During the normal course of our day, we encounter patients asking the same medically related questions – questions about their overall health, questions as to how medications will be affected by implant surgery, questions in regards to the procedures themselves. Our clinical team of surgeons and support team members address all these concerns daily with patients, which we have published here. In addition to medically related questions, below you’ll find answer about insurance issues, medications, pre, post and day of surgery procedures, and other such topics.
Nothing out of the ordinary:
The following questions are typical; however your particular case should be fully discussed with your own medical doctor(s). In addition, all cases are individual and unique, and we here at the TeethToday Dental Implant Center have an entire team dedicated to address your specific concerns.
Will antibiotics be prescribed prior to surgery? If so, what kind and for how long?
Since dental implants are foreign materials, we commonly use antibiotics such as amoxicillin or clindamycin to kill bacteria found in the mouth, which will prevent infection after treatment. Antibiotics are virtually always recommended when implants are placed at the same time that teeth are extracted. The specific drug used will depend on the treatment planned and the medical profile of the patient. Post operative instructions about antibiotics will vary depending on your specific needs.
Are there any medications and/or vitamins that need to be avoided? If so, for how long?
It is important to discuss all of your medications and supplements with your surgeon prior to treatment. Typically Plavix, aspirin, and other types of blood thinners (even Coumadin) can be continued during treatment. We will work with your physician to safely manage these medications since careful control is important to avoid bleeding complications. Other medications should be continued unless specifically instructed to withhold them. Again, it is very important to discuss these and other medications and supplements with both your physician and your implant surgeon before the implant procedure.
Are there food and drink restrictions prior to surgery?
Only if the patient is being sedated. In this case, the patient must not consume anything, including water unless specifically instructed to do so for 6 - 8 hours prior to the procedure. Necessary medications may be taken with a sip of clear liquid prior to sedation.
What anesthesia will be used? How will it be administered?
The patient and implant surgeon will discuss anesthesia options. It is our goal to provide advanced care with minimal discomfort and anxiety. Local anesthesia (such as lidocaine) is used at the surgical site. If the treatment is more involved or you are nervous about treatment, nitrous oxide, oral or intravenous sedation may be recommended.
Will vital signs be monitored?
Yes, the implant surgeon and surgical assistants will continuously monitor vital signs.
Will sedatives and/or anti-anxiety medication be used? If so, which one(s)?
With IV sedation all of the drugs have anxiolytic (anti-anxiety), amnesic and sedative properties designed to relax you. These include Versed, Valium, Ativan, or Benadryl and possibly a narcotic such as fentanyl. A preoperative oral sedative can be prescribed in some cases. Other medications to prevent swelling like prednisone, as well as anti-nausea drugs such as Zofran may be used. For patients preferring oral sedation, pills such as Ativan® (lorazepam) will be prescribed by your implant surgeon and taken before treatment. This allows patients to feel more relaxed and less anxious about the procedures.
What type of pain management will be administered?
During the procedure a local anesthetic to block pain, such as lidocaine, articaine or bupivicaine will be given. Following the procedure, a combination of adequate pain medications or narcotics may be prescribed with non steroidal anti-inflammatory drugs such as ketorolac or ibuprofen. For those unable to take a non-steroidal anti-inflammatory, acetaminophen is recommended and very affective.
What is estimated length of surgery?
Single tooth implants can be placed in about 30 minutes, multiple tooth implants can be up to an hour, while a full jaw could be approx 3 hours.
Is there much blood loss?
No. Blood loss from dental implant surgery is generally very minimal, even if you are taking anticoagulants (blood thinners).
If jaw bone health was evaluated and found appropriate prior for surgery, is it possible to find inadequate conditions during surgery resulting in the inability to complete the procedure? What alternatives are available if this should occur?
With thorough radiographic assessment it is highly unlikely to discover unfavorable conditions for implant placement or loading during surgery. On these rare occasions, either immediate bone grafting or implant surgery can correct the problem. The key is to have experienced implant surgeons skilled in many procedures be able to assess, react and seamlessly address any unexpected findings.
How many implant procedures has your team placed?
Since the practice began, our clinicians placed over 20,000 implants, with an overall success rate greater than 97%.
How long do I need to stay at your office following surgery? What criteria must be met before I will be released to go home?
If sedation is used, plan to stay approximately 20 minutes or until the doctor is satisfied that you are recovered sufficiently to go home. The patient must be alert and oriented prior to leaving which is assessed by evaluating vital signs and mental status at regular intervals. Basically, you can be tired when you leave but you should be alert. Sedated patients are not allowed to drive from the office or for 24 hours following the completion of the procedure.
What pain medication will be prescribed? Which one(s) and for how long?
Usually, we prescribe narcotics such as hydrocodone or oxycodone and/or a non-steroidal anti-inflammatory such as ibuprofen, diflunisil or ketorolac for 3-5 days after surgery.
Will antibiotics be prescribed following surgery? Which one(s) and for how long?
In most cases, depending on the procedure itself, amoxicillin or clindamycin is prescribed for 2-7 days after surgery. We may also recommend an antimicrobial chlorhexidine mouth rinse for 1-2 weeks.
How long will I need to be off work?
Depending on the extent of the procedure, type of sedation and what you do for work, you will need anywhere from a matter of hours to a few days to return.
Is there likely to be any facial bruising?
Ordinarily, bruising is not seen. But there can be some bruising, particularly if many teeth are removed and numerous implants placed. Women and light skinned patients may bruise more. Similarly, patients taking blood thinners tend to show some bruising. It is possible, but not common to have a black eye or discolored cheek or neck following extensive procedures. If bruising occurs, it may take up to 2 weeks to disappear.
When can I resume fluid intake? Food - soft, normal?
Clear liquids can be started immediately. The patient’s diet will be determined based on the nature of the surgery, type of provisional teeth and recovery protocol.
Are there restrictions for activities? Driving?
With intravenous or oral sedation there should be NO driving for 24 hours. If nitrous oxide was used for anxiety management alone, you can drive immediately following recovery in the office. Depending on the extent of surgery, and in the most severe cases, curb strenuous activities for 7 days.
How soon do I need to return to office for post-surgical follow-up?
We usually like to see patients in one week, depending on the case. For minimally invasive procedures when no sutures are placed, you might be allowed to heal 1-2 months before returning for follow up. Patients who see us from out of town will have special arrangements made, which will differ from patients who live locally. Our treatment and scheduling coordinators will discuss your post-operative and follow up visits and keep you informed of your appointments.
Are any surgical procedures covered under medical benefits? My dental benefits are limited to $1,500.00 per calendar year?
Typically, medical insurance may cover implant/tooth replacement procedures related to the following types of conditions: 1) loss of teeth due to a medical condition, 2) if teeth are lost in the course of tumor treatment.
Are anesthesiologist's fees billable to medical insurance?
Here at the TeethToday Center, the implant surgeon administers the anesthesia, which is included in the overall fee.
I am sure that the best post-operative care will depend on giving up smoking. Do you have any comments with regard to drugs to assist in accomplishing this, Chantix® in particular?
Chantix® has the best rate of success with regards to quitting. It should be started with physician monitoring prior to the operative date. For smokers, quitting smoking will greatly improve your overall health and oral health in particular. However, smoking is not by itself a reason to avoid implant dentistry as most smokers have excellent results.
What type of cleaning is required? At home? Professional?
Both at-home and professional cleaning are required. The tissue surrounding an implant can become chronically inflamed as a result of poor oral hygiene and lead to peri-implantitis (inflammation and bone loss around an implant). In extreme cases - such as with teeth - this can cause the implant to fail. Single unit implants should be flossed and brushed, whereas an implant supported bridge should be brushed as per protocol. Our team of doctors, dental hygienists and surgical assistants will review oral hygiene instructions and will recommend the most appropriate oral hygiene aids for you during and following treatment.
How often do I need to return for maintenance and periodic cleanings?
Regardless of the number of implants placed, we recommend 3 - 6 month recall visits for professional cleanings with our hygienists.
Will x-rays/CT scans be used to assess for potential problems after treatment?
X-rays and scans are used throughout the post-operative phase to assure proper healing.
How long can the temporary bridge remain? When is the permanent bridge placed? Is this a surgical procedure?
The temporary bridge (referred to as the provisional implant-supported bridge) is designed to last 6 months under normal wear. The provisional bridges often begin to stain or weaken after about 6 months in the mouth. After that point, the permanent bridge (referred to as the definitive implant-supported bridge) will be placed. Depending on the materials used (titanium, gold alloy, ceramic, porcelain, acrylic, composite) it is designed, under normal wear and following a maintenance and checkup routine, to last for many years. There is no additional surgery required. Although the teeth on top of the implants may wear overtime and require replacement, the implants should last a lifetime.
Are there any additional costs/fees to expect?
All surgical fees will be discussed prior to surgery, during the consultation appointment. You will be given a thorough examination to help determine your needs, concerns, and to give you all of the information needed to make an informed decision regarding the best possible treatment and the best possible outcome. A single fee will be presented for all surgical work, including the provisional implant-supported bridge. That is the fee, no add on’s.
