First your surgeon will examine the soft tissue in your mouth. They will then evaluate the jaw bone using medical imaging, called cone-beam, computed tomography. They will also discuss oral or IV sedation options for you. Don’t forget to mention the source of your reference.

1. Following the exam, the team will provide you with the details and the estimated cost of the procedure.
2. If you do not already have a prosthodontist, we will be happy to refer you to a specialist who can take good care of your teeth.
3. During the appointment with your prosthodontist, they will analyze the optimal position of the implants with the help of the scan and will take an impression to make the initial prosthesis.
4. On the day of the surgery, our oral surgical team will prepare a sterile environment for surgery which will reduce the risks of complications. Since this is one-day procedure, you will be able to leave the same day with your prosthesis in your mouth.
5. A soft diet is recommended for 6 weeks following the procedure.
6. A follow-up appointment will be scheduled one week after the procedure to make sure that you are healing properly.
7. Another follow-up appointment will take place about 6 to 8 weeks after your procedure. A radiograph will be taken to see help assess the healing of the implants.
8. Finally, with the approval of your surgeon, you will return to your prosthodontist who will create your final prosthesis.

Pre-operative instructions with intravenous sedation

Intravenous sedation is a technique of administering medications through a vein to help relax you and reduce discomfort. This is done without putting you completely to sleep. It is most important that you follow the instructions below very closely.

1. The meal before your appointment should consist of light food and fluids such as broth, tea, or Jello, and should be taken no less than 6 hours prior to your appointment. Do not eat meat, fried or fatty foods. You may drink clear fluids (water, fruit juices, carbonated beverages, clear tea, and black coffee) until 2 hours before your appointment.
2. If you are given medication to take before your appointment, it should be taken with a small amount of water, one hour prior to the appointment.
3. Do not take other medications on the day of surgery without checking with your surgeon. Let us know of any changes to your health status or your medications before your appointment.
4. It is advisable to wear loose-fitting clothing to make you more comfortable. Short sleeve shirts or blouses are necessary, so we can see your arm for monitor placement and intravenous access.

After your appointment the medications used will still be in your system. The following precautions should be followed:

• You MUST be accompanied home in a car or taxi by a responsible adult who will stay with you for the remainder of the day. No public transportation.
• Change position slowly. Sudden standing or sitting up may cause dizziness.
• No driving or operating machinery for the rest of the day after surgery.
• No alcoholic beverages for 24 hours.
• Rest at home with your head slightly elevated for the rest of the day.

If you follow these guidelines along with your surgeon’s post-operative instructions, you will find the procedure will go smoothly and comfortably.

Post-op risks

The main risks are infections and bleeding. If you ever experience abnormal discomfort, contact us or the Oral and Maxillofacial Surgery residents of the Montreal General Hospital. Your surgeon will take charge of the situation.

A bruise, sometimes important, in the mouth, on the face and sometimes through the neck is quite normal.

Post-op instructions

Postoperative instructions will be provided following the intervention by the surgical assistant. You will normally leave with a prescription from your surgeon for painkillers and sometimes antibiotics.

The following instructions have been compiled to assist you in the postoperative period. If you follow these guidelines, your recovery will be more comfortable.

• After a All-on-4 procedure, there is often swelling of the face and sometimes bruising of the skin. This is normal. An ice pack applied to the area (30 minutes on and 30 minutes off) for 48 hours will keep swelling to a minimum. Maximum swelling usually occurs within 24 – 48 hours after surgery. Swelling can persist for 7 to 10 days. If the swelling resolves but then returns, you should contact our office.
• Eat a light diet for the first two days; e.g. yogurt, soup, jello, milk drinks, etc. Avoid hot foods and do not use straws for the first 48 hours after surgery, as this may cause bleeding.
• A soft diet must be followed for the first 6 weeks to ensure proper healing of the implants.
• If the implants were done in the upper jaw, avoid blowing your nose for 3 days and use a saline spray to thin your secretions as needed.
• Rest for the remainder of the day following your operation and keep your head slightly elevated.
• Refrain from smoking for 2 months after an All-On-4 procedure.
• Some bleeding is normal for the first 24 – 48 hours. If bleeding is heavy, use gauze squares folded in 4 and apply firm pressure to the bleeding area by biting on the gauze for 20 minutes. Do not spit for the first 72 hours following your surgery, as this tends to cause bleeding.
• Gentle tooth brushing can be resumed the day after surgery. Do not brush the area of surgery until your next appointment with your surgeon.
• It is important to keep your mouth clean. Starting the following day, a saltwater rinse (1 teaspoon salt in 1 glass of warm water) should be used twice a day after eating (ex: after your breakfast and before going to bed).
• You will be given a follow-up appointment to check the healing, if necessary.
• Dissolving stitches are used for most operations. It is normal for these to begin to fall out after 3 – 4 days.