Post-op Instructions for Implants

ENDOSTEAL IMPLANTS: STAGE I - PLACEMENT

Follow the General Instructions

• Sensitivity to cold on the natural teeth can occur, and will disappear gradually with time. 
• Avoid ice, ice cream, cold drinks, and solids. 
• Swelling is to be expected. 
• Increased Vitamin C intake to 1000-2000 mg. Per day to aid healing
• DO NOT apply pressure to the implant or prosthesis with your tongue or fingers.
• DO NOT eat sticky or hard foods.

NOTIFY THE OFFICE IF:

• Numbness persists after initial day of surgery. 
• Bleeding has NOT decreased after three days.
• The temporary becomes loose, or fractures.
• Pain increases after several days.
• The implant becomes loose.

IMPORTANT: These instructions are in addition to the General Instructions.  If duplicated, the instructions on this page supersede all others.

MUCOSAL INSERTS: STAGE II - UNCOVERING

Patient Post - Operative Care & Instructions

1. Take precriptions as directed.
2. Take 250 mg. Vitamin C four times daily.
3. Rinse with 50% diluted mouthwash and cold water every hour the first day and every four hours the following day.
4. Initially swab the inserts with a soft cotton Q-tip soaked in Periogard after healing.  One to two weeks later, brush the inserts while in your mouth with a soft toothbrush and mild toothpaste two times daily. 
5. Make sure your prosthesis remains completely seated or in place until your next appointment. 

NOTIFY THE OFFICE IF:

• The abutment is loosened.  Hand tighten, do NOT use instruments.
• The medication DOES NOT relieve the discomfort

FINAL HEALING: POST-SURGICAL CONSIDERATIONS

Maintenance

Hygiene protocol

After placing the final restoration, evaluate the patient on a routine schedule until the patient demonstrates the ability to keep the abutments and prosthesis plaque-free.  The patient may then be placed on a 3-4 month evaluation schedule.

The patient should be educated and motivated on the importance of good oral hygiene.  Patients should clean implants daily.  Cleaning should be thorough, but gentle.

To avoid plaque-retaining scratches or abrasions to the titanium abutment surface, it is recommended that hygiene procedures be executed with non-metallic hygiene instruments such as the Steri-Oss graphite scalers.

Patient oral hygiene instruments may include:

• Soft, nylon, multi-tufted manual toothbrush
• Multi- or uni-tufted motorized toothbrush
• Interproximal brush with a coated center wire
• Low velocity oral irrigators
• Low abrasive toothpaste
• Implant floss with floss threader
• Nylon yarn
• Cotton gauze
• Toothpick with holder
• Disclosing tablets
• Chlorhexidine digluconate
• Phenolics (anti-bacterial oral rinses)

Non-metallic clinical oral hygiene instruments are recommended.  These instruments include:

• Steri-Oss graphite scalers
• Plastic instruments
• Wooden instruments
• Prophylactic pastes developed specifically for implants

On annual appointments, it is recommended to:

• Confirm integrity of the implant
• Evaluate changes in osseous topography.  Base line radiographs may be used as a guide.
• Evaluate and document periodontal health.
• Perform soft tissue debridement.
• Polish abutments with a prophylactic paste developed specifically for implant abutments.
• Evaluate occlusal function.  Subtle changes in occlusion can overstress implants.

Post-surgical healing

The post-operative healing period depends on several factors including quantity and quality of bone and health of the patient.  Other factors to consider are the design and load potential of the prosthesis.  A general guide to the healing period is:

• Type D-1 bone: minimum 5 months
• Type D-2 bone: minimum 4 months
• Type D-3 bone: minimum 6 months
• Type D-4 bone: minimum 8 months

Post-surgical provisionalization

If available, use the patient’s existing prosthesis as the provisional (interim) prosthesis. 

• Relieve acrylic in area of implants.
• Reline the prosthesis with tissue conditioning material.
• The prosthesis MUST NOT contact or load the implant(s).  Premature loading of implants may create micromovements at the implant-to-bone interface.  This could ultimately result in implant failure.
• It is recommended to observe the patient every two to three weeks to:
• Evaluate the prosthesis
• Evaluate soft tissue health
• Confirm non-loading of implants

Second Stage Surgery (uncovering)

After the initial healing phase, second stage surgery is performed by the surgical doctor to expose the implant and to verify integration.  The implant Healing Screw is removed at this time with a Hex Driver and replaced with a Healing Abutment.  This is the first step in the restorative process. 

Normally, four to eight weeks after second stage surgery, the patient’s gingival tissue should be adequately healed around the Healing Abutment.  The patient is ready to proceed with the restorative procedures.

Bone Graft

• DO NOT spit for 3 to 5 days.  “Gently” rinse with Periogard.
• DO NOT apply pressure with your tongue or fingers.  The material is movable during the initial healing.
• DO NOT lift or pull on lip to look at sutures (stitches).  This can cause undue pressure and tear the sutures.
• You may expect to find small granules in your mouth for the first several days to weeks. 

NOTIFY THE OFFICE IF:

• A suture falls out within the first three days.
• If a bandage that has been placed should loosen within the first three days.
• If a large amount of granules are lost from the surgical site.
• If your medications DO NOT relieve your discomfort.

IMPORTANT: These instructions are in addition to the general instructions.  If there is duplication, the instructions on the page supersede all others.

SINUS ELEVATION

• DO NOT blow your nose.
• DO NOT smoke or use smokeless tobacco.
• DO NOT take in liquid through a straw.
• DO NOT lift or pull on lip to look at sutures (stitches).
• If you must sneeze, do so with your mouth OPEN to avoid ANY unnecessary pressure on the sinus area.
• Take your medication as directed.  INCLUDE SINUS MEDS- Sudafed, Afrin, or Claritin, Flonase, etc. depending on your case.
• You may be aware of small granules in your mouth for the next few days.  This is NOT unusual. 

NOTIFY THE OFFICE IF:

• You feel granules in your nose. 
• Your medications DO NOT relieve your discomfort. 
• There is bloody discharge from your nose.

IMPORTANT:  These instructions are in addition to the General Instructions.  If duplicated, the instructions on this page supersede all others.

Please notify the office at (361) 992-3873, if you have ANY questions.  Usually a single explanation can resolve the situation.