Preparing for implant surgery: a checklist

A large part of what decides how surgery will go takes shape not at the clinic but beforehand. First among these is smoking. Smoking impairs the blood supply to the tissues around the implant and their healing, and it is one of the strongest known modifiable risk factors for losing an implant. Stopping in the weeks before surgery, or at least cutting down markedly, is the step with the biggest pay-off that is in the patient's own hands.

The second is the list of medications, and this is the thing that most often arrives incomplete. The name and dose of every medication you take should be written down, not recalled from memory. Blood thinners, bone medications, and diabetes and blood pressure medications have a direct effect on the plan. If you have a pacemaker, a stent or a heart valve, bring your card. Herbal products and supplements should go on the list too; some of them can affect bleeding.

An important warning: do not stop any medication on your own. With blood thinners in particular this can be dangerous, and in most cases stopping is not necessary anyway. If a change is needed, your dentist will tell you, and if necessary the decision is made after talking to the doctor who treats that condition. Skipping blood pressure and heart medications because you are having surgery is also one of the most common mistakes.

The third is the current state of your mouth. If there is an active infection, gum inflammation or a sore that has developed under a denture, it needs to be dealt with before surgery. These are largely picked up on the CBCT scan and at the examination; but if a new problem appears between your appointment and the surgery, let us know. A patient who arrives with swelling or pain is not operated on that day.

The fourth is fasting, and this is the point that causes the most confusion. If only local anaesthetic is being used, you do not need to come on an empty stomach; on the contrary, it is better to have your normal meal. Low blood pressure and feeling faint are more common in patients who have not eaten. If sedation is planned, things change and you are given separate fasting instructions; those instructions are not relaxed.

The fifth is what happens after you get home. On the first day you will not be in a fit state to go shopping. Getting soft foods, your painkillers and an ice pack for cold compresses ready in advance makes the day of surgery noticeably easier. This is the simplest item on the list, but the one most often forgotten.

For the groups below, preparation goes beyond the standard, and this is discussed at the examination.

Three time frames. Each one does its own job, and none of them can stand in for another.

1. 1

   Weeks before: stop or cut down smoking

   The item on the list with the biggest pay-off. Smoking impairs the blood supply to the tissues around the implant and their healing. Even if you cannot stop completely, cutting down markedly before and after surgery makes a difference.

2. 2

   Weeks before: write down your list of medications

   The name and dose of each medication, with the times you take it. Photos of the boxes are fine too. Include herbal products and supplements. If you have a card for a pacemaker, stent or heart valve, bring it with you.

3. 3

   Weeks before: get your readings under control

   Blood sugar if you have diabetes, blood pressure if you have high blood pressure. Uncontrolled readings get surgery postponed; a few weeks spent getting them in order is far better than a postponed appointment.

4. 4

   The day before: rest and get things ready

   Sleep well, avoid alcohol and do not plan a demanding day. Get soft foods, your painkillers and an ice pack ready. If you need someone to go with you, confirm it. If you are travelling from another city, arriving the day before also helps.

5. 5

   That morning: have your normal meal and take your medications

   Unless you have been told otherwise, do not come on an empty stomach; low blood pressure is more common in patients who have not eaten. Take your medications at the usual time. Wear comfortable clothes, avoid heavy make-up and lipstick, and wear glasses rather than contact lenses, as they are more practical.

6. 6

   On your way to the clinic: bring your documents

   Your list of medications, any X-rays and CBCT scans, records of previous treatment, and your ID and insurance documents. If a new problem has come up recently, let us know before you come.

On the first day you will not be in a fit state to go shopping. The following should be prepared in advance.

These are the things that get appointments postponed or make healing harder.

This is where your preparation pays off.

1. The first few hours

   Cold compresses, rest and the medications you have been given. No strenuous activity, hot showers or alcohol. If you had sedation, do not drive or make important decisions, and have someone with you.

2. The first night

   Sleep with your head raised; this noticeably reduces swelling by the morning. Taking your painkiller just before bed means it covers the most uncomfortable hours of the night.

3. Days two and three

   Swelling peaks on these days, and this is the expected course, not a sign that things are getting worse. You are still on soft foods. Your preparation should cover these two days as well.

4. The first week

   The swelling goes down and you get back to your normal routine. Not smoking still applies this week, and it is the one thing you do that makes the biggest difference to healing.

The preparation items are small, but the cost when they are skipped is large.

The cost of a postponed appointment

An incomplete list of medications, an active infection or not following fasting instructions gets the procedure postponed. For patients travelling from another city, this means a second trip and a second day off work.

The long-term cost of smoking

One of the strongest known modifiable risk factors for losing an implant. Stopping costs nothing; not stopping can cost you a repeat treatment.

Preliminary procedures

If an extraction, gum treatment or treatment for an infection is needed, these are separate items. Some of this can be done at a state healthcare facility, which brings the total down.

Choosing sedation

A separate item that should be discussed at the quote stage. For very anxious patients, it can be what makes the procedure possible; whether you want it should be settled from the start.