310 Theories and techniques of oral implantology

Lunch

Strained vegetable soup 3/4 cup

Gelatin (warm) 1/2 cup

Pineapple juice   4 oz.

Milk   1 glass Beverage, sugar, milk

Supper

Cream of chicken soup 3/4 cup

Vanilla ice cream   1 serving

Tomato juice   4 oz.

Milk   1 glass Beverage, sugar, milk

Although such a diet contains a variety of flavors, it is nutritionally inadequate and must be supplemented with a liquid formula high in calories, proteins, vitamins, and minerals, especially calcium.

The patient who needs more than the normal daily nutrient requirements may be advised to use an antistress vitamin formula. This consists of 500 mg. vitamin C, 100 mg. pantothemic acid, and 2 mg. each of vitamins B2 and Be. These are mixed with "fortified milk." To make fortified milk, mix two egg yolks or whole eggs, 1 tablespoon each of lecithin and mixed vegetable oils, 11/2 teaspoons of calcium lactate or 4 teaspoons calcium gluconate, 1/2 teaspoon magnesium oxide, 1/4cup yogurt or 1 tablespoon acidophilus culture, and 1 teaspoon granular kelp (optional). When these have been thoroughly beaten together, add 1 to 2 cups whole

or skim milk, 1/4 to 1/2 cup yeast fortified with calcium, 1/4 cup soy flour or powder, 1/4 to 1/2 cup non-instant powdered milk, 1/4 cup wheat germ (option-al), nutmeg or 1 teaspoon pure vanilla, and 1 teaspoon granular kelp (optional). Pour the mixture into a container and add the remainder of the quart of milk. Cover the beverage and keep it refrigerated. Stir each time before using.

When the patient can handle soft foods, he can either eat already soft foods or soften more solid foods by mashing them or mixing them in a blender. No hard or crusty foods or highly seasoned hot foods should be eaten until all healing is completed. Gradually the patient may resume his normal diet, and with his new secure prosthesis eat foods that he may have avoided for years because of the impossibility of chewing with loose or poorly fitting re-movable prostheses.

Postoperative instructions

The patient will need to know how to care for his mouth after implantation. These general instructions are useful following soft tissue surgery.

First day (today). Icepacks should be applied as directed—usually 10 minutes on, 15 minutes off—for a few hours at a time. Salt water rinses should not be used on the first day. An appropriate pain killer should be taken as prescribed, such as Darvon Compound-65 every 4 hours.

Second day (tomorrow). Icepacks are not necessary. Warm salt water rinses should be used every hour, but the solution should not be swished too vigorously or the sutures may tear through the tissues. Continue the pain killer if needed.

Third day. Rinse the mouth vigorously with a warm salt water solution every hour or two for the next few days.

Later. From 5 to 7 days after surgery the sutures are removed, and the patient is instructed to continue the rinsing as often as possible without inconvenience.

Long-term instructions

No matter what type of implant was inserted, the patient should learn how to care for his implant restoration. The proper toothbrushing technique should be explained or reinforced. Vigorous warm mouthwash or warm saltwater solution rinses are suggested immediately after meals and after tooth-brushing. The water pic may be prescribed for numerous implant cases as a substitute for rinsing, but the patient must be warned to use the water jet on low power. The water pic is usually not recommended for those patients who have only one, two, or three weak teeth supported by an implant restoration, since the water pic has a tendency to loosen and wash out the cement in these cases.

Clinical follow-up

For the first year each implant patient should return to the office every 3 to 4 months for periodic check-ups. At these visits x-rays should be taken to detect any bone changes. The articulation should be carefully checked and reevaluated, and all necessary interfering cusps should again be spot-ground. At least three times the first year a cavitron treatment should be given, being careful not to dislodge any of the cement inside the implant crowns. The pocket depths around the implant posts should be examined. If any inflammation occurs, the afflicted tissue should be removed and all necessary curetting of the inflamed area accomplished.

It is a good policy, especially on full arch reconstruction cases with teeth and implant abutments supporting the fixed dentures, to periodically refer these patients to a periodontist.