Chapter 02 • Question 6

Do You Have Stitches with a Tooth Implant?

📺 3:00 video📖 8 min read

BDS – Dental Surgeon (GDC Reg: 83324)

Whether or not you'll have stitches after dental implant surgery is a common question, as many patients want to understand what the healing site will look and feel like. The answer depends on the specific surgical technique used, but most implant procedures do involve some form of suturing. Understanding what to expect regarding stitches can help you prepare for recovery and recognize what's normal during healing.

The Standard Answer

Yes, most dental implant procedures involve stitches (sutures) to close the gum tissue over or around the implant. However, the type, number, and duration of stitches vary depending on the surgical approach used and whether additional procedures like bone grafting are performed.

Why Stitches Are Used

Stitches serve several important purposes in implant surgery:

Closing the surgical site: When the dentist makes an incision to access the jawbone for implant placement, the gum tissue must be sutured back together once the implant is positioned.
Protecting the implant: Stitches help ensure gum tissue covers and protects the healing implant from bacteria, food particles, and trauma.
Controlling bleeding: Sutures help achieve haemostasis (stopping bleeding) by bringing tissue edges together and applying gentle pressure to blood vessels.
Maintaining tissue position: Stitches hold gum tissue in the desired position during healing, particularly important for achieving good aesthetic results.
Supporting bone graft material: When bone grafting accompanies implant placement, stitches are crucial for keeping the graft material contained and protected.

Types of Sutures Used

Dental implant procedures typically use one of two types of sutures:

Dissolvable (absorbable) sutures

Most commonly used in implant dentistry. These are made from materials that break down naturally in your mouth over time, eliminating the need for a separate removal appointment. They typically dissolve completely within 7-14 days, though some may take up to 3-4 weeks depending on the material used and the location in your mouth.

Common dissolvable suture materials include:

Polyglycolic acid (PGA)
Polylactic acid (PLA)
Chromic gut
Plain gut (dissolves faster, within 7-10 days)

Non-dissolvable (permanent) sutures

Occasionally used when the surgeon wants more control over the healing timeline or when dealing with tissues under more tension. These sutures must be removed by your dentist, typically 7-14 days after surgery. Non-dissolvable sutures are made from materials like silk, nylon, or polyester.

Most implant surgeons prefer dissolvable sutures because they eliminate the need for a removal appointment and reduce patient discomfort. The sutures gradually weaken and fall away on their own as healing progresses.

What Stitches Feel Like

Understanding the sensation of having stitches can help you know what to expect:

Immediately after surgery

While still numb, you won't feel the stitches at all. As the anaesthetic wears off, you'll become aware of them as a pulling or tight sensation at the surgical site. This tightness is normal and actually helps control swelling.

During the first few days

Stitches feel like small bumps or threads in your mouth. You'll be very aware of them with your tongue, though you should avoid touching or playing with them. The tightness sensation continues but gradually becomes less noticeable as you adjust to it.

As they dissolve

Dissolvable stitches gradually soften and weaken. You might notice pieces breaking off or finding fragments in your mouth. This is completely normal and not a cause for concern. Some people don't notice the stitches dissolving at all—they simply realize one day that the stitches are gone.

Important: The sensation of stitches isn't usually painful, though the surgical site itself will be tender. The tightness from stitches is distinctly different from pain and is actually a reassuring sign that the tissue is being held in proper position for healing.

How Many Stitches to Expect

The number of stitches varies based on the procedure:

Single implant: Typically 2-4 stitches to close the incision around the implant site.
Multiple implants: More extensive suturing proportional to the surgical area, possibly 8-12 stitches or more depending on how many implants are placed.
With bone grafting: Additional stitches are needed to ensure the graft material stays protected under the gum tissue, sometimes resulting in double the number of stitches compared to implant placement alone.
All-on-4 or full-arch restoration: Extensive suturing across the entire arch, potentially 15-25 stitches or more, as these procedures involve creating full flaps of gum tissue.

The number of stitches doesn't necessarily correlate with healing difficulty or pain. Sometimes more stitches indicate more precise tissue closure, which can actually promote better healing.

Caring for Your Stitches

Proper stitch care is essential for optimal healing:

Don't touch or pull at stitches: Resist the urge to feel the stitches with your tongue or fingers. Disturbing them can cause bleeding, delay healing, or even open the surgical site.
Be gentle when brushing: Avoid the stitched area completely for the first 24 hours. After that, brush very gently around (not directly on) the stitches using a soft-bristled brush.
Rinse carefully: Gentle saltwater rinses (after the first 24 hours) help keep the area clean without disturbing stitches. Avoid aggressive swishing that could dislodge stitches or disrupt healing.
Avoid hard or crunchy foods: Foods that require significant chewing or could scratch the surgical area should be avoided while stitches are present. Stick to soft foods that won't put pressure on or irritate the stitched area.
Watch what you eat: Avoid extremely hot foods or beverages that could irritate the stitched tissue. Also avoid spicy or acidic foods that might cause stinging at the surgical site.
Don't smoke: Smoking dramatically impairs healing and increases the risk of complications. The chemicals in smoke interfere with blood flow to the healing tissue and can cause stitches to fail.
Skip the straw: Using a straw creates suction that could dislodge stitches or disrupt the healing blood clot.

When Stitches Come Out Early

Sometimes dissolvable stitches come out earlier than expected:

A few stitches loosening early (within 3-5 days) is usually not a problem if the surgical site remains closed. The tissue has often already begun bonding together, so not every stitch needs to remain in place for the full healing period.

All stitches coming out in the first 2-3 days might indicate a problem. If this happens, contact your dentist. The tissue might not have bonded sufficiently, potentially leaving the surgical site vulnerable.

Seeing the implant or graft material if stitches fail is a concern requiring immediate attention. This exposure can lead to infection or graft failure.

Signs of Stitch-Related Problems

While stitches are generally straightforward, occasionally issues arise. Contact your dentist if you experience:

Excessive tightness and pain: Some discomfort is normal, but severe pain that seems to worsen rather than improve might indicate stitches are too tight.
Foul smell or taste: This could indicate infection at the surgical site.
Pus or discharge: Yellow or greenish discharge from around the stitches suggests infection requiring antibiotic treatment.
Increasing swelling after day 3: While swelling peaks around day 2-3, it should then begin subsiding.
Stitches cutting into tissue: If you have a stitch that's particularly bothersome or seems to be cutting in, your dentist can trim or remove it.
Allergic reaction: Rare, but some people have allergic reactions to certain suture materials, causing excessive redness, itching, or rash.

The Removal Appointment (For Non-Dissolvable Stitches)

If your surgeon uses non-dissolvable stitches, you'll need a removal appointment:

Timing: Usually scheduled 7-14 days after surgery, once the tissue has bonded sufficiently that stitches are no longer needed.
The process: Stitch removal takes just a few minutes. The dentist cuts each stitch and gently pulls it out. This creates a brief tugging sensation but is rarely painful since the tissue has healed by this point.
No anaesthetic needed: Most patients don't require anaesthetic for stitch removal, as the discomfort is minimal and momentary.
Relief: Many patients feel immediate relief once stitches are removed, as the tightness and pulling sensation disappears.

💡 Key Takeaways

Most dental implant procedures involve stitches to close the gum tissue after surgery
Dissolvable stitches are most common, typically dissolving within 7-14 days
Stitches feel like tightness or pulling at the surgical site but aren't typically painful
You'll be very aware of stitches with your tongue, but you should avoid touching or pulling at them
The number of stitches varies from 2-4 for a single implant to 15+ for full-arch procedures
Gentle oral hygiene around stitches is essential—avoid brushing directly on them for the first few days
Some stitches coming loose early is usually not a concern if the site remains closed
Non-dissolvable stitches require a removal appointment after 7-14 days, which is quick and minimally uncomfortable
Flapless or minimally invasive techniques may use fewer stitches but some suturing is still typical
Contact your dentist if stitches cause severe pain, the site opens up, or signs of infection develop
Stitches are a temporary part of recovery that helps ensure proper healing of your implant site