Implant surgeries are one of the treatments that patients who come to a dental clinic are most concerned about. After all, although it is a much quicker procedure than most people tend to believe, and despite the fact that it is performed under local anaesthesia, it is surgery and as such is more similar to what can happen in a hospital operating theatre - with the obvious differences - than to the rest of the treatments we perform in the clinic. In addition, sometimes patients seeking complete rehabilitation undergo surgery to place four implants at the same time, a longer and more complicated procedure that requires a greater effort from everyone involved, including the patient.
For this reason, this type of surgery is usually performed under intravenous sedation, which requires the presence of an anaesthetist, in addition to other precautions. It has many advantages and is quite safe, but first, let's get to know what it consists of.
Types of clinical sedation in dentistry
In our dental clinic in Murcia we offer various types of sedation options to patients, which are sometimes confused with each other. Therefore, let me give you a brief overview of them to help you understand how they differ from intravenous sedation, also known as conscious sedation.
Local anaesthesia is the most common type of anaesthesia used in the clinic, and practically all treatments are receptive to its use. In fact, it is even administered to certain patients when performing tartrectomies if they are very sensitive or if it is necessary to intervene in depth in the gum area (for example, in periodontal patients who do not need scaling but do require special care in the gingival area). Fillings, inlays, onlays, root canals... local anaesthesia is used in all these procedures. And in implant placement surgeries that require conscious sedation, too, since they have nothing to do with each other.
The aim of local anaesthesia is that the patient does not suffer pain in the operated area, but in no case does it intervene neuronally in the patient's state of mind, consciousness or perception of reality in general.
Nitrous oxide sedation
It is the next step for patients who also want to be calm and relaxed during the procedure. It is administered with what is known as 'laughing gas', by inhalation, and because it has no contraindications or side effects it is widely used to treat children. Nitrous oxide is a safe sedative agent whose effects wear off as soon as it is no longer inhaled and which is immediately recoverable, but which provides a state of conscious relaxation that is very useful for certain treatments. Patients are calm and serene but can respond to necessary cues (open mouth, spit, etc.) without any problems.
It is also combined with local anaesthesia, as nitrous oxide has different effects. In fact, in implant surgery they are often used together. However, for a long-term procedure such as the placement of four implants in one appointment, intravenous sedation is better.
Although it is not performed in the clinic itself, as it does not take place in our facilities, at Vélez y Lozano we also perform interventions under full sedation, i.e. general anaesthesia. The patient and the clinical team involved are transferred to the operating theatre of a hospital where, with the help of an anaesthetic team, they will carry out the treatment. Due to the risks, albeit minimal, associated with general anaesthesia and the complications for both the team and the patient, they are not performed very often and are the only alternative for special patients such as people with some form of mental impairment or autistic spectrum disorder who cannot be treated while conscious.
Intravenous conscious sedation
Finally, the case at hand. Through the administration of certain drugs, an anaesthetist who has moved here, to the clinic itself, manages to ensure that a patient who is going to undergo a complex surgery of long duration (four hours or more on certain occasions) can do so in a much less traumatic way than usual. In fact, in many cases, the patient suffers from mild amnesia or confusion about the procedure, so psychologically it is also an ideal option for many.
As with other types of sedation, it must be combined with local anaesthesia, as the aim of the drugs administered is not to 'numb' the area so as not to feel pain, but to sedate and reassure the patient.
What is an intravenous sedation procedure like?
The first step takes place well before the day of the operation, with the patient's medical history. Once the patient's medical history indicates that they are receptive to this type of sedation, it is the anaesthesiologist who comes to our clinic and administers the drug cocktail to the patient intravenously. For the duration of the procedure, the patient can understand and listen to instructions, but enters a deeper state of sedation than we can achieve with nitrous oxide.
Throughout the procedure, the anaesthesiologist will monitor the patient's vital signs with monitoring equipment, in addition to monitoring the patient's oxygen levels and blood pressure. In addition, the patient receives a constant flow of oxygen through nasal goggles to minimise the risk of sedation at this level.
When the time comes and the operation is over, it is time for resuscitation, which is carried out by administering other drugs for the opposite purpose. A recovery period will be necessary for the patient to be able to stand up and walk safely, and it is necessary for those involved to ensure that he is in good condition, but after this period the patient will be able to leave the clinic under his own steam. However, the patient may not drive or engage in activities that could put him or herself or any other person at risk during the hours indicated.
If you are interested in this type of procedure, you can contact us, we will study your case and make sure that you are receptive.