthesis using a toothbrush or denture brush. You should also use a denture cleanser soak daily to eliminate debris, food particles, and bacteria. Be sure to rinse them well before reinserting them. It is also crucial that you keep brushing your gums, tongue, and cheeks with a soft toothbrush and toothpaste twice a day. This will not only eliminate the bacteria that causes bad breath, it will also prevent fungal infections.

Speak More

Typically, there is a slight learning curve when it comes to speaking with dentures or overdentures. While some patients become used to them right away, others may require a few weeks before talking feels natural. We encourage you to speak as much as possible during the first couple of weeks. Even reading out loud helps. The more you can practice, the faster your tongue and soft tissues will become accustomed to your new teeth.

Stay Hydrated

Drinking lots of water is a good idea for anyone. However, if you suffer from dry mouth, it is even more important to stay hydrated. Certain medications can lead to dry mouth. If you think this could be the underlying cause of your condition, speak to your medical doctor about the possibility of adjusting your prescriptions or dosages.

Give Your Tissues a Rest

We always recommend sleeping without your dentures. This will give you plenty of time to soak them, and it will also give your gums a break and allow them to heal from any soreness or irritation.

Generally, it takes time to get used to any new restoration. However, after a period of time, the implant-supported prosthesis should look, function, and feel like regular teeth.

Periodic Monitoring

Implants should be professionally evaluated at least twice a year during regular checkups. Criteria for the success are the absence of pain, stability, mobility, bone integration around implants, the lack of infection or bleeding in the soft tissues, adequate function, and aesthetics in the prosthetic. X Rays are taken annually, the oral mucosa is checked and a cleaning is performed. The patients should report any pain, discomfort or unusual signs. Necessary adjustments will be made. 

Maintenance of Removable Dentures and Overdentures

Removable dentures and overdentures require continuous maintenance. 

Replacement of Worn Attachments

The attachments that are housed in the denture need to be changed or refreshed every one to two years because they wear. The operation is extremely simple and quick.

Relining

Relining is indicated when a removable denture fit has worsened due to the manufacturing material (normally acrylic) from the base of the denture wearing and/or the bone beneath the denture has diminished in height. This results in an unstable denture causing tissue trauma. A denture reline involves the replacing and refitting of the tissue side of the denture to custom fit to the mouth. This is done at the dental lab and the procedure typically takes 2 appointments. It is not very expensive.

Oral Hygiene

At-Home Implant Care

Proper and thorough oral hygiene is a prerequisite for a successful dental implant. Poor oral hygiene greatly increases the risk of failure.

Patients with dental implants generally have a history of less-than-ideal home care, resulting in the partially or edentulous state. These patients may moreover have improper oral hygiene practice due to postsurgical fear of causing damage, on the one hand, or overzealous home care trying to stay absolutely plaque free, on the other hand. Either of these situations can lead to detrimental consequences. Therefore, oral hygiene instructions should include detailed verbal guidance and visual demonstration for the long-term success of the implant and its restoration. Also, the oral hygiene techniques and aids used by patients should be reevaluated during every hygiene visit. 

Removable dentures, overdentures, fixed prostheses and implant crowns and bridges will accumulate plaque and tartar just like your natural teeth. They can also stain. Therefore, it is important to brush using a toothbrush.  On a removable denture, use a denture brush. You should also use a denture cleanser soak daily to eliminate debris, food particles, and bacteria. Be sure to rinse them well before reinserting them.

Even if you are missing all of your natural teeth, it doesn’t mean you should stop brushing. On the contrary, it is crucial that you keep brushing your gums, tongue, and cheeks with a soft toothbrush and toothpaste twice a day. This will not only eliminate the bacteria that causes bad breath, it will also prevent fungal infections.

Brushing

Twice daily cleaning of implants to remove bacterial plaque accumulations should be accomplished using a soft toothbrush or a power brush. A tapered brush to access the undersurface of connector bars or to aid with interdental cleansing is also recommended. 

Several powered toothbrushes have been shown to not cause hard or soft tissue damage and to effectively reduce plaque and inflammation around the adjacent periodontal tissues. These brushes are considered superior to a manual toothbrush in removing plaque and they contribute to the improved interproximal cleaning due to bristle shapes. A patient with limited dexterity should use a power toothbrush.

In difficult-to-access areas smaller-diameter toothbrush heads such as end-tufted brushes or tapered  brushes may be of benefit. An end-tufted brush can accommodate the shape of the prosthesis and is especially useful in posterior regions where a conventional toothbrush might not reach. You can use the interdental brush heads to clean under hybrids

Interproximal Cleaning

There are many flosses, interproximal cleaners, and water irrigation systems commercially available and safe for use around implants.

Floss choice should be based on the clinical indication. The following types of floss may be used to remove interproximal plaque.

Braided flossing cord, such as PostCare is more rigid than conventional floss and suitable for open areas and places where a floss threader may be too fragile to remove denser plaque, debris, and calculus.

Satin Floss or Glide is particularly appropriate for a single tooth implant with tight tissue adaptation.

Woven, such as Thornton Bridge & Implant Cleaners or GUM Expanding Floss is indicated where there are large interproximal spaces or long expanses of a bar retained prosthesis.

Yarns can be used to access and cleanse larger embrasure spaces and under connector bars, but these should not be considered if there is the possibility of the fibers being retained on rough surfaces or around the restorations.

Dental Tapes are available in different “widths” and are used to clean the exposed abutment.

Other types include tufted, coated, and gauze thicker dental floss. All of these can be used in a “shoe-shine rag” fashion to facilitate optimal home care procedures around the abutment post. Threader floss may also be needed to access bridgework or around connector bars.

Interproximal brushes, aka “proxabrushes” can be selected and recommended considering the size and shape of the space, when patients are unable to use floss.  Whereas larger spaces can be properly cleaned with a proxabrush, smaller proxabrushes, such as Go-Betweens Cleaners are helpful in narrower interproximal spaces. However, caution must be used with interproximal brushes that have an exposed tip of metal wire or if enough pressure is exerted, as that can easily scratch the abutment’s titanium surface. 

Rubber tip stimulators and disposable picks are among the many auxiliary devices that can assist in plaque removal.

Water Irrigation 

A water flosser is a must for implant maintenance. However, care must be taken to direct the stream interproximally and horizontally between implants, as improper positioning can cause inadvertent damage to the peri-implant seal. Keep the unit at a low to medium setting and spend 3 seconds per implant site. 

Tablets that contain Xylitol that can be added to the water flosser. Xylitol starves the Streptococcus Mutans bacteria that are the source of plaque and acid.  

Locally Applied Chemotherapeutics

For implant patients especially those prone to occasional tissue inflammation, an at-home regimen of daily cleansing with chemotherapeutic agents in the form of rinses, gels, or solutions is extremely essential. CrestPro Health or StellaLIfe is typically what our office recommends for healing or sore tissues. Another option is rinsing with a salt water solution. Dissolve ½ to one teaspoon of salt in a glass of warm water. This solution helps to soothe irritated tissues as well as draw out infection, allowing your gums to heal.

Professional Hygiene Care

Routine maintenance, professional evaluations, cleanings and radiographs are necessary to insure the long life of these restorations. These procedures are performed at selected intervals to assist you in maintaining oral implant health.  Typically, every 6 months. 

During your hygiene appointment, our hygienists and doctor will evaluate these 8 items:

  1. Assessment of peri-implant and gingival tissues=color and consistency
  2. Palpate for presence of exudate/suppuration=signs of infection
  3. Probe depths are taken=bone loss or peri-implantitis
  4. Oral hygiene evaluation=presence of plaque and calculus
  5. Mobility of the implant or prosthetic components=loose abutments or screws
  6. Radiographic evaluation=bone levels around the implant(s)
  7. Occlusal evaluation=correct bite
  8. Prosthetic assessment=retention of attachments, missing or worn attachments 

Implants necessitate intensive care that goes far beyond mere brushing of teeth. Natural teeth are anchored to the socket via periodontal ligament, which has an inherent protective defense mechanism, and hence are better protected against outside attacks than the implant. Despite the long-term predictability of implants, complications do occur in a percentage of cases and can ultimately result in loss of implants and failure of prostheses. Regular professional hygiene care for patients with dental implants as well as treating peri-implantitis in a timely manner can minimize and prevent implant loss/failure due to such complications.

The dental hygienist has an important role to play in keeping dental implants infection-free, and there are many factors to be considered in selecting the right instruments for a professional cleaning. They include: the nature of the debris, meaning whether soft (biofilm, foods) or hard (calculus or tartar); the location of the deposits; the type of surface on which they accumulate; and the stubbornness with which they adhere.

Your hygienist will select instruments for cleaning that will not damage the crown, abutment, or the implant itself. Maintaining the highly polished, smooth surface of the abutment and crown are critical. If they are scratched they can attract and harbor bacteria. That’s why the instruments used in our office, called scalers and curettes, are made of solid titanium. Medical grade titanium instruments are biocompatible and soft enough to avoid scratching implants. Natural teeth don’t scratch in the same way, and therefore metal instruments can be used to clean them.

Another method we use to clean around implants is with an ultrasonic scaler.  The ultrasonic instruments have plastic tips to minimize implant damage. They clean by using high-frequency vibration, which may be necessary if large quantities of debris have accumulated. They are used on a low power setting with a lot of water irrigation, and sometimes antibacterial solutions, to clean and flush debris.

If any part of the implant body itself is visible, this may mean there is infection that has resulted in tissue and/or bone loss. The implant surface becomes exposed following loss of its fusion to the bone. Implant surfaces are generally microscopically “roughened” to increase surface area for bone attachment. But this surface roughness makes implants difficult if not impossible to clean and disinfect. Additionally, some implants are screw-shaped and their threads just add to the cleaning dilemma.

Brushes are used to clean biofilm from exposed areas of an implant wherever possible. If calculus or dental cement (used to secure the crowns) is present on an implant surface, the hygienist needs to use instruments that are effective in removing these contaminants. In such cases the clinician must ensure no scratching or damage is caused by completing the task.

Risks and Complications

Within the First 6 Months

These complications occur in the first 6 months after implant placement. The most common complication is the failure to integrate. However, the risk of complications is considered to be very low – less than 5 percent, according to current statistics. Problems are rare and when they do occur, they are usually minor and easily treated. Please, contact us if you are experiencing any pain or tenderness. 

Long Term Complications

Long-term implant failures may be caused by an improper design of the prosthetic restoration or by inappropriate care and maintenance. Regardless of the cause, implants fail due to either loss of bone around them or a mechanical failure of the implant.

There are also risks associated with the prosthetic components which over time can wear off, chip, break or cause a lack of satisfaction on the part of the patient.

The good news is that about 95% of implants today are successful. Moreover, a well-integrated implant with appropriate biomechanical loads can have long-term success rates for the fixture and close to 15 years lifespan for the prosthetic teeth.

The professional implant maintenance you will receive at our office, coupled with your diligent home care are critical factors that will ensure the long-term success of your implants.  We pride our practice on providing an exceptional dental experience and we give our patients the compassion we would offer our own family members. You deserve to be proud of your smile and confident in life. Thank you for choosing our office to provide you with your dental implants. We look forward to many more years together as we maintain your optimal dental health.

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