Chapter 04 • Question 12

What Should I Expect on the Day of Surgery?

📺 15:00 video📖 18 min read

BDS – Dental Surgeon (GDC Reg: 83324)

Understanding what to expect on the day of dental implant surgery helps reduce anxiety and ensures you're properly prepared. From the moment you wake up to arriving home after the procedure, knowing the timeline, what you'll experience, and what you need to do makes the day much less stressful. While individual experiences vary based on sedation choices and procedure complexity, the overall flow follows a predictable pattern.

Quick Timeline Overview

Arrive: 30-45 minutes before scheduled surgery time
Check-in & assessment: 15-30 minutes (paperwork, vital signs)
Preparation: 15-25 minutes (positioning, sedation if used, anaesthetic)
Surgery: 45-90 minutes for single implant
Recovery: 30-60 minutes if sedation used
Home: Rest and follow post-operative instructions

Before You Leave Home

Morning Preparation

If having local anaesthetic only:

Eat a normal breakfast
Take regular medications as usual (unless dentist instructed otherwise)
Brush teeth thoroughly
Dress comfortably

If having oral sedation:

Light breakfast 2-3 hours before appointment
Take sedation tablet as instructed (usually 30-60 minutes before appointment)
Arrange for someone to drive you
Comfortable, loose clothing

If having IV sedation or general anaesthetic:

Nothing to eat from midnight before (or as instructed—usually 6-8 hours)
Clear liquids up to 2 hours before may be allowed (check specific instructions)
Take essential medications with small sip of water (if approved by dentist)
Comfortable, loose clothing with short sleeves
Remove contact lenses (bring glasses instead)
Remove jewellery, especially around mouth/neck area
Arrange for responsible adult to drive and stay with you

What to Bring

Essential Items:

Photo ID
Insurance information (if applicable)
Payment method or payment plan documentation
List of current medications including dosages
Medical alert information if relevant

For After Surgery:

Ice pack or bag of frozen peas wrapped in towel
Soft foods for when you get home
Pain medication if prescribed (collect from pharmacy beforehand)

Leave at Home:

Valuables
Work laptop or documents (won't be working after)
Stress—easier said than done, but remember this is routine for the dental team

Mental Preparation

Normal to feel:

Nervous or anxious
Uncertainty about what exactly will happen
Worry about pain
General apprehension

Helpful reminders:

Thousands of these procedures performed daily
Modern anaesthetic makes it pain-free
Dentist has done this many times
Most patients report "it wasn't as bad as I expected"
You can signal if you need a break

Relaxation techniques:

Deep breathing exercises
Mindfulness or meditation
Light physical activity (walk, yoga)
Avoiding caffeine (can increase anxiety)
Getting good sleep night before

Arrival at the Practice

Check-In Process (15-30 Minutes)

Arriving:

Arrive 30-45 minutes before scheduled surgery time
Earlier if sedation being used
Allow extra time for traffic, parking

Reception:

Check in with reception staff
Provide any updated information
Verify contact details
Confirm someone will collect you if sedation used

Paperwork:

Final consent forms
Medical history updates (any changes since planning appointment?)
Sedation consent if applicable
Payment processing if balance due

Waiting room:

Brief wait while treatment room prepared
Use restroom now (won't be able to during surgery)
Some practices offer water, tea, coffee (if no sedation restrictions)

What's happening behind the scenes:

Staff preparing surgical instruments
Setting up monitoring equipment if sedation
Sterilising environment
Reviewing your treatment plan

Pre-Operative Assessment (10-20 Minutes)

Vital signs:

Blood pressure measured
Heart rate checked
Oxygen saturation (finger clip sensor)
Temperature sometimes taken

Medical review:

"Any changes to your health since we last saw you?"
"Are you taking all medications as usual?"
"Any new allergies or reactions?"
"Have you followed pre-operative instructions?" (fasting if sedation, antibiotics if prescribed)

Anxiety assessment & final questions:

Staff gauge your anxiety level
Offer reassurance
Explain what's about to happen
Answer last-minute questions
Any concerns or clarifications needed?
Ready to proceed?

In the Surgical Chair

Getting Comfortable (5-10 Minutes)

Positioning:

Reclined in dental chair
Often nearly horizontal for best surgical access
Head support positioned
Armrests adjusted

Protective equipment:

Safety glasses placed on you (protect eyes from debris, bright light)
Disposable bib over chest
Sometimes drape over body

What you'll see:

Overhead light (very bright—close eyes or glasses shield this)
Instrument tray (usually covered, instruments added as needed)
Monitor screens if sedation being used
Staff preparing around you

What you'll hear:

Staff communicating
Equipment sounds
Water running
Possibly music playing in background

Sedation Administration (If Applicable)

Nitrous oxide:

Nose mask placed
"Breathe normally through your nose"
Takes 2-3 minutes to feel effect
Relaxed, slightly euphoric feeling develops

Oral sedation:

Already taken tablet at home or earlier
Should be feeling drowsy by now
Staff monitor you more closely

IV sedation:

Numbing cream applied to hand or inner elbow
Small needle placed in vein
"You'll feel drowsy very soon"
Medication administered through IV
Within 1-2 minutes, profound relaxation
May not remember much after this point

Monitoring begins:

Blood pressure cuff on arm
Oxygen sensor on finger
Sometimes ECG patches on chest
Staff watching monitors continuously

Local Anaesthetic Administration (10-15 Minutes)

Topical anaesthetic first:

Gel or spray on gums
Slight unpleasant taste possible
Wait 30-60 seconds

The injections:

"You'll feel a small pinch"
Brief sharp sensation (1-2 seconds)
Pressure and slight burning as anaesthetic delivered (5-10 seconds)
Usually 2-4 injection sites
Total injection time: 3-5 minutes

Waiting for numbness:

"We'll wait a few minutes for the anaesthetic to work"
5-10 minutes typically
Numbness gradually spreading
Lip and tongue start feeling "fat"

Testing:

Dentist touches area with instrument
"Can you feel this?"
Should feel pressure but not sharp sensation
If inadequate, more anaesthetic given

Signs you're numb:

Lip feels swollen (though it isn't)
Difficult to speak clearly
Tongue feels thick
Possibly drooling (can't feel saliva)

During the Surgery

What You Experience

Physical sensations:

Pressure

Constant pushing, pressing sensation

Vibration

Especially during drilling

Tugging

When tissues manipulated

Water flowing

Irrigation and suction

NO PAIN if properly numbed

Sounds, tastes & sights:

Sounds:

High-pitched drill (similar to dental filling drill)
Whooshing water (irrigation)
Suction device (vacuum sound)
Instruments clinking
Staff communicating

Tastes:

Metallic taste sometimes
Irrigation solution taste
Nothing particularly pleasant but not terrible

Sights:

Bright light (keep eyes closed or glasses shield this)
Not much else—can't see what's happening in your mouth
Some patients keep eyes closed entire time

Duration perception:

Often feels shorter than actual time
If sedated, may feel very brief or remember nothing
If anxious, may feel long
Most patients: "Passed more quickly than expected"

Communication During Surgery

You cannot speak normally:

Mouth open, hands and instruments inside
Numbed mouth makes speech difficult

Hand signals:

Raise hand if need to stop
Agreed signals for different needs
Staff watching for your signals

Dentist checks in:

Periodically asks "Okay?" or "Any pain?"
Head nod/shake for response
Will stop immediately if you signal discomfort

⚠️ If you feel pain:

SIGNAL IMMEDIATELY
Don't tolerate pain thinking "it must be normal"
More anaesthetic can be given at any time
Surgery won't continue until you're comfortable

The Phases of Surgery

Phase 1: Initial access (10-15 minutes)

Gum tissue incision and reflection
Relatively quiet phase
Minimal vibration

Phase 2: Site preparation (20-40 minutes)

THE drilling phase
Most intense vibration and sound
Multiple drills of increasing size
Frequent pauses for irrigation and measurement
Often the longest-feeling phase

Phase 3: Implant placement (5-15 minutes)

Quieter again
Different sensation—torque and pressure
Verification of positioning

Phase 4: Closing (10-15 minutes)

Stitches placed
Pulling sensation as sutures tightened
Final adjustments
Relief that end is near

Total time: 45-90 minutes for single implant (preparation and closure time excluded)

What Staff Are Doing

Surgeon/dentist:

Precise surgical technique
Constant measurement and verification
Adjusting approach based on what's encountered
Ensuring optimal implant position

Assistant:

Managing suction
Passing instruments
Retracting tissues
Irrigation management
Monitoring you

If sedation used, additional staff:

Monitoring vital signs
Adjusting sedation level
Ensuring your safety

Immediately After Surgery

In the Chair (5-10 Minutes)

"All done"

Huge relief hearing this—surgery complete

Cleaning up:

Face wiped clean
Protective equipment removed
Mouth rinsed if appropriate

Gauze placement:

Sterile gauze placed over surgical site
"Bite down gently"
Controls bleeding

Sitting up slowly:

Chair gradually raised
Given time to adjust
Some dizziness normal (from lying flat)

Recovery Period (If Sedation Used)

Move to recovery area:

Assisted to recovery chair
Can't walk unaided immediately after IV sedation
Monitored closely

Vital signs monitored:

Blood pressure, heart rate, oxygen
Checked every 15 minutes initially

Gradual awakening (if IV sedation):

First 15-30 minutes: Very drowsy
30-60 minutes: Becoming more aware
Still unsteady, confused
Little memory of this period

When ready for discharge:

Able to walk with minimal assistance
Vital signs stable
Responsible adult present to take you

Post-Operative Instructions (15-30 Minutes)

Dentist or nurse explains what to do—will be repeated because it's hard to remember in the moment.

Bleeding management:

Keep gauze in place, bite gently for 30-60 minutes
Some oozing normal for hours
If heavy bleeding, bite on fresh gauze 30 minutes
Blood-tinged saliva normal for 24 hours

Ice application:

20 minutes on, 20 minutes off
For first 24-48 hours
Reduces swelling significantly
Use wrapped ice pack, never directly on skin

Pain management:

Take pain medication BEFORE numbness wears off
Don't wait until pain starts
Usually 2-3 hours after surgery
Follow dosing instructions

Diet:

Soft/liquid diet only
Nothing hot for first 24 hours
Cold foods helpful (ice cream, smoothies)
Avoid surgical area completely

Oral hygiene:

Don't rinse, spit, or use straws for 24 hours
After 24 hours: gentle saltwater rinses
Avoid brushing surgical area initially
Keep rest of mouth clean

Activity:

Rest remainder of day
No exercise, bending, or strenuous activity for 48 hours
Sleep elevated (2-3 pillows)
No smoking (critical)

⚠️ Warning signs to watch for:

Excessive bleeding
Severe pain not controlled by medication
Fever over 38°C/100.4°F
Excessive swelling after day 3
Foul taste or smell

Written instructions & medications:

Comprehensive written document provided
Review at home when clearer-headed
Keep for reference
Prescriptions provided if not already collected
Antibiotics schedule explained
Pain medication guidelines
Antimicrobial rinse instructions (starting 24 hours post-surgery)

Emergency contact & follow-up:

Dentist's emergency phone number
When to call
Out-of-hours arrangements
Follow-up appointment scheduled before you leave
Typically 7-14 days
Suture removal if non-dissolvable used

Going Home

The Journey

If local anaesthetic only:

Can drive yourself
Take your time
Have tissues for oozing saliva
Keep gauze in place

If sedation used:

Responsible adult drives
You may sleep in car
Have sick bags ready (nausea possible)
Bring you straight home

What you'll be experiencing:

Still very numb (mouth, lips, tongue)
Possibly drowsy if sedation used
Gauze in mouth
Slight bleeding/oozing
Possible mild discomfort starting if anaesthetic wearing off
Relieved it's over

First Hour at Home

Continue gauze biting:

Keep first gauze in for full 30-60 minutes
Can replace if needed
Don't check constantly—leave it alone

Apply ice:

Get ice pack wrapped in towel
20 minutes on cheek over surgical area
20 minutes off
Repeat cycle

Take pain medication:

BEFORE numbness wears off (critical timing)
Usually 2-3 hours after surgery
Follow prescribed schedule

Rest:

Lie on sofa or in bed
Don't try to be productive
Relaxing is healing
If sedation used: will probably sleep, need supervision, stay hydrated when awake

Rest of First Day

What's normal:

Numbness wearing off (2-4 hours post-surgery)
Mild to moderate discomfort starting
Some oozing continuing
Possibly swelling beginning
Tiredness

What to do:

Continue ice application (20 on/20 off)
Maintain pain medication schedule
Drink plenty of fluids
Eat soft, cold foods when hungry
Rest, rest, rest
No rinsing mouth yet (wait 24 hours)

What to avoid:

Spitting (causes dry socket risk)
Straws (suction can dislodge clot)
Hot foods/drinks
Alcohol
Smoking
Exercise or activity
Prodding surgical site with tongue or fingers

💡 Key Takeaways

Plan to arrive 30-45 minutes before your scheduled surgery time for paperwork and preparation
If having sedation, you must have nothing to eat for 6-8 hours before and arrange for someone to drive you
Pre-operative assessment includes vital signs check and final medical review before proceeding
Local anaesthetic injections cause brief discomfort (1-2 seconds), then numbness develops over 5-10 minutes
During surgery you'll feel pressure and vibration but no pain if properly numbed—signal immediately if you do feel pain
Surgery typically takes 45-90 minutes for a single implant from first injection to final suture
You can communicate during surgery using hand signals since speaking is difficult
If sedation used, expect 30-60 minutes recovery time before being discharged with your driver
Post-operative instructions cover bleeding control, ice application, pain medication, diet, and activity restrictions
Take pain medication 2-3 hours after surgery BEFORE numbness wears off—this is critical timing
First 24 hours involve ice application (20 on/20 off), soft diet, rest, and no rinsing or spitting
Most patients report the experience was easier and less painful than they expected

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