Does dental implant surgery hurt? What happens, how long it takes and the first two weeks of recovery

Does placing the implant itself hurt?

Placing a dental implant should not hurt, because the procedure is usually carried out under local anaesthesia, which numbs the surgical site. Guy’s and St Thomas’ hospital in London explains that once the anaesthetic has been given, patients do not feel pain during surgery. The British Association of Oral and Maxillofacial Surgeons (BAOMS) also states that implants are usually placed under local anaesthesia.

Hashem et al. (2006), who asked patients to keep diaries, described implant placement as a mildly to moderately painful and stressful procedure, with anxiety highest on the day of surgery. None of the 18 participants reported severe symptoms.

If you are very anxious about surgery, mention this at the consultation: the dentist can discuss inhalation sedation with nitrous oxide. General anaesthesia is a medical decision following assessment, used in specific situations, for example an allergy to local anaesthetic agents.

What happens during dental implant surgery, step by step?

Placing a single implant usually takes about half an hour, and several implants take proportionately longer (BAOMS). Guy’s and St Thomas’ hospital describes a series of straightforward stages.

Stitches are removed at a follow-up appointment, which the London hospital schedules 7 to 14 days after surgery. Dissolving stitches may take several weeks to disappear (BAOMS).

• Local anaesthesia of the surgical site and a check that the area is numb.
• Moving the gum away from the bone where the implant is to be placed.
• Preparing a socket in the bone with drills and inserting the implant into the bone.
• Repositioning the gum and placing stitches.
• Discussing aftercare, the painkillers recommended by the dentist and the follow-up date.

How long does pain last after dental implant surgery?

Pain after implant surgery is usually greatest during the first 24 hours and eases considerably over the next few days. In Hashem et al. (2006), average pain on a scale from 0 to 100 was 24 on day one, 12 on day three and 9 on day six. Peak pain and interference with daily activities fell by roughly half by the second or third day.

Urban and Wenzel (2010) studied 92 patients who had an implant placed immediately after a molar extraction, together with bone augmentation. Pain peaked 5 to 6 hours after surgery and swelling the following day. Smokers experienced more pain on days one to three, and people aged 50 or over experienced less than younger patients.

Longer surgery, preoperative anxiety, diabetes or high blood pressure and bone quality were also associated with greater pain (Kuroi et al., 2015). Guy’s and St Thomas’ hospital says discomfort is usually relieved by regularly taken painkillers and lasts up to a week; the dentist determines the medicine and dose.

The severity of symptoms depends on the extent of surgery. BAOMS describes implant placement as rarely very painful, with usually mild swelling. In Urban and Wenzel’s study, however, where surgery included extraction and bone augmentation, average swelling in the first 24 hours was rated at 62 out of 100.

Swelling after an implant: what can you expect in the first 14 days?

Swelling may occur after an implant, and how severe it is and how long it lasts depend on the extent of surgery. In Urban and Wenzel’s study of 92 people who had an implant placed immediately in a molar site with bone augmentation, swelling was greatest the day after surgery. The table is a rough guide combining research findings with advice from hospitals in the UK’s National Health Service (NHS); follow your dentist’s individual instructions.

What can you eat after dental implant surgery?

After implant placement you can usually eat normally, although your dentist may recommend a soft diet (Guy’s and St Thomas’ NHS). Royal Berkshire hospital’s advice following minor oral surgery recommends soft meals for about a week and avoiding excessively hot food and drinks on the day of surgery.

In practice, a soft diet means meals that need little chewing, such as soup, yoghurt, scrambled eggs, fish or well-cooked pasta. Your dentist will provide specific instructions for the days ahead, including when a tooth has been extracted at the same time.

• On the day of surgery, choose lukewarm or cool food and drinks rather than hot ones.
• For about a week, choose soft meals unless your dentist advises otherwise.
• Avoid alcohol for 24 hours after surgery.
• Do not smoke: Guy’s and St Thomas’ hospital recommends stopping before treatment and giving up permanently.

How do you care for the wound, and when can you return to work or sport?

Aftercare aims to avoid irritating the wound while keeping the mouth clean. Guy’s and St Thomas’ hospital advises not brushing the implant area for a week, using the prescribed mouthwash twice a day and brushing the other teeth as usual.

You can usually return to work the next day (Guy’s and St Thomas’ NHS). BAOMS advises taking the rest of the day of surgery off and notes that, depending on your job, an extra day may be needed. Avoid exertion on the day of surgery, because it raises blood pressure and can increase bleeding and swelling (Royal Berkshire NHS); agree a return to sport with your dentist.

Smoking increases the risk of implant loss: in a meta-analysis of 107 studies, 6.35% of implants placed in smokers and 3.18% of implants placed in non-smokers were lost (Chrcanovic et al., 2015). You must not drive for 24 hours after intravenous sedation or for 48 hours after general anaesthesia (BAOMS).

When do you need urgent medical help after implant surgery?

Most symptoms after implant surgery ease from day to day, so a symptom that worsens rather than improves is a particular warning sign. Contact the dental practice, and call for emergency help in a life-threatening situation.

• Bleeding that does not stop after at least 30 minutes of pressure with a rolled handkerchief or gauze: see a doctor or go to a hospital emergency department (SOR).
• Swelling or pain that becomes worse after several days instead of easing.
• Fever or pus from the wound, which may indicate infection.
• Numbness or tingling of the lip, chin or tongue that remains after the anaesthetic has worn off and may indicate irritation of a nerve in the lower jaw.
• Difficulty breathing or swallowing, or rapidly increasing swelling of the neck or around the eye: call the emergency number 112 or go to a hospital emergency department.

What happens to the implant over the following months?

After the wound heals, the implant fuses with the bone (osseointegration), which usually takes several months before a crown can be fitted. A Cochrane review (Esposito et al., 2013) states that implants have traditionally been left unloaded for 3 to 8 months. Guy’s and St Thomas’ hospital describes a wait of usually at least 3 months.

In selected cases a temporary crown is attached immediately. The same Cochrane review found no convincing difference in implant loss between immediate, early and conventional loading. The subsequent stages, from uncovering the implant to fitting the crown, are explained in the article on dental implants step by step.

How dental implant surgery works at DentalBlue

At DentalBlue, implants are planned using CBCT images from the clinic’s own radiology unit. Placement is carried out under local anaesthesia or, in patients assessed as suitable, under general anaesthesia provided by the clinic’s own anaesthesiology department; the clinic also offers inhalation sedation with nitrous oxide. In the clinic’s price list, “Wszczepienie implantu” (implant placement) costs 3 500 zł, “Kontrola po zabiegu implantacji” (post-implantation check-up) 0 zł and “Fibryna bogatopłytkowa, 2 próbki” (platelet-rich fibrin, 2 samples) 800 zł. The final scope and cost are agreed at the consultation, and prices may change.