Doctor Artem Naimushin

Dear patient! Для того чтобы послеоперационный период прошел комфортно и безопасно, я прошу вас соблюдать следующие рекомендации: 1. Remove gauze swab (if available) from mouth after 20-30 minutes. 2. Apply cold compresses to the postoperative wound area every 2 hours for 20 minutes for the first 24 hours after the intervention. 3. Refrain from eating and drinking for 2-3 hours. 4. For 3-4 days, exclude coarse, hot, spicy food from your diet. 5. For 3-4 days cancel sports, excessive exercise, refrain from visiting the bath, sauna, solarium, do not take a hot bath, try not to overheat and do not overcool. 6. Never gargle the area of a sore or postoperative wound without a doctor’s prescription. 7. Handle the postoperative wound with maximum care and gentleness, try not to disturb it. 8. Do not self-medicate, homeopathy or folk medicine. Attention! In the postoperative period, the following phenomena are possible: painful sensations, swelling and edema in the area of the postoperative wound, bleeding, bruising of the skin and/or mucous membrane, increased body temperature, worsening of general well-being, difficulty opening the mouth, pain when swallowing, chewing, talking, rarely – numbness in the chin area and lower lip, bleeding from the nasal cavity. These phenomena pass on their own within 8-10 days if the doctor’s recommendations are followed.

Dear patient! Thank you so much for your trust, patience and the right attitude towards your health. You have just had a surgical procedure – implants of the right size are placed into your jawbone in a specific order. In order to make the subsequent rehabilitation period as comfortable and safe as possible, I ask you to read this memo and follow the recommendations and appointments mentioned in it. So, 1. Please maintain oral hygiene carefully but thoroughly. Brush your teeth with a soft toothbrush with minimal toothpaste in areas not adjacent to the surgical field. Why? Swelling, discomfort, the presence of the surgical wound and sutures seriously complicate oral hygiene. As a result, plaque accumulates even in places far from the surgical site. Plaque particles entering the postoperative wound can lead to complications – increased inflammation, purulent process, etc. As a result, the stitches may come apart and the surgical wound may become infected. What if… Just don’t brush your teeth and that’s it? Over time, plaque containing bacteria will enter the still-healing post-operative wound, infecting it with unpredictable consequences. It is unlikely that there will be any problems with the implants – they integrate even in the most difficult conditions, but the tissues surrounding the implant (gum and bone) can be damaged by infection. 2. Rinse your mouth gently with an antiseptic solution after brushing your teeth and after eating. Why? No matter how thoroughly we brush our teeth, we still can’t remove all the bacteria from the mouth. During the day, they multiply, there are more of them. In addition, the area of the surgery itself is poorly cleaned with even the softest toothbrush due to stitches, soreness and discomfort. In order to prevent germs from getting into the wound itself, its area should be cleaned periodically at least with a rinse. But, I must warn you, it must be done extremely carefully, without straining the rinse through your teeth, without intense cheek and tongue movements. By the way, you can use not only chlorhexidine solutions for rinsing, but also any antiseptic rinse for every day. I think they taste nicer than Chlorhexedine. What if… you didn’t rinse your mouth after eating and brushing your teeth? I don’t think it’s going to be a big deal. However, if only because of the odor, you will not have the most pleasant experience, because hard-to-remove plaque, fibrin films, etc. accumulate in the wound area. This is especially true when using polyfilament resorbable suture materials for suturing postoperative wounds (Vicryl, Lactisorb, PGA, etc.). In these cases, the cleanliness of the surgical area must be given extra attention. 3. It is common to offer ice for cold compresses after surgery. It is advisable to make cold compresses every 2 hours for 20 minutes for the first 24 hours after surgery. Why? The body responds to any surgical intervention as a trauma (yes, it is a trauma for it) with an appropriate reaction: bleeding, hemorrhage, plasma release into the intercellular space of tissues, etc. Vessels in the area of surgery expand, blood circulation increases – that is why bleeding increases, swelling increases, and the cheek in the area of surgical intervention becomes hot. Thus, the mechanisms of post-traumatic inflammation are triggered, which, in fact, is the body’s defense reaction to excessive external impact. There is no way to completely defeat it. And, really, you don’t have to do that – it’s a defensive reaction! Our job is to keep the postoperative inflammatory process within certain limits, preventing it from escalating into something more serious. And that’s where the cold helps us. Cold compresses do not allow swelling to grow, help stop bleeding, relieve pain, prevent the formation of hematomas. Remember when we put ice on the site of a bruise or sprain? Here, we are essentially doing the same thing. What if… not to put ice on it? In fact, it’s not going to be a big deal. It’s just that the swelling and subsequent hematoma will be larger, the blood will take longer to stop, and the pain will be more intense. Otherwise, the entire postoperative period will follow the same pattern as with ice. 4. Do not take food or hot drinks for 2-3 hours after surgery. Why? Anesthesia! Chewing involves not only the teeth, but also the cheeks, lips, and tongue. After anesthesia, they all remain insensitive for a while (from half an hour to several hours), which means that when chewing something we can, literally, “chew”, burn and seriously injure them. But this is just one reason why it is recommended to eat only after the effects of anesthesia have worn off. It should not be forgotten that a wound is left in the oral cavity after surgery. Its edges are not yet “glued” by the blood clot, which means that food can get into it. In addition, chewing even cold food in the oral cavity raises the temperature, increases blood flow, which will eventually lead to increased postoperative swelling and bleeding. What if … … after surgery feel thirsty and hungry? Well, to drink, for example, cold water without gas or cold tea, you can immediately after surgery, nothing terrible will happen. As for the food…. I’d rather you didn’t. 5. For 3-4 days, exclude rough, hot, hard, spicy food. Why? As I have already written in point 3 (about cold), from the point of view of the body, it does not matter whether the bone tissue was damaged as a result of a blow or the implant was carefully placed in sterile conditions – it reacts to the surgery as a trauma and responds to it with an appropriate defense reaction, inflammation. It is characterized by a number of symptoms of varying degrees of severity (see below), which are the source of discomfort in the postoperative period. Coarse and hard foods can tear the stitches in the post-operative wound or traumatize the mucous membrane around it – and this will in no way promote calm healing. In addition, the ingress of solid food under the sutures will inevitably lead to infection of the surgical area and unfavorable outcome of surgery Hot and spicy food increases blood flow in the oral cavity, including in the surgical area. This, in turn, leads to the formation of swelling, hematomas, bleeding, and worse – can contribute to the spread of infection, toxins and tissue breakdown products (and there is always one) beyond the area of surgery. What if… …really hungry? For the first few days, it is better to switch to soft, warm foods that do not irritate the mouth. This can be various fruit and vegetable purees, porridge, broths, homogeneous soups, steamed fish, steamed cutlets, meatballs, yogurt, dairy products, soft cheeses, etc. Starvation is in no way possible, as the body needs to take strength from somewhere to recover. In addition, starvation is additional stress, which does not ease the post-operative period in any way. 6. For a few days it is recommended to limit excessive physical exertion, sports, cancel solarium, sauna, sauna, bath, hot bath. Why? For the same reason. Doing sports, dragging bricks and plowing potatoes at speed puts a strain on the cardiovascular system: heart rate increases (to varying degrees for everyone), blood pressure and body temperature rise. Accordingly, local blood flow in the area of surgical intervention is also increased. And with it comes swelling, the likelihood of bleeding and sutures coming apart under the pressure of the swelling. Sauna, tanning bed, hot bath – same reason. What if… …I’m an athlete and I can’t go without training? Also, I work as a bath attendant at a women’s bathhouse, so no sauna for me? My guess is that over the years of training in the sauna, the body has adapted to the physical exertion and high temperature, so maintaining a normal routine is perfectly acceptable. But, we are talking about excessive physical exertion, which means that for a few days after surgery, it is better to refrain from setting Olympic records for running in a hot tub. If you run 5 km daily before breakfast, 3-4 days after surgery, reduce your pace and intensity slightly, reducing the distance to 3 km. Your body will appreciate it. 7. Do not dissolve the stitches, try not to disturb the area of surgery. Refuse to use an irrigator for a few days. Why? So as not to unnecessarily disturb the edges of the surgical wound and not to damage the sutures. I would like to remind you that suture discrepancy leads to the entry of germs, food residues, saliva, etc. into the surgical area. As a consequence, we can get problems with the tissues surrounding the implant. What if… …bothered by an odor (or whatever), it seems like food got under the stitches, etc.? The best solution in this case is to contact the attending physician or, at the very least, a telephone consultation with him. Trying to get something out of the post-op room with a toothpick or rinsing it with an irrigator can seriously complicate the post-op period. 8. The implantation is usually completed with sutures. A non-resorbable monofilament suture material is used, which means the sutures will need to be removed after 10-14 days. Why? Monofilament non-resorbable sutures (Polyamide, Prolene, Resolone, etc.) are a much more hygienic and predictable suture material compared to polyfilament resorbable sutures (Vicryl, PGA, Catgut, etc.). We use it wherever reliable wound closure is required. The side effect is that these stitches need to be removed. In addition, sometimes the tendrils from the nodules scratch the mucosa, causing some discomfort. If you notice this, tell your doctor to tidy up your stitches. What if… …you can’t get your stitches out within the specified time frame (10-14 days)? You can take them off later! 9. Do not self-medicate, folk medicine, do not take homeopathic remedies. Why? The effectiveness of homeopathic remedies and folk remedies for all diseases is a controversial issue. Let’s not argue about it. All the more reason to recommend why it shouldn’t be done lies in the legal and ethical realms. Your work with the doctor is not just limited to the surgery itself, he or she is responsible for your rehabilitation period, among other things. Your attending physician, taking into account the nature of the surgery and your body, will make appointments and recommendations that are best suited to your clinical case. At the same time, the doctor rightly assumes that you will comply with them, and this gives him the opportunity to predict the course of the postoperative period and, in case of any problems, to make the necessary adjustments. 10. You need to take the following medicines: – antibacterial therapy. There are more than 100500 kinds of different antibacterial drugs, in each clinical case, the doctor selects them individually, based on the indications and your health condition. Antibiotic therapy usually accompanies all types of tooth-preserving surgeries. Especially do not write here the names of drugs, so as not to provoke attempts to self-medicate – once again I emphasize that the right to prescribe you medication has only your doctor. – anti-inflammatory therapy. Usually consists of one or two components: non-steroidal anti-inflammatory (NSAIDs) and antihistamine (AHS) medications. We often call NSAIDs “painkillers”, rightly believing that their main purpose is to control pain. Uh, no. Anti-inflammatory drugs help keep the inflammatory process that always develops after surgery under control, and pain relief is just one of their effects. With anti-inflammatory drugs you need to be extremely careful, do not abuse them, do not prescribe them to yourself, for the consequences can be worse. Antihistamines are part of anti-inflammatory therapy, not a cure for allergies as some people think. We prescribe them because factors similar to those that trigger allergic attacks are involved in the development of inflammation – that’s why we need AHS to control them. – additional drug therapy. Serves both to eliminate the side effects of antibiotics and anti-inflammatory drugs and to treat the underlying disease. For example, the prescription of NSAIDs to patients with gastritis or GI ulcers is often accompanied by antacid medications, and when complicated by perforation of tooth extraction on the upper jaw, vasoconstrictors and antibacterial drops for the nasal cavity are prescribed. – vitamin therapy. For several years I have been practicing the administration of vitamins to accelerate the regeneration of bone wounds in preparation for implant treatment. Again, even trifles like prescribing vitamins should be taken seriously, as they can be seriously harmful in some diseases and conditions. Again, only your doctor can prescribe medications. I strongly discourage taking medication without a doctor’s prescription. What if … … … don’t take the medication at all? Such actions fall under paragraph 9 of these recommendations, it is a direct violation of the contract on the provision of medical services from your side – the doctor and the clinic have the right to disclaim responsibility for the result of your treatment. And, if any problems suddenly arise, you will have only yourself to blame. 11. You will need to come for a postoperative checkup, usually scheduled for 2-3 days after surgery. Why? The most difficult part of a surgeon’s job is not performing surgery, because even a monkey can be taught how to swing a scalpel. In my opinion, the most difficult thing is to make the patient rehabilitate as quickly as possible after surgery, with minimal discomfort and risk of complications. At the same time, even in one person the nature of the postoperative period can vary significantly, depending on the characteristics of the surgical intervention, and to predict how pronounced after the operation will be swelling, hematomas, painful sensations, it is difficult enough. The postoperative examination, which is performed “at the peak of symptomatology”, allows us to assess the consequences of the surgery and, if necessary, to adjust recommendations and prescriptions, hence alleviating the patient’s condition. Usually the rehabilitation period after implant surgery takes from 2 to 10 days and may be accompanied by the following symptoms: – painful sensations may appear immediately after surgery, their peak is 6-12 hours after surgery, then their intensity decreases. – swelling, swelling of the surgical area usually appear on the second day after surgery, peak after 48-72 hours, and then decrease. – swallowing pain is associated with the development of regional lymphadenitis, may appear immediately after surgery and subside within 72 hours. – Difficulty opening the mouth is due to swelling of the intermuscular tissue and irritation of the muscle capsule. It passes within a few days. – discomfort when chewing, talking – appears for the same reason as difficulty opening the mouth. – bleeding from the postoperative wound may be of varying intensity and continue for 24 hours. – the appearance of hematoma, “bruise” on the skin in the area of surgery happens because blood infiltrates the soft tissues around the wound. – increased body temperature, a natural reaction to the postoperative inflammatory process – nosebleeds are extremely rare in upper jaw surgery. – worsening of general well-being can be both a consequence of the surgery itself and a side effect of prescribed medications. – divergence of sutures in the area of the postoperative wound sometimes occurs due to stretching of soft tissues by swelling. These phenomena pass on their own within 4-10 days if all recommendations and prescriptions of the doctor are followed. In case of symptoms beyond those mentioned above, it is necessary to urgently consult with the attending doctor and, if necessary, adjust the postoperative rehabilitation program. Well, the most important rule of any rehab period is that any problem, question, or concern is a reason to contact your primary care doctor. Remember: as long as you are under your doctor’s care and in touch with your doctor – you are safe.

Sinuslift (or subantral augmentation) is the most common osteoplastic surgery in the world. In fact, it has to be done in 92% of patients when it comes to placing implants in the lateral teeth of the upper jaw. However, unlike other osteoplastic surgeries (NCR, ATCCF, etc.), sinus lift surgery has a number of peculiarities that affect, among other things, the rehabilitation period: in particular, the area of intervention is located directly under the nasal cavity and is separated from it by a thin mucous membrane (the so-called “Schneider membrane”) lining the maxillary sinus. The area of intervention is directly under the nasal cavity and is separated from it by a thin mucous membrane (the so-called “Schneider membrane”) lining the maxillary sinus. That is why our main efforts in the postoperative period are aimed at preserving the integrity of the Schneider membrane and preventing infection of the surgical area from the nasal cavity. Another important feature of the postoperative period is the almost inevitable development of congestion in the maxillary sinus, impeding its ventilation and worsening evacuation of secretions. Combined with bleeding of varying degrees of intensity, this creates an ideal environment for bacterial growth directly over the graft and, in the absence of proper prophylaxis, significantly increases the risk of infection. Therefore, an important part of the postoperative appointments is nasal care and the use of vasoconstrictive and antibacterial drops: Otherwise, the recommendations after sinuslift surgery are almost the same as for other osteoplastic surgeries and implants. Для того чтобы послеоперационный период прошел комфортно и безопасно, я прошу вас соблюдать следующие рекомендации: 1. Please maintain good oral hygiene. For hygiene, it is better to use a soft toothbrush, minimal toothpaste. 2. Always rinse your mouth with an antiseptic solution after eating and after brushing your teeth (see point 10, “medication after surgery”). 3. Apply cold compresses to the postoperative wound area every 2 hours for 20 minutes for the first 24 hours after the intervention. 4. Refrain from eating and drinking for 2-3 hours. 5. For 3-4 days, exclude coarse, hot, spicy food from your diet. 6. For 3-4 days cancel sports, excessive exercise, refrain from visiting the bath, sauna, solarium, do not take a hot bath, try not to overheat and do not overcool. 7. Do not puff up your cheeks, do not blow your nose, refuse to use oral and nasal irrigators. 8. Handle the postoperative wound with maximum care and gentleness, try not to disturb it, do not dissolve the stitches, do not try to “squeeze something out”. 9. Use vasoconstrictor and antibacterial nasal drops twice a day according to the regimen suggested by your doctor. 10. Do not self-medicate, homeopathy or folk medicine. 11. Refrain for 6-8 weeks from scuba diving, playing wind instruments, and other activities that involve rapid and significant pressure changes between the mouth and nose.