Peri-operative care

As described in Patient Assessment, a thorough evaluation of patient health factors and psychology influencing whether to proceed with surgery is relevant.
If surgery is the chosen option, prescribe eventually pre-operative medication and antibiotic coverage: Oral antiseptic rinse or spray pre- per- and postoperatively are routine.
Assess the pros and cons of immediate restoration on single implant.

Peri-operative measures immediately prior to surgery

• Repeat briefly the information about the planned procedure to ensure that the patient understands and can freely ask questions 
• Check the availability of radiographs of areas in the immediate vicinity of the planned surgery to avoid any damage to teeth or relevant anatomical structures (nerve …)
• Short acting benzodiazepines can be useful for ambulatory surgery although for single implant placement rarely necessary
• If conscious sedation is provided, ensure that an accompanying, responsible adult person will be present with the patient for at least 3 hours after surgery
• If guided surgery is used check if the template is present
• Disinfect the operative field
• Preferably cover patient’s nose – the most infected part of this area - with a perforated cap to allow easy breathing and cover face and body with sterile drapes to limit/avoid use of antibiotics.
• Use appropriate surgical safety checklist (http://www.for.org/checklists)

Peri-operative care during surgery

• Gentle conversations focused on the patient and smooth movements improve patient’s confidence and comfort
• Avoid external pathogens by ensuring that the entire team wears masks properly and is trained in asepsis
• If conscious sedation is being provided, the patient's vital signs should be continuously monitored like heart rhythm and tension
• If the patient panics, remove surgical fields and interrupt the surgery
• Use appropriate surgical safety checklist (http://www.for.org/checklists)

Peri-operative management immediately after surgery

• If the patient needs some rest or if premedication was used provide a relaxing seat in a quiet environment. Supervise until the premedication effect is over (3 - 4 hours).
• If conscious sedation was provided, ensure that an accompanying, responsible adult person will be present with the patient for at least 3 hours
• Before local anesthesia has vanished, prescribe and/or administer analgesics that do not interfere with coagulation, such as paracetamol.
• If significant edema is expected, which seldomly occurs for single implant placement, non-steroidal anti-inflammatory medications are indicated. Opioids should only be prescribed/administered for intractable pain
• Prescribe/administer antibiotics only if necessary. If prescribed, antibiotic therapy should not be discontinued before 4 days and completed according to the antibiotic type used
• Consider to prescribe for several days an antiseptic mouth rinse or spray (e.g. Chlorhexidine)
• Provide brief verbal instructions, including for nutrition. But also provide a written summary ( patients tend to forget after surgery) and 24-hour telephone number to call in an emergency
• Schedule post-operative appointments and provide a round-the-clock telephone number if complications occur
• Use appropriate surgical safety checklist (http://www.for.org/checklists)