Implants Stage I and Stage II
Implants are inserted into the jaw bones to facilitate the construction of teeth and dental prostheses where the natural teeth have been lost. The process involves inserting small titanium fixtures into the living bone (Stage I surgery). Depending on the quality of your bone the fixtures may be left uncovered or alternatively if the bone is soft or in other specific circumstances the fixtures may be covered with mucosa (gum) and left to heal for up to six months. Patients then need to undergo Stage II surgery which involves exposing the heads of the implants to prepare the mouth for attachment of the replacement teeth or prostheses. Patients who are treated with the fixtures left protruding through the mucosa at Stage I undergo what is termed “single stage surgery”.
The information below is a guide for patients to follow on discharge from hospital:
- HYGIENE/CARE OF WOUNDS.
It is ESSENTIAL to maintain a high standard of oral hygiene following implant surgery using a combination of mouthwash diluted 1 in 10 with warm water and regular toothbrushing. You should commence your mouthwashes and toothbrushing the day OF surgery and you should aim to use at least 4-5 mouthwashes per day. Where indicated, a Broxojet may be supplied to assist with oral hygiene. Gentle toothbrushing around the wounds may cause a small amount of bleeding, but it is important to remove food debris and plaque from the area of the wounds. If food and plaque are allowed to accumulate around the wounds there is a very real chance of the implants becoming infected or lost.
Generally dressings are not used with implant surgery however you will be supplied with mouth packs to assist with possible post-operative bleeding.
- SWELLING AND BRUISING.
Swelling and bruising are not uncommon following implant surgery. Generally swelling takes up to three days to reach its maximum then this will slowly subside over about ten days. Bruising is variable and may range from some minor patches of bruising around the face through to quite extensive bruising which may extend up to the orbits and down the chin into the neck. The bruises slowly discolour with time and may take 10-14 days to disappear. Ice packs should be applied regularly to the face over the first 48 hours. The hospital will normally supply you with several packs to take home. These can be re-frozen and re-used.
When you recover from your surgery you may notice parts of your face are quite numb. You are given local anaesthetic injections at the time of your surgery and this is done deliberately as a pain control measure. The numbness generally takes 6-8 hours to wear off and during this time you should avoid contact with hot liquids etc.
On occasions some of the sensory nerves in the jaw bones can be disturbed by the surgical procedure and this may cause some prolonged numbness lasting a few weeks, or in severe cases some months. On very rare occasions there may be some permanently altered sensation in and around the jaws.
From time to time bleeding and oozing may occur from a recently operated implant site. This can be controlled by the use of pressure packs which will be supplied by the ward. These should be placed over the wounds and pressure applied by biting down firmly on the packs. YOU SHOULD REST QUIETLY WITH YOUR HEAD ELEVATED. The hospital will supply you with some spare pressure packs to take home and if the bleeding or oozing does not stop within 30 minutes please contact the hospital in which you were treated.
You will need to be on a “clear fluid” and milk free diet (no dairy products) for the first 48 hours to allow for some initial healing around the implant sites. Following that you will need to be on a very soft/blended diet for about a week as the wounds heal and you can then gradually increase the texture and variety of the foods. If you are treated as a “single stage” case or alternatively following Stage II surgery when the healing abutments protrude through the gum you should NOT use the abutments as “teeth” for chewing. Dr. Bowler will let you know when you are able to “load” the implants. It is very important that you do not prematurely put pressure on your implants. If you have any queries regarding diet the hospital dietitian can provide you with further information.
Patients undergoing any form of implant surgery MUST NOT SMOKE AT ALL. Smoking is known to significantly reduce the chances of successful implant surgery, particularly during the 3-6 months that are required for implants to integrate. Generally patients will not be treated for implant surgery unless they have given up smoking for at least 3 months prior to surgery. Long-term, once the implants have healed, smoking is still considered a significant disadvantage and there is an increased risk of long-term fixture loss.
- SPECIAL ASPECTS.
You MUST NOT WEAR YOUR DENTURES OR ANY OTHER FORM OF INTRAORAL PROSTHESIS for at least ten days following Stage I surgery. It may be possible to wear your prosthesis earlier than this following Stage II surgery however Dr. Bowler will advise you regarding this. If you wear your dentures or prostheses too early there is a very real chance of causing wound breakdown and infection and/or loss of the implant.
- POST-OPERATIVE MEDICATIONS AND SUPPLIES ETC.
You will be provided with the following medications on discharge:
A course of antibiotics.
You will have been given intravenous antibiotics in the operating theatre and sometimes on the ward post-operatively. A prescription for your oral antibiotics will be available for you to take home or alternatively the ward may have the prescription filled for you before discharge. IT IS ESSENTIAL YOU COMPLETE ALL OF THE ANTIBIOTICS as indicated on the label.
These are also prescribed and the prescription will be available for you to take home or, as with the antibiotics, the ward may have the prescription filled for you before discharge. Generally “middle of the range analgesics are satisfactory for pain control following implant surgery.
A bottle of Savacol mouthwash will be supplied for you to take home. Please use this diluted 1 capful in a glass of warm to hot water (i.e. 1 in 10) and the mouthwash should be used 5-6 times per day, particularly at night before bed. You should start your mouthwashes the day AFTER surgery. You may need to purchase another bottle of mouthwash, depending on the progress of your wounds.
Steroid ointment (Sigmacort – large tube).
A tube of steroid ointment will be provided for you to take home. A THIN SMEAR of ointment should be placed on the lips once or twice a day, particularly in the corners of the lips where these may have been stretched, and this can be continued for approximately a week post-operatively. The steroid ointment will assist with healing of the lips.
As indicated earlier you will be supplied with ice packs to keep on your face constantly for 24-48 hours post-operatively to help reduce your swelling. The ice packs can be re-frozen and re-used and should make your face feel more comfortable.
Spare mouth packs/gauze are usually supplied by the hospital to assist with the control of oozing and bleeding from surgical sites.
- FOLLOW-UP CARE.
It is important that all patients are seen for follow-up and generally an appointment will have been made for you to attend Dr. Bowler’s rooms around a week post-op. Frequently the sutures used for implant surgery need to be removed. This is a painless procedure as the sutures stay wet in the mouth and are easy to remove. It is not uncommon for sutures to fall out and this is not a matter for concern. If you do not have an appointment please telephone the practice on 4942 1211 to make a post-operative appointment.
If you have any concerns following your surgery please do not hesitate to contact the hospital in which you were treated. Dr. Bowler can be reached through the hospital and is available most times. If for some reason this is not possible, there is a 24 hour service available through Lake Macquarie Private Hospital Emergency Department Tel 02 4947 5700