SURGERY + IMPLANT

PREPARATION

MEDICAL HISTORY.  It is important that you have supplied the office with an up-to date current Medical History to be reviewed prior to your surgical procedure. Blood pressure needs to be controlled before starting the procedure.

SEDATION.  If you wish to take an oral sedative prior to your surgery, this must be discussed in advance of your surgery appointment. Please do not drink or eat anything 8 hours before your scheduled surgery time.  You will need someone to drive you home after your surgery. Do not take any other medications or substances other than what has been prescribed by your doctor(s).

OVER-THE-COUNTER MEDICATIONS.  Discontinue Aspirin and any medications containing Aspirin for 7 days prior to your surgical appointment, unless otherwise advised by your physician.  Discontinue Advil or any other non-steroidal anti-inflammatory medication 7 days prior to your surgical procedure. Discontinue Vitamin E and any other homeopathic medications 7 days prior to your surgical procedure. Only make a change after discussing with your physician and dentist.

PRESCRIPTION MEDICATIONS.  Take all routine prescription medications as directed by your physician unless otherwise advised. Take the antibiotic prescription before your procedure if the doctor directed.

PREPARATION.  Eat a light meal prior to your surgical appointment.  Avoid heavy or greasy foods. Plan to rest at home for the remainder of the day of your surgical appointment.  Following surgery, you should have cold liquids for your next 3 meals. Protein shakes, ice cream, and yogurt are good choices.  Ice packs may need to be available for the first 24 hours as well. Wear loose or comfortable clothing.  If you smoke, avoid smoking for 2 weeks prior to your procedure if possible. Smoking may delay healing.

DURING THE PROCEDURE. We will place a numbing jelly in the area the dentist will be numbing.  This will help make the local anesthetic injection more comfortable.  It's our goal to have you feel as little as possible during this part but cannot be guaranteed.  Please raise your left hand (the doctor will be on your right side) if something is too uncomfortable so the doctor stop.  Everything is within your control to pause the procedure or take breaks if you need.  We want you to feel comfortable at all times. Sometimes, especially during long procedures, the anesthesia can start to wear off.  Please don't try to "tough" it out, but be sure to let us know so we can give you more anesthesia.

DISCHARGE. You can drive home only if you did not have sedation (including an oral sedative like Valium).  We will provide you with instructions and a take-home kit (if necessary). For larger and longer procedures, we recommend someone to pick you up. If you’ve had sedation, your driver will need to come up to the office and sign for your release. We aren’t able to do Uber or Lyft.

AFTER-CARE INSTRUCTIONS

DISCOMFORT.  Some discomfort is expected after the anesthetic wears off. Begin taking your prescribed pain medication before the anesthetic wears off to minimize discomfort. Taking the pain medication will make a more comfortable night's sleep and recovery. Patients who follow the pain medication instructions carefully have reported mild discomfort that is manageable. Expect to have soreness for 3-5 days for small procedures and 3-7 days for larger procedures. However, please keep in mind that everyone's body responds to pain differently and heals at different rates. Generally speaking, most people are no longer taking pain medications after 5 days. The main thing to consider is daily progress and if the area seems to be heading in the right direction. Even if all pain is not completely eliminated within these time periods, its usually fine as long as everyday the pain is getting less and less. Continue taking pain medications as needed. Red flags are: increasing pain, increasing swelling, unstoppable bleeding, or a continuous bad taste from the area. Call or text us immediately if you have any of these symptoms.

SWELLING.  Some swelling may occur the day after surgery, and will generally persist for 24 to 36 hours, then will subside and diminish over the next few days.  Swelling can be minimized by placing an ice pack on the outside of the face, over the surgical area, alternating on and off for 10 minute intervals. You may do this for an hour or two following your surgery. Take Motrin / Ibuprofen to help reduce swelling only if this medication is approved for you. Swelling can peak at 2-3 days after the procedure before slowly decreasing. Elevating the head with an extra pillow at night and also light walking helps to keep the circulation moving, helping to reduce the swelling faster.

DO NOT TOUCH the surgical area.  Implants and bone grafting especially need to heal undisturbed.  Do not touch, put pressure, or irritate the area. This will disturb the healing process and could cause the surgery to fail.  When placing an icepack on your face, be careful not to place too much firm pressure on the surgical area.

BLEEDING.  Continue changing out the cotton gauze (additional ones are inside the care package) when it gets soggy. Dry gauze and firm biting pressure is the key to bringing bleeding to a stop (hemostasis). You can also place a moistened non-herbal tea bag over the area and apply gentle pressure. Continue this for 15-20 minutes. If there is no reduction in the amount of bleeding, please call our office immediately: (949) 734-0126.  If after hours or weekends, the best way to reach the doctor is to text the office phone number.  He will get a notification on his cell phone and will get back to you shortly.

HYGIENE.  Following your surgery, you should gently rinse the surgical area with warm salt water or the chlorohexidine rinse using the plastic syringe after every meal and before you sleep, brushing the top of your tongue. DO NOT brush or floss any of the teeth or gums involved in the surgery — simply rinse with the syringe. If you have been prescribed mouthwash remember to use it twice daily starting 24 hours after your procedure has finished and continue until the stitches are removed. Although a low probability, if a stitch comes undone, please contact our office to have it restitched.

MEALS.  It is necessary for healing that you maintain a normal healthy diet. In the first 24 hours it is not recommended to have any hot drinks like coffee. For the 3-4 days following surgery, soft foods (oatmeal, potatoes, cottage cheese, egg whites, avocado, fruit, smoothies and vegetable juices etc) can be eaten, but chewing should be done on the opposite side of the mouth from where surgery took place. Avoid any hard / coarse food (seeds, berries, nuts, chips, popcorn, etc). It may be necessary to maintain a liquid diet for a few days if chewing is uncomfortable. Increase your fluid intake (water is best) for a few days. Recommended foods: fruit and vegetable juices, egg whites (in all forms), soup, bouillon, oatmeal, tofu, very soft meats and fish (white meats and fish filet with no bones), pureed vegetables (potatoes, peas, beans, broccoli etc) - fortified organic milk products (yogurt, cottage cheese, etc.). Be sure to stay hydrated by drinking plenty of water after your surgery.

REST. Please rest as much as possible the day of your procedure. This means just taking it easy, don’t run, lift heavy weights, or perform any exercise that elevates your heart rate. The goal is to have the bleeding stop and elevating blood pressure can restart bleeding or dislodge the blood clotting on the surgical area. When you go to sleep, place an old towel under your pillow — sometimes people wake up with red marks on their pillow or sheets.

BONE GRAFTS.  Take extra care around the surgical site where you received bone grafting treatment. It's normal for possibly a small amount of bone graft particles to come out of the treated area anytime after the procedure even up to several months. Please notify the doctor if this happens but don't be alarmed, it is a common occurrence and does not indicate a failure.

REMOVABLE PROSTHESIS.  Avoid wearing your removable prosthesis (if applicable) as much as possible until your checkup appointment with Dr. Heldt in 2-3 weeks. Pressure from the prosthesis can harm the surgical site. Only use it when Dr. Heldt has approved for full use and functionality.

TEMPORARY SINGLE IMPLANT CROWN PROVISIONAL. DO NOT CHEW OR BITE USING YOUR TEMPORARY IMPLANT CROWN (CRITICAL). If the temporary breaks or comes loose, call our office to have it retightened. DO NOT use any other temporary glue except for glue that is approved for dentistry. Using non-dental glue can damage your gums, teeth, or make you ill.

ALL-ON-X or FULL ARCH TEMPORARY PROSTHETIC. Because multiple implants are splinted & connected together, this provides enough strength and stability for immediate function. It is OK TO USE FULL-ARCH TEMPORARY TEETH FOR CHEWING. You need a minimum of four implants (we recommend six if possible) to be able to chew with your temporary implant teeth. The technology is limited to chewing soft foods (nothing harder than a chicken breast or sandwich). Avoid hard to chew foods like nuts, steak, hard candies, etc. When chewing, try to chew as soft as possible and be mindful during the healing phase which can be upto 6 months. Be sure to brush your teeth with a soft toothbrush and rinse near your gums with a WaterPik and low setting, or you can also use the irrigating syringe our office provides. Avoid heavily colored foods and drinks like wine, curry, and coffee or drink through a straw. The temporary teeth are made of plastic and are more easily stained. The final teeth will be made in zirconia and porcelain which does not stain. If you feel pain when biting using the temporaries, have a bad taste, or have swelling that arises in any area (after the 2 weeks check-up visit), please notify us immediately.

MEDICATIONS

This is a brief glossary of medications that are commonly prescribed for your surgery, only available at a pharmacy. Follow only what's been prescribed by your doctor, this is just a reference for your convenience. Please let us know if you have any reactions to any of these medications and an alternate medication will be prescribed.

AMOXICILLIN.  A penicillin-based antibiotic that will reduce bacteria and help prevent an infection after the surgery. Take 2 pills one hour prior to your surgery and 1 pill three times per day until all the tablets have been consumed. This medication is the most important to prescription to follow carefully. Patients who don't take their antibiotic or follow the instructions carefully have a higher risk of complications or treatment failure. Twenty-eight tablets will be dispensed.

CEPHALEXIN.  An alternative to those who are allergic to Amoxicillin and Clindamycin.

VALIUM.  Sedation pill to help with relaxation if you are nervous.  You will need a driver if you take this medication at the time of surgery. This will need to be prescribed ahead of time by our office if needed. Do not take until instructed by the Doctor.

IBUPROFEN.  Also known as "Motrin" which is the brand name. Pain and anti-inflammatory medication. Take 1 tablet every 6-8 hours as needed for pain. Helps reduce swelling. Don't exceed 3,200mg or 4 pills per day. For your own comfort, please take this medication for the first three days. On the fourth day, you can taper off if you feel the pain level is manageable.

TYLENOL #4.  Stronger pain medication (acetaminophen) that can be taken if needed.

HYDROCODONE.  Stronger pain medication (acetaminophen) that can be taken only if needed. Take this medication every 6-8 hours as needed for pain alternating with ibuprofen.

CHLOROHEXIDINE.  An anti-microbial mouth rinse. If you were prescribed this, use the plastic irrigating syringe to keep the surgical area clean. Rinse away food, plaque, and other debris but be careful not to undo the stitches. If the stitches come undone, call us to discuss the situation. It's important for your tissues to heal with all the stitches in place until the doctor removes them in 3 weeks. Start using the rinse 24-36 hours after your surgery is finished. Please rinse 2x per day until the doctor removes your stitches. One bottle will be supplied.

NEXT APPOINTMENTS

THE FOLLOWING SEQUENCE IS TO GIVE AN IDEA OF FUTURE APPOINTMENTS. HOWEVER, EVERY PATIENT HAS SOME VARIATION DEPENDING ON YOUR INDIVIDUAL TREATMENT PLAN. PLEASE CONSULT WITH THE DOCTOR AND OFFICE FOR YOUR SPECIFIC TIMELINE.

POST-OP CHECK + SUTURE REMOVAL. Your check-up appointment has been scheduled in 2-3 weeks from the surgical date. This appointment is usually short where Dr. Heldt may take x-rays, remove your stitches and evaluate the healing progress.  If you've had wisdom teeth removed or an extraction with no plans for an implant, then this is the last follow-up appointment that's needed related to this project. Please continue your regular cleaning and/or periodontal maintenance schedule.

SURGICAL GUIDE IMPRESSION. If you are planning to have the tooth replaced with an implant, we will have an appointment in a few months to take an updated CT scan, evaluate the healing, and discuss the dental implant process. Any questions you may have to related to the implant process can be answered at this appointment or any other time during the process. Just call us if you have any questions.

IMPLANT SURGERY. If you had an implant placed today, then you'll have a suture removal appointment in 2-3 weeks. After healing has completed in 4 - 6 months, you’ll have another short appointment to take measurements for the final implant crown. We’ll also take photos of your teeth and portrait photos (for front teeth cases) so the lab can make your new teeth to look the best way possible, depending on your goals.

HEALING ABUTMENT. Most of the time, there will be a healing abutment or immediate tooth so numbing won’t be needed. Sometimes however, a cover screw will be placed which is below your gums. If this is your case, we will need to have a minor procedure to open the gums to add a healing abutment. Dr. Heldt will take a digital scan to locate the implant, and start the process of designing and creating your custom abutment and implant crown. This is typically a minor surgical procedure and although antibiotics are not usually prescribed here, pain medication is recommended for a few days as needed. If you had a healing abutment placed at the time of surgery or an immediate provisional implant crown, then an “implant exposure” surgery is not needed. The appointment will typically not require local anesthetic numbing and is fairly short. Dr. Heldt will just need to unscrew the healing abutment or provisional crown, take a measurement with the digital scanner, and photos for the lab to match the crown to your existing teeth. It will take a few weeks for the lab to receive, design, finish, and deliver your case back to us. Dr. Heldt also needs a day or two to review and make sure the case turned out the way he had intended.

TRY-IN #1. An abutment and crown try-in appointment is scheduled to make sure the final result turns out well both functionally and esthetically.  This appointment is usually 1-2 hours and usually doesn't involve anesthesia, but sometimes a small amount may be necessary to make the appointment more comfortable. This may be combined with other restorations such as crowns or veneers. Depending on the scope of teeth involved, this appointment length can vary considerably. We will try-on the restorations. After the doctor verifies the restorations are in perfect condition, you will have an opportunity to review the shade, shape, and aesthetics of the final teeth. We will ask for your authorization to permanently bond the teeth in place. If there is something you don’t like or would like to change, this is your opportunity to let us know. Once we bond them in place, we cannot make anymore modifications to shape or color. We can however, make reducing or “grinding” modifications. There is a chance the restorations may need modification, and if Dr. Heldt can’t make the modifications in the office, they will need to be sent back to the lab for revision.

FINAL DELIVERY of the abutment and crown. Depending on your type of prosthesis, it usually takes 2-3 weeks for the final crown to be made. Before completing the project, you will have the opportunity to approve of the fit, form, feel, and esthetics of the final restoration. Your satisfaction is important to us, so be assured that we will not complete the project until you're happy with the results. However, sending it back to lab for any revisions will require more time (typically an additional week or two but usually no additional costs). Once you and Dr. Heldt are satisfied with the results, we will obtain your authorization to permanently finalize the project. We want you to be happy with the result and you’ll have an opportunity to inspect the case. An x-ray will be taken to verify ideal results.  Instructions will be given on how to take care of the crown.

MAINTENANCE. Your implant crown needs to be taken care of just like a natural tooth.  Daily brushing, flossing, and routine dental hygiene cleaning and checkup appointments are necessary to make sure the implant stays clean and healthy. It's important for a dental professional to monitor the health of the implant to make sure no infections develop around the implant before any permanent damage develops. Unless otherwise directed by your dentist or hygienist, a minimum of 2 cleaning / checkup appointments per year is recommended.

EMERGENCY & QUESTIONS

If something doesn't feel right or if you have any questions, please call or text our office phone number (949) 734-0126 even during the weekend or evening is fine. If no one is available, please text the phone number and it will be forwarded to Dr. Heldt's cell phone. You will receive a response shortly.  In the extremely rare event you feel you have a life-threatening emergency, please call 911. These instructions are a supplement to what your doctor has advised but FOLLOW ONLY THE SPECIFIC INSTRUCTIONS THE DOCTOR HAS GIVEN TO YOU.