What is recovery like after implant surgery?

It is worth noting that, although healing is an individual process, the inflammatory response is determined well before the surgery.

All surgery should be carried out in a way that is minimally invasive, so that the post-surgical inflammatory process is as small as possible for the patient. For that, it is decisive that the dentist plans the case on a cone beam computed tomography scan — CBCT — and uses precise methods of execution, such as guided surgery or navigated surgery, which make it possible to follow the planning as defined and to avoid interventions that are more invasive than necessary.

Is it normal to have pain or swelling?

There may be some discomfort in the operated area, particularly in the first few days. In general the prescribed medication allows it to be controlled, and it should be taken observing the doses and the times indicated — not only when the pain appears.

Swelling — oedema, in clinical terms — varies from person to person. In some cases it may be very slight. It tends to increase during the first 48 to 72 hours and only then begins to go down: that is the expected course of the inflammatory response to the surgery.

Following the postoperative recommendations is decisive at this stage. Applying ice regularly to the outside of the face during the first 48 to 72 hours, always protecting the skin, is essential in order to limit the swelling and to help it go down.

Depending on the complexity and the extent of the surgery, it is normal for bruising to appear on the face. It generally appears after the first 24 hours and disappears gradually.

A small amount of blood in the saliva is usual in the first few hours. To avoid bleeding, you should not undertake physical exertion or lower your head, so as not to raise your blood pressure.

If there is bleeding, you should apply pressure with a clean gauze, following the instructions given after the surgery by your dentist, or contact the clinic and the dental assistants immediately.

What can I eat after surgery?

After surgery, instructions for eating are always given, appropriate to the type and the extent of the procedure you have undergone.

In the first few days you should favour foods of soft consistency, cold or at room temperature, that require no chewing at all in the operated area. It is at this time that the inflammatory response peaks, and so it is important to create the conditions for there to be no trauma or worsening of the swelling.

In the first few hours: yoghurt, jelly, smoothies, cold soups, ice cream. Smoothies should be taken with a spoon or from the glass, and not through a straw — this is a routine precaution, intended to avoid suction over the operated area in the first 24 hours.

In the days that follow the soft consistency should be maintained: soups and purées that are lukewarm or at room temperature, scrambled eggs, poached fish, fresh cheese, well-cooked pasta, cooked or puréed fruit.

Crunchy or hard foods, or foods that require a lot of chewing, must be avoided altogether.

A practical rule that dispenses with lists: if the food needs to be cut with a knife or bitten into forcefully, it is not yet time to reintroduce it into your diet.

After surgery, and for as long as the local anaesthetic lasts, it is very important to take particular care not to bite your lip or your cheek.

The return to your usual diet is gradual and depends on the surgery carried out and on the type of rehabilitation.

After simpler surgery — the placement of a single implant, with no associated bone graft — it is usual for eating to return to normal a few days later. In more extensive rehabilitations, care with eating is maintained, as a rule, throughout the first month.

When there is immediate loading

It is here that the instructions deserve most attention, because there is a tooth or a fixed prosthesis in the mouth from the first day. The comfort that immediate loading provides is such that the patient, feeling comfortable, may forget that integration is still taking place.

When replacing a single tooth. In a central incisor, for example, the implant may be placed and an immediate provisional fitted over it, to restore the patient's appearance. In that case it is essential to keep to a soft diet and not to bite with the front teeth, so as to avoid micromovement at the implant.

In a full fixed prosthesis on implants. The prosthesis does not only restore appearance: it is in function, and eating will generate load on the implants. As these are positioned in strategic areas, that force is distributed across the implants as a whole. And for that reason, during the healing phase, it is important to control the diet, particularly throughout the first month, so that there is no excess load that would compromise osseointegration.

The reason is biomechanical and is well established. It is not the load itself that prevents the implant from integrating: it is the excessive micromovement during the healing phase that interferes with bone formation and favours the interposition of fibrous tissue. There is a threshold of tolerated micromovement, placed at between 50 and 150 micrometres ^[5]. Controlling the diet at this stage is one of the ways of keeping it below that threshold.

Eating before and after surgery: detailed guidance ›

How should I carry out oral hygiene?

It is very important that oral hygiene is not suspended after surgery. It should, rather, be adapted to the surgical context you have been through.

Brushing continues in the non-operated areas from the first day, with the same thoroughness as usual. Close to the operated region, extra care is needed.

Cleaning the whole of the oral cavity keeps its bacterial load lower, which reduces gingival inflammation and favours healing.

Cleaning of the operated area follows the instructions given. A surgical toothbrush, whose bristles are extremely soft, is generally recommended for cleaning the operated area.

In some cases an antiseptic gel or mouthwash is prescribed, usually chlorhexidine-based, to be used for the period indicated. After clinical examination and assessment of the healing, you will be told when you can resume your usual hygiene.

It is important to be aware that the accumulation of dental plaque in the operated area compromises healing. Keeping the mouth clean is part of the healing care, as much as rest or medication.

It is equally important that the dentist or the assistant explain the care to be taken and the correct way to carry out hygiene. In cases where a bone graft or a gingival graft has been carried out, that explanation is decisive: the integration of these grafts requires stability of the tissues in the operated area, and micromovement caused by incorrect hygiene can compromise it.

When can I go back to work?

The return to work should be discussed with the dentist, since it depends on the extent and the complexity of the surgery.

After simpler surgery, you may be able to return to work the next day, particularly if the activity does not involve physical exertion. More complex surgery may warrant a few more days of recovery.

Intense physical exercise should be postponed during the first few days. If you are used to exercising, tell your dentist: it is a factor to take into account in deciding when you will be able to resume your usual activity, and how to do so — gradually, and starting at moderate intensities.

If the surgery was carried out under sedation, also follow the specific instructions on driving and on returning to your usual activities.

Can I smoke during recovery?

In the placement of dental implants it is very important to be aware that smoking is a decisive factor, which may affect the healing of the peri-implant tissues and the osseointegration of the implant.

A systematic review with meta-analysis that brought together 292 publications, comparing 35,511 implants placed in smokers with 114,597 in non-smokers, found a significantly higher risk of failure in smokers — odds ratio of 2.40 — and marginal bone loss on average 0.58 mm greater ^[1].

The risk increases with consumption. In another meta-analysis, in patients who smoked more than 20 cigarettes a day, the relative risk of failure was four times higher than that of non-smokers ^[2].

Stopping smoking before treatment begins, and maintaining that in the long term, is therefore recommended.

If you are a smoker, you should tell the clinic, so that the surgical preparation can be worked through with you to that end and you are able to stop the habit before the surgery — and not only in the immediate postoperative period. It is a factor that changes the probability of the treatment succeeding.

It is worth bearing in mind that the success and the longevity of a rehabilitation with implants do not depend on the surgical technique alone. They depend, to a large extent, on the patient's state of health and habits — and smoking is one of those with the greatest impact.

Is it necessary to take an antibiotic?

The need for an antibiotic is assessed case by case, taking into account the patient's state of health and the procedure planned.

As a rule, an antibiotic is prescribed for implant placement surgery. The reason is well known: a postoperative infection makes failure of the implant more likely, and preventing it is a legitimate concern in the planning.

Even so, the prescription should not be taken as universal. It is a clinical decision, which it falls to the dentist to justify in each case.

The clinical evidence is not unanimous. There are reviews that report a reduction in implant failure with antibiotic prophylaxis ^[3].

There are also systematic reviews that brought together randomised controlled trials — in one case, seven trials, 1,859 patients and 3,014 implants — and found no statistically significant difference in early failure between antibiotic prophylaxis and placebo, in generally healthy patients. The authors conclude that the results do not support routine prescription ^[4].

The practical conclusion is the same as the one already stated: the prescription should be assessed case by case and not taken as universal. If an antibiotic is prescribed for you, complete the dose and the duration indicated.

When are the review appointments?

After the surgery a review appointment is arranged for the following days, to assess the healing. Subsequent appointments are arranged according to how things progress and to the treatment carried out.

These appointments also serve to give the instructions appropriate to each moment of the healing: the care that makes sense in the first week is not the same as in the first month.

One distinction is worth noting. The improvement in discomfort, after the peak of the inflammation, is a good sign in the assessment of healing — but it does not mean that integration of the implants is complete.

That is why it is important to keep to the care indicated by the dentist, so that the definitive rehabilitation can go ahead as soon as possible after osseointegration of the implants and healing of the tissues.

In what situations should I contact the clinical team?

It is important to be alert to the signs of inflammation at this stage.

You do not need to wait for the review appointment to clear up a query about your recovery. Assessment allows us to see whether progress is within what is expected or whether some additional care is needed.

That is why we attach such importance to close contact with the patient. Only with careful, monitored healing is it possible to obtain predictable and stable results.