Healing after dental implant surgery is an essential step for the success of the treatment and for the long-term stability of the implant. After the procedure, it is normal for the body to go through a recovery process, during which some symptoms are natural, while others may require medical attention.

The healing period after dental implant surgery can be divided into two stages. The first is rapid, lasting 1–2 weeks, during which time the gum gradually closes and the inflammation subsides. The second stage is osseointegration, a slower process that lasts between 3 and 6 months, during which the implant becomes fixed in the bone, becoming stable and functional, similar to a natural tooth.

The success of a dental implant does not end with the surgery, but depends largely on how the osseointegration process proceeds.

It is normal for certain reactions to occur after dental implant placement. These are part of the normal healing process and, as a rule, should not cause concern to the patient.

In the first few days after the procedure, normal signs include mild to moderate pain, swelling, bruising and slight bleeding.

Moderate inflammation (swelling)

"Swelling of the gums and adjacent facial area is common in more complex procedures, such as those involving bone augmentation (bone addition). This is a natural reaction to surgical stress, a procedure that involves tissue manipulation, and therefore controlled inflammation. Its extent is correlated with the extent of the procedure, but also with the individual reactivity of the patient," explains Dr. Marina Băjinaru, Specialist in Dento-Alveolar Surgery at DENT ESTET clinics.

The swelling peaks after 48–72 hours, then begins to subside.

At this stage, it is recommended to maintain a low local temperature using cold compresses or ice packs.

Mild to moderate pain

It is also normal to experience mild pain after dental implantation, especially in the first 24–48 hours. This discomfort after implantation may be more pronounced during chewing and usually manifests as localised pain. The intensity may vary from patient to patient, but the pain is generally manageable.

To relieve discomfort, your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs), which are effective in most cases.  

Bleeding, bruising (ecchymosis)

Normally, post-surgical bleeding stops after 5-20 minutes as a blood clot forms. Saliva may be pink or reddish in colour for a few days, but this is nothing to worry about.  

In certain situations, however, post-extraction haemorrhages characterised by significant blood loss may occur.  

Local bruising (ecchymosis) is also normal.  

"These do not require treatment, as they resolve spontaneously within 5-7 days. They are usually accompanied by haematoma. Antibiotic prophylaxis is recommended to avoid superinfection of the haematoma, and cold compresses are recommended to speed up resolution. They are especially visible in patients with vascular fragility and gradually disappear within a few days," says Dr. Marina Băjinaru.

Persistent trismus

Trismus is defined as limited opening of the dental arches, resulting from spasm of the masticatory muscles. It is usually a temporary complication that resolves completely after 7-8 days. Treatment is limited to the administration of non-steroidal anti-inflammatory drugs.

In the acute phase, warm compresses, analgesics and, if necessary, muscle relaxants are recommended. Compresses are applied for 20 minutes every hour.

If the pain persists, diazepam or other benzodiazepine drugs may be administered for muscle relaxation.

"Mechanotherapy is also recommended, consisting of opening, closing and lateral movements for 5 minutes every 3-4 hours. The patient usually notices an improvement within the first 48 hours. However, treatment will be continued until complete remission of symptoms," explains Dr Marina Băjinaru. 

Temporary numbness

This symptom is due to intraoperative trauma to the inferior alveolar, mental or even lingual nerve and has a fairly low incidence.

In general, these disorders are short-lived, but in the case of more serious injuries, they can persist for approximately 6 months.  

"It manifests itself through the appearance of hypoesthesia, paresthesia, neuralgia-like pain or even anaesthesia in the area of the damaged nerve. To prevent this type of injury, a correct preoperative assessment and management of all operating times is necessary," says Dr Marina Băjinaru. 
 

Swelling that does not go away

If, after dental implant treatment, the swelling increases excessively, becomes hard or spreads rapidly across the face, this is a warning sign and you should notify your dentist.

Intense pain or pain that persists beyond the normal limit

If the pain persists for more than two weeks after the procedure or reappears after initially improving, it is important for the patient to contact their dentist for further evaluation.  

These symptoms may indicate a possible complication, such as an infection.

Heavy or unstoppable bleeding

Depending on when the post-extraction bleeding occurs, it can be classified as follows:

• immediate prolonged bleeding - bleeding continues beyond the normal clot formation period and there is no tendency for spontaneous cessation;
• early haemorrhage, bleeding reappears 2-3 hours after extraction;
• late haemorrhage - bleeding starts a few days after extraction.

"Haemorrhages occur due to local and/or general factors that either oppose clot formation or promote its premature lysis. Active bleeding that does not stop on its own or through classic compression methods must be reported. In case of recurrence of haemorrhage, the patient may maintain compressive tamponade for a maximum of 48-72 hours in case of massive bleeding," explains Dr Marina Băjinaru.

High fever and severe general symptoms

A fever above 38°C or lasting more than 2-3 days, accompanied by fatigue and chills, are signs of superinfection of the post-surgical wound.

In such situations, the intervention of a dentist is required, who can prescribe medication to treat the infection and reduce the fever.

Purulent secretions or unpleasant taste

Postoperative suppuration generally occurs within the first 15 days after surgery, but in rare clinical situations, it can also occur 1-2 months after surgery, with a reported incidence of between 2% and 5.6%.

This category includes infectious complications of the surgical wound, bone graft and, in some cases, the maxillary sinus, when the implant is inserted in this region.  

"For example, acute maxillary sinusitis occurring after a sinus lift procedure may actually represent a reactivation of a pre-existing chronic sinus infection. Therefore, it is essential that these conditions be identified at the stage of diagnosis and determination of the surgical indication and treated appropriately in the preventive-therapeutic phase, before the surgical procedure is performed," said Dr. Marina Băjinaru. 

A stable dental implant is essential for long-term treatment success. Normally, the implant must be completely fixed in the bone through a process called osseointegration.

There are situations in which this process does not occur correctly, and the implant becomes mobile, an important sign that the treatment may be compromised. According to research, implant stability is also influenced by the surface of the implant screw. Thus, it has been found that the degree of implant roughness is directly proportional to the degree of secondary stability impairment.

Factors influencing the osseointegration process:

• Biocompatibility between the dental implant material and bone
• Microscopic characteristics of the dental implant and screw surface
• The quality and quantity of the patient's bone tissue
• The patient's immune system
• The quality of the surgical procedure in accordance with the surgical protocol.

"Sometimes, mobility can come from the crown or prosthetic stump, which have become loose. The difference can only be determined by a doctor through clinical and radiological examination. However, if mobility is associated with pain, bleeding or purulent secretions, there is a high probability that the implant is compromised. On the other hand, if only slight movement is perceived during chewing, without pain, it is most likely a loose, unscrewed crown," explains the doctor from the DENT ESTET team.

Smoking, poor diet, improper postoperative oral hygiene, and certain medications can increase the incidence of postoperative infection. To prevent this complication, preoperative measures must be taken, including thorough cleaning of the oral cavity and rinsing with a chlorhexidine mouthwash to reduce the bacterial load in the surgical area.

Postoperative patients must also strictly adhere to oral hygiene measures.

After the insertion of a dental implant, the diet should consist of soft, cold/room temperature foods (pureed soups, yoghurt, purées) for the first 24-48 hours, avoiding chewing on the operated side, crunchy foods, hot, spicy, sticky foods, carbonated drinks and alcohol, to allow healing and prevent infections and irritation. 

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2. M.A. Pogrel, J. Bryant, J. Regezi - Nerve damage associated with inferior alveolar nerve blocks, Journal of American Dental Associated, 1995.
3. P. I. Branemark - Osseointegration and its experimental background, The Journal of Prosthetic Dentistry, 1980
4. E.F. Eriksen - Normal and pathological remodelling of human trabecular bone: three-dimensional reconstruction of the remodelling sequence in normal and in metabolic bone disease, Endocrine Reviews