Dental Implant Warnings

It is a surgical procedure so it won’t be painless afterwards however the post-operative stage won’t be as sore as if a difficult wisdom tooth has been removed.

The incidence and severity of problems post-op in part relate to the complexity of the procedure and the individual’s response to it.

Not all possible complications or risks can be foreseen in any medical or surgical treatment and this is the case for dental implant surgery.

These are the commoner risks. There may be other unusual risks that have not been listed here.

Please ask your Oral Surgeon if you have any general or specific concerns.

The medico-legal landscape of consent has been shaped by a number of cases, such as Chester v Afshar [2004], Montgomery v Lanarkshire Health Board [2015], Duce v Worcestershire Acute Hospitals NHS Trust [2018] amongst others, so that it is more patient-centred.

Many of the legal claims in surgical (& medical) cases occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent.

A pre-requisite for obtaining consent for a surgical (medical / dental) procedure from a patient, is a full exchange of information regarding any risks, drawbacks and limitations of the proposed treatment and any alternatives to it (even non-treatment).

The clinicians should provide the patient with as much information as is appropriate and relevant, that it should be in terms the patient understands & the risks should be personalised for that individual patient. Also, there should be enough time for the patient to understand the information given and get a second opinion if needs be.

The following list of warnings regarding dental implant placement is neither exhaustive nor is it predictive. You are to have a dental implant placed.

You can expect the following:

Common Surgical Consequences:

Pain.
As it is a surgical procedure, there will be soreness after the implant placement. This can last for several days. Painkillers such as Ibuprofen, Paracetamol, Solpadeine or Nurofen Plus are very effective. Obviously, the painkiller you use is dependent on your medical history & the ease with which the dental implant was placed.

Swelling.
There will be swelling afterwards. This can last up to a week. Use of an icepack or a bag of frozen peas pressed against the cheek adjacent to the operation site will help to lessen the swelling. Avoidance in the first few hours post-op, of alcohol, exercise or hot foods / drinks will decrease the degree of swelling as well.

Bruising.
Some people are prone to bruise. Older people, people on aspirin or steroids will also bruise that much more easily. The bruising can look quite florid; this will eventually resolve but can take several weeks (in the worst cases).

Stitches.
The implant site will be closed with stitches. These dissolve and ‘fall out’ within 10 – 14 days.

Limited Mouth Opening.
Often the chewing muscles and the jaw joints are sore after the procedure so that mouth opening can be limited for the next few days. If you are unlucky enough to develop an infection afterwards in the operation site, this can make the limited mouth opening worse and last for longer (up to a week).

Post-Op Infection.
You may develop an infection in the operation site after the procedure (even if on antibiotics). This tends to occur 2 – 4 days later and is characterised by a deep-seated throbbing pain, bad breath and an unpleasant taste in the mouth. This infection is more likely to occur if you are a smoker, are on the Contraceptive Pill, on drugs such as steroids and if bone has to be removed to facilitate tooth extraction. If antibiotics are given, they are likely to react with alcohol and / or the Contraceptive Pill (that is, the ‘Pill’ will not be providing protection).

Should the infection develop, you need to contact the Oral Surgeon post-haste as an infection at the op site can lead to the implant failing.

Surrounding Teeth.
The surrounding teeth may be sore after the procedure; they may even be slightly wobbly but the teeth should settle down with time. It is possible that the fillings or crowns of the surrounding teeth may come out, fracture or become loose. If this is the case, you will need to go back to your dentist to have these sorted out. Every effort will be made to make sure this doesn’t happen.

Less Common Surgical Consequences:

Numbness / Tingling / ‘Burning’ of the Lip, Chin and / or Tongue.
The nerves that supply feeling to the tongue, lower lip and the chin run within the lower jaw, close to where the root-ends of the lower molar teeth were and exit onto the gum close to the roots of the premolars / bicuspids. There is a risk that when implants to replace molars ± bicuspids are placed, these nerves can be crushed, bruised, compressed by bleeding or stretched resulting in numbness (at the worse end of the scale) to altered sensation (at the other end of the scale) in the region of the lower lip, chin and / or tongue.

If this is apparent after the local anæsthetic has worn off, you need to contact the Oral Surgeon immediately as prompt action is needed so that the nerve damage is not permanent. If it occurs, the nerve damage is often temporary but normal sensation can take quite a few months before it returns.

Bleeding into Cheeks / Lips / Floor of Mouth.
Swelling that does not resolve within a few days may be due to bleeding into the cheek / lips / floor of mouth. The cheek swelling will feel quite firm. Coupled with this, there may be limitation of mouth opening and bruising. If an implant is being placed in the front of the mouth, there is a chance of bleeding into the lips.

Also, if an implant is being placed in the lower jaw, there is a chance of bleeding into the floor of the mouth. This can look and feel quite alarming. In a worst-case scenario, swelling of the floor of the mouth secondary to bleeding can compromise the patient’s breathing. This scenario needs to be respected and the patient should have a low threshold to contact the Oral Surgeon, should this happen.

Both the swelling, bruising and mouth opening will resolve with time.

Mouth-Sinus Communications.
The floor of the (maxillary) sinus can often been in close proximity to the upper jaw; this is more likely if upper molars and pre-molars have not been present for awhile (i.e. the sinus expands). Hence, when upper implants are placed, the level of the sinus floor has to be checked to see if there is enough bone (height) to place an implant. If there is not, certain stubby types of implants can be used or if, there is not enough bone height even for these, bone has to be placed in the area to provide the bone height for the implants.

There is a chance, with upper jaw implant surgery, that a hole can be created from the mouth to the sinus. This is sometimes is not evident at the time of operation but may develop several weeks afterwards. If this ’hole’ persists or is left un-repaired, every time you drink, fluid can come out of the nose and you may develop a marked sinusitis. This ‘hole’ if small enough, can spontaneously close.

Dental Implants in the (Maxillary) Sinus.
Whilst placing implants in the upper jaw, the implant can end up in the sinus. If this happens, then it needs to be retrieved as it represents a ‘foreign object’ in the sinus and the sinus responds to its presence.

The removal of the implant, if deemed necessary, may entail making a bony window in the upper jaw to remove the implant. Alternatively, the Ear, Nose & Throat Surgeons can remove wayward dental implants with a different approach. It is quite possible that a chronic sinusitis will result that can take awhile to settle.

Dental Implants in the Nasal Floor.
Whilst placing implants in the upper jaw especially towards the front of the mouth, there is a small chance that the implants may perforate through the floor of the nasal cavity. If this happens, then it needs to be retrieved as it represents a ‘foreign object’ in the sinus and the sinus responds to its presence. The removal of the implant, if deemed necessary, may entail making a bony window in the upper jaw to remove the implant. It is quite possible that a chronic sinusitis will result that can take awhile to settle.

Oro-Nasal Communications.

Incisive Neurapraxia.