What To Expect
Serving Patients in Vancouver WA
Initial Exam
Your first visit with Dr. Lewis will be a comprehensive exam to see if you are a good candidate for extractions and dental implants. This will consist of a 3D-scan of your jaws, photos of your teeth and jaws, and a full review of your medical/dental history. Additional X-rays may be necessary if any natural teeth are being evaluated to keep. It is important that you provide an accurate list of all medications that you are taking. Some medications may need to be stopped before your surgery.
The incredible 3D-scan technology is calibrated to allow Dr. Lewis to do a virtual extraction and implant surgery on the computer while you watch on the computer monitor. This means Dr. Lewis can determine which areas of your mouth are the best possible places to put your implants prior to actually doing the surgery. Most patients have their extractions done and their implants placed at the same time. There are some circumstances that require implants to be placed 3-6 months following the extractions for ideal implant placement. Dr. Lewis will thoroughly review his recommendations for your individual case, which can widely vary from one patient to another.
At the end of the 1st appointment we will take time to review the cost breakdown for your recommended procedure. You will review and sign consent forms for your procedure after all of your questions are answered. If you are ready to schedule your surgery appointment prescriptions will be given for antibiotics, pain medication, and a sedative (Valium) if desired. If you take the sedative for the surgery it is illegal for you to drive so a ride will be required.
If you are determined not to be a good candidate for dental implants we may refer you to an oral surgeon. This is usually because there is not enough bone for dental implant placement and there are bone-grafting procedures that may make it possible to have dental implants placed.
Surgery
It is best to have a meal 1-2 hours prior to your appointment to have some nourishment in your system. Great care will be given to ensure that you are comfortable during you entire procedure. We start by using a high strength topical jelly and place it in the areas we will administer the anesthesia. The topical jelly really helps limit the amount of discomfort you feel from the anesthetic. We do not start your procedure until we verify with you and achieve total and profound numbness. You will be able to feel some pressure and vibrations throughout the procedure but should not be in any discomfort. If you do experience any discomfort whatsoever you will be instructed to raise your hand and let us know right away. We will frequently check in with you during your surgery to make sure you are doing well. Additional anesthesia will be given as needed to keep you comfortable during your visit.
After your extractions and implants are completed sutures may placed. The sutures are resorbable and typically come out in 3-5 days on their own. Many times smoothing of the bone is required during the extraction and implant placement. The term used is “alveoloplasty” and is necessary to form and ideal site in the bone for the implant as well as round bulbous areas of bone to help with the fit of the denture. An X-ray will be taken to verify correct implant placement and position. Your dentures will be adjusted to fit passively over the implants and will not engage the implants until after your 90 day follow up exam and x-rays.
90-day Exam and X-rays
This important exam is to determine how well the implant has integrated into the bone. We take the appropriate X-rays or scan to evaluate that the implants have fully healed and are ready to be attached to your denture. Most implants are determined to be successful at this appointment. Your denturist will be informed that the implants are now ready to be used. You will make an appointment with your denturist to fit your denture to the implants and can finally start enjoying having a denture that is stable and secure.
Post Operative Instructions
You will wear your dentures for the next 24 hours to keep pressure on the wounds and act as a band-aid. Keep in mind there be some swelling and the dentures will not fit to place well until the swelling goes down. If wearing the dentures is extremely uncomfortable and not tolerable it is ok take the dentures before 24 hours however this may result in increased swelling and prolonged bleeding. After the initial 24 hours dentures are to be taken out at night and placed in a denture solution. Expect to have some bleeding for up to 48 hours following your surgery. There will be large increase in saliva production for the first week especially for new denture wearers. The saliva mixes with the blood and makes it seem like you are bleeding much more than you really are. In some circumstances the dentures are made 1-2 weeks following extractions and implants.
In most cases the pain and swelling peaks at 48-72 hours. It is recommended to ice the outside of the your face alternating 10-15 minutes on and 10-15 minutes off as much as possible for the first 24 hours. Try to keep up on your pain medication as directed for the first 48 hours and can start cutting back the prescription pain medications and transitioning to over the counter pain medication (ibuprofen, Tylenol)
It is important throughout the healing process to keep hydrated and nourished with a soft diet (protein shakes, ensure, yogurt, applesauce, etc.)
Over the first month the gum tissue will shrink during the healing process and will make the healing caps of the implants appear to be getting taller. It is normal for the healing caps to be different heights. The healing caps can start to loosen and even come out. If you notice the healing cap is getting loose or comes out contact our office immediately so we can get the healing cap tightened back in place. It is extremely important that the dentures DO NOT rest or ride directly on the metal healing abutments during the initial 90-day healing period. This can cause the implant to fail. If you feel your denture is hitting your metal healing caps contact your denturist or our office immediately so the denture can be further adjusted so your denture fits passively over the metal healing caps.
It is normal to develop denture sores where the dentures rub on tissues that are not use to having anything touching those areas. Sometimes it is necessary to see your denturist for adjustments to these areas and sometimes it just takes time for the tissue to toughen up and get use to the friction of the denture. Much like getting a blister from a new pair of shoes.
For patients having multiple extractions it is normal to develop small bone spurs that project through the gum tissue over the first 90 days. These are small but can be quite uncomfortable. These projections are small pieces of bone that break free from the boney socket that surrounded the tooth. Most of the time these will come out on their own, can be scraped off with a Q-tip, or sometimes require an appointment to have them removed.