Healing after dental implant surgery: what helps

What healing involves

After placement, the implant has to fuse with the jawbone before it can carry a tooth over the long term. The gum over or around it heals first.

The time the bone needs is decided for each patient. A Cochrane review of loading trials used three categories. Teeth fitted within one week were "immediate", from one week to two months "early", and after two months "conventional"². These are the trials' definitions, not a personal timetable.

In selected patients a temporary tooth is fitted straight away. The bond with the bone still has to form under it. The evidence on this is mixed. The Cochrane review found no clear difference in implant loss within a year. Another review found slightly lower survival with immediate loading³. The dental implants page explains how treatment is timed.

The steps below come from UK guidance for tooth extraction, which is also surgery in the mouth; they were not written for implants. Your own written instructions come first where they differ.

The first day: protect the clot and get home safely

• Bleeding. Some oozing that stains your saliva pink is common. If the wound keeps bleeding, UK guidance on extractions advises biting on gauze moistened with water, for 20 minutes⁴ before checking. These times come from guidance, not trials: a Cochrane review found no trials it could include⁵ in searches up to January 2018. If you take a blood thinner, a UK leaflet for people on these medicines advises pressing on the bleeding area for 30 minutes⁶, and contacting your dentist if that does not stop it.
• No rinsing. The same guidance says to avoid rinsing on the day of the extraction⁷, so that the clot is not disturbed.
• No alcohol, smoking or exercise. Once bleeding has stopped, SDCEP advises avoiding all three for 24 hours and keeping your head raised if possible. For smoking after an implant, no safe time to start again has been shown; see below.
• After sedation. If you had sedation, someone must take you home. UK sedation standards say that without an escort, sedation must not be given⁸, except for inhalation sedation in adults. The person who takes you home should be given the written and spoken aftercare instructions too. The NHS advises not driving for 24 hours⁹ after a sedative injection. Ask beforehand whether someone needs to stay with you afterwards, and for how long.

The first two weeks

Pain and swelling. Some pain and swelling is expected. After wisdom tooth removal, the NHS says they can last for up to 2 weeks⁹ and should start to improve after 1 or 2 days. The guidance we use gives no separate course for implant surgery, and it varies with how much was done.

Painkillers. The NHS advises paracetamol or ibuprofen. In trials mostly after wisdom tooth removal, ibuprofen combined with paracetamol¹⁰ relieved at least half the pain in almost 70 in 100 people. Follow the pack on doses. If you take blood thinners, a UK leaflet for people on these medicines advises paracetamol and avoiding anti-inflammatories such as aspirin, ibuprofen or diclofenac⁶. Ask a pharmacist first if you are pregnant, have a long-term illness such as asthma or stomach problems, or take other medicines.

Cold packs, wrapped in a cloth. A review of 6 trials after wisdom tooth surgery found a small reduction in pain on the third day¹¹ and no clear effect on swelling. The evidence is of low certainty.

Keeping it clean. Do not rinse on the day of surgery (see above). After that, the NHS advises rinsing gently with mouthwash or warm salt water⁹; it gives no start day. Brush your other teeth as usual and keep the brush away from the wound until your dentist says otherwise.

Food. Eat soft food at first, and follow your instructions on when you can chew normally on the implant side, even if it feels comfortable sooner. If you wear a temporary tooth or denture, ask when and how to use it. Avoid hard or crunchy food, food that can get stuck in the wound such as nuts or seeds, and very hot drinks. Chew on the other side.

Antibiotics. They are prescribed case by case. A Cochrane review of extractions, mostly of wisdom teeth in healthy people, found that about 19 people had to be treated¹² with antibiotics to prevent one infection. The evidence was of low certainty, and it came from extractions, not implant surgery. If you are given antibiotics, take them exactly as prescribed.

Follow-up. Keep the check-up you are given after surgery, even if all feels well.

What is linked to slower healing or implant loss

These come from observational studies. They show a link, not proven cause, and they do not predict what happens to one implant.

• Smoking. In people smoking more than 20 cigarettes a day, implant loss was about 2.5 times as likely per implant¹³. No safe number of cigarettes has been shown, and no safe time to start again. Your dentist sets the smoke-free period in your instructions.
• Diabetes. The findings are mixed. Two of three reviews found no significant difference in implant loss (2021 review¹⁴; 2016 review¹⁵), and the third found higher odds of implant loss¹⁶ in people with diabetes than in people without. The 2021 review, of type 2 diabetes, tied its reassuring result to strictly maintained oral hygiene. All three found more bone loss around implants in people with diabetes. Keep your blood sugar under control, clean carefully every day and tell your dentist about it.
• Gum disease treated in the past. In 14 prospective studies that followed people for at least three years, those treated for periodontitis (gum disease that damages the bone) lost implants at about 1.75 times the rate¹⁷ of people without that history. This is about long-term implant loss, not about how fast the implant heals.

Tell your dentist about every medicine you take, and do not stop one without asking the doctor who prescribed it.

When to contact your dentist

Contact your dentist if you notice any of these:

• Bleeding that does not stop after 20 minutes of firm pressure on gauze
• Pain or swelling that is severe or getting worse, when painkillers are not helping
• Pain with a bad taste in your mouth, a high temperature, or feeling unwell
• Pus or a bad smell around the implant
• The gum over the implant opens, or the implant or a temporary tooth feels loose
• Numbness of the lip, tongue or chin that lasts after the anaesthetic should have worn off

The NHS lists the first three as reasons to get urgent help⁹ after wisdom tooth removal. Scottish guidance for extractions says bleeding that has not stopped after a second 20 minutes of pressure, or that does not stop or starts again in someone on a blood thinner, needs emergency care⁴. If you cannot reach your dentist, go to the nearest emergency department. We found no source saying that a mild fever is normal after mouth surgery, so do not wait it out.

Emergencies. Difficulty breathing or swallowing, rapidly spreading swelling of the face or neck, or swelling around the eye are serious signs. Do not wait for the clinic's reply: go to the nearest emergency department or call 112.

Frequently asked questions