Diving after a dental implant

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jfcl01

Contributor

Has anyone had an implant? Did you have any problems diving after the implant? How long did you have to wait to get back in the water?

DocVikingo

Senior Member

This Mar/Apr ’05 DAN Alert Diver magazine article provides what you need to know. It’s written by my dentist diving buddy Larry Stein (reproduced with permission):

“Scuba Diving and Dental Implants
Dr. Laurence Stein, D.D.S.

More people are electing to have failing or missing teeth replaced by dental implants. Traditional solutions for missing teeth include these types of implants: bridges, removable partial dentures, or full dentures.

This results in divers’ questions ranging from “How long should I wait after implant surgery before diving?” to “Will the pressure on the bite of my regulator affect the implants in my mouth?”

A Short History of Dental Implants

How old is the art and science of implants? Archeological evidence suggests that certain early civilizations attempted to reimplant lost teeth as well as making tooth substitutes made of carved wood or ivory. In the 1800s, gold – and later, platinum – implants were placed into the human jaw. These proved to be unsuccessful.
Dr. Alvin E. Strock at Harvard University placed the first successful implants in 1937. They were made of a type of surgical stainless steel called vitallium, an alloy of chrome, cobalt and molybdenum (a gray metallic element) commonly used in removable partial dentures.

The root form implant is the prototype of today’s most common dental implant. The key to the implant’s success is the use of titanium metal. In 1952, while Brånemark was doing bone-healing studies on rabbits, he inserted a small titanium plate with a lens attached into the bone of his experimental animals. This allowed him to peer microscopically into the bone and actually view the healing process.

At the completion of the experiments, when Brånemark attempted to remove the titanium plate, he found that the surrounding bone had fused to the metal. He called this fusion of bone to metal osseointegration. Through this serendipitous occurrence, successful dental implants and other implantable orthopedic devices became possible.

The first step is to remove the tooth at the problem sites. It might then be necessary to graft bone into socket to create a site suitable for the future implant; or the procedure may require the surgeon to fill in part of the maxillary sinuses to give a patient enough vertical bone height to support implants in the upper back part of the mouth.

In extreme cases, it may be necessary to harvest bone from dense areas in the body, such as the hip, or to use artificial sources, to restore bone that has receded. It is the surgery, the requisite healing period, and the prosthetics that affect patients who wish to scuba dive.

Generally, if there is a missing tooth and there are appropriate bone dimensions, the surgeon makes a specially sized hole in the bone using precisely sized drills. The implant is then threaded into it. A cover screw or a healing abutment is then screwed into the “top” of the implant. The implant is then allowed to osseointegrate for a period of four to six months.

To avoid second-stage surgery, most surgeons now use healing abutments that purposely project through the gums during the healing period. This abutment is simply unscrewed by the prosthedontist when the implant is ready to be restored.
The implant is then surgically re-exposed following the osseointegration period, and parts are attached to the exposed implant to make it possible to complete the restoration.

Avoiding Dive / Bite Pressures

At this point, surgeons have not developed uniform recommendations related to oral surgery and scuba diving: generally, the more complicated the surgery, the longer the wait before diving. Surgical complications will add to this time, as can any underlying medical conditions, tobacco use and alcohol consumption.

During post-surgical osseointegration, it is necessary to avoid anything that could apply pressure to the skin over the implant and cover screw or the healing abutment. Diving too soon after surgery with its resultant pressure, no matter how slight, could damage the site. For example, if the regulator’s bite tabs are over the implant site, transmitted biting forces can result in implant failure.

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Besides avoiding diving, it’s also advisable to maintain a softer diet while healing and to avoid chewing directly in the surgical area. The risk for damage is greatest during the first four weeks after surgery, then it decreases.

There are other considerations as well. Diving should be suspended for as long as it takes to avoid other complications associated with oral surgery:

• revascularization (resumption of blood flow);
• stabilization of the implant;
• oral and sinus cavity pressure changes;
• ability of the patient to hold a regulator in the mouth; and
• use of medications for pain or infection.

Gas exchange, such as what the body experiences when diving – with subsequent solution and offgassing of nitrogen – is partially a function of the vasculature (arrangement of blood vessels) of the local tissues. Simple extraction sites quickly develop a blood supply. Similarly, extraction socket grafting (socket preservation) also revascularizes rapidly. Diving following a simple extraction usually requires a one- to two-week recuperation time.

Bone Grafts Affect Recuperation Time

Bone grafting procedures and sinus surgery are more complex and will require a longer waiting period. The larger the graft site, the longer the wait. Some doctors will recommend avoiding any activity that causes micro-movement for at least six months. It can actually take up to one year for complete bone healing at an implant site. While diving sooner than one year may not cause a problem, your surgeon should determine the appropriate time period. Even if your surgeon doesn’t dive, follow his or her advice.
The quantity and quality of the underlying bone also affects implant / dive wait periods. Some people have very hard, dense bone, while others have soft, spongy bone. This affects the primary stability of the implant inserted into it. Implants placed into hard, dense bone are less susceptible to the micro-movements described above.

The opposite is true for soft, spongy bone. Newly inserted implants are most vulnerable to movement within the first two to four weeks following surgery. The implants actually get looser within the surgical site before they begin to stabilize. Scuba diving must be avoided during the initial stages of osseointegration. A minimum of five weeks to two months is needed to render the implant stable. Longer times would be appropriate if substantial bone grafting has been done.

Making the Final Implant Work

During the implant healing period, the patient generally wears nothing in this area; or he / she may be fitted with a temporary prosthesis that is generally not attached to the healing implant(s). A temporary removable partial denture is an example of this. In the past several years, surgeons have developed protocols to help patients receive their final prostheses more quickly.

Any temporary devices will usually be made of plastic and anchored with some sort of temporary cement or temporary screw. It would be safer to be more conservative and delay scuba diving until the final restorations are in place. For example, if the temporary cement were to loosen or the plastic were to break, there is a danger of aspirating (swallowing the temporary prosthesis).

Your surgeon makes the final prosthesis – whether it’s an implant-supported crown, fixed bridge or fixed detachable denture – after the requisite four to six months of osseointegration.

Once dental implants are fully osseointegrated and the final prostheses have been placed, there is nothing inherent in scuba diving that would pose a threat to either the implants or the restorations. The spaces engineered into the implants to hold the overlying screws, abutments and prostheses are small and are completely contained within the titanium structure. There is no air space communication between the implants and the surrounding tissues. The implant structure is strong enough to withstand any pressure differentials that might occur if small amounts of gas were to migrate into these engineered spaces.

The overlying implant prosthetics can exhibit some of the same, albeit extremely rare dental problems associated with scuba diving. Breakage of porcelain or cementation failures can occur and the use of implants affords no special property of the dental restorations to resist such failures.

Some implant-supported devices are cemented, and as such, a cementation failure due to pressure changes is possible. Again, this is a rare occurrence. Some dentists prefer to use weaker, temporary cement under the final, permanent implant crowns and bridges. This allows for future removal of the restoration if deemed necessary.
Other dentists treat the cementation to implants just like teeth and use permanent cement. Their philosophy is, “If I wasn’t worried about permanent cement for teeth, why worry about it for implants?”

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It would be wise to know whether your dentist has used temporary or permanent cement under your implant restorations. The likelihood of even the temporarily cemented prosthesis coming off is rare, but you should be aware that it could become a problem.

Generally, if you keep an implant and/or restoration for more than a year, in all likelihood, it will not fail as a result of a loss of osseointegration. However, there are other ways restorations can fail. These are unrelated to the surgery, placement and healing of the implants: there are rare instances of implant breakage, abutment breakage or retaining screw failures. This is usually associated with a very strong bite, trauma, poor treatment planning or a failure of materials. Generally, diving would not cause such failures.

The increased use of dental implants makes it more than likely that some scuba divers will be diving with these devices. Although there are certain aspects of dental implant procedures and restorations that would temporarily limit a diver’s participation in the sport, scuba diving is not forbidden for people who have had successfully healed and restored implants. A thorough discussion with your oral surgeon and dentist should make your implants successful and your diving safe.”

Diving After Dental Work

Scuba diver gets a cavity filled at their local dentist Scuba diver gets a cavity filled at their local dentist

Most of us have had to have some type of dental work done; and, while most of the time we’re left with smiles that look great and feel fantastic, there are some circumstances under which diving post-dental work is just not advisable. If you know you have upcoming dental work which needs to be done and you’re trying to schedule a vacation for about the same time, be sure to talk with your dentist about any negative ramifications of diving after dental work.

Pressure and Air Space

As you know, any type of bubble or air space inside your body can cause pain and even physical trauma while diving. Some types of dental work, particularly root canals with temporary caps or crowns covering unfinished work, are not compatible with diving at all. The reason for this is that as you ascend and air pressure increases inside your tooth or teeth, your dental work could literally explode inside your mouth, causing injury and perhaps even causing you to inhale or swallow portions of the dental structure. The pain from an accident like this is excruciating, and the inhaling a foreign object while diving introduces the possibility that death could occur. If you have any type of temporary dental work at all, assume that the bonds between the temporary fixtures and your teeth are not strong enough to withstand increased air pressure, and don’t risk your health or your life by diving.

Dental Conditions Exacerbated By Diving

If you have chronic dental pain of any type, you may find that diving causes the pain to increase. If you have problems with the roots of your teeth, and if your dentist has recommended a pulpectomy or root canal to rectify those problems, you’ll probably find that enjoyable diving is an impossibility until you have the problems fixed. Cavities, loose fillings, and any other dental work that is not securely bonded can cause pain and potential problems, too. If you are considering porcelain crowns, you should know that they have been known to shatter at a depth of just 65 feet, as have other types of fragile dental work. If your teeth are fractured, or if you wear any type of dentures or orthodontics, they could also pose a problem while diving. Dry socket infections can also cause problems, if you have a dry socket infection, you’ll probably have to wait between two and eight weeks before diving.

Diving Dentistry

Some dentists specialize in providing dental work for divers. Some common services these dentists offer are tooth repairs that are compatible with diving, TMJ therapy to deal with the pain that can sometimes occur from the continuous jaw movements that are required to keep your regulator in place, and creating custom dentures for divers who cannot dive with standard partial dentures in place due to the risk of aspiration.

There are a number of dental issues that can cause problems for divers. The best way to avoid these problems is to be candid with your dentist and to take very good care of your teeth. If you’re in doubt about the safety of a certain cosmetic procedure or other dental procedure, avoid diving until your safety can be assured.

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how long after tooth extraction?

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DaveV

Registered

I had 2 wisdom teeth extracted. The oral surgeon didn’t seem to have a grasp on how long I should wait before returning to diving and seemed to be most concerned about “stuff” getting in my mouth while diving in the ocean. I am planning on waiting at least 2 weeks, but does anyone have any contrary advice? My concerns would be mainly sinus issues as the upper wisdom tooth typically pokes into the sinus cavity.

Thanks much!
Dave

scubadada

Diver

Duke Dive Medicine

ScubaBoard Supporter

Were they impacted such that they were actually protruding into the sinus?

Best regards,
DDM

Information provided is for educational purposes only, is not intended to replace the advice of your own health care practitioner, and should not be construed as a practitioner/patient relationship. Duke Dive Medicine does not condone the placement of “Skimwords” advertisements and does not endorse any of the products or services advertised.

MaxBottomtime

Contributor

Altamira

ScubaBoard Supporter

question.png

DAN Sinks Its Teeth Into Dental Issues and DivingMy wife had oral surgery about six weeks ago for the removal of a wisdom tooth. The dentist said that there is no infection, and the wound is healing nicely. But it was deeply rooted, and the nerve was traumatized. She’s still taking painkillers. The problem is that we are going on a trip to Hawaii next week, where we planned to make a few — i.e., two to four — dives. Her oral surgeon, who’s not a diver, said that it’s probably not a very good idea for her to dive. What’s your read?
First, let’s state what might be obvious. If your wife’s surgery had been routine, with normal healing, uncomplicated by infection or pain and she could hold a regulator without discomfort, then it would be hard to advise her to wait any longer than she has already waited — i.e., six weeks. Normally, four to six weeks is sufficient time to allow for the risk of infection, provided there has been good healing and gum tissue has begun to fill in the empty socket. However, the nerve trauma may indicate that her case may be different. I had to consult with two of DAN’s referral oral surgeons with experience in dive medicine for assistance on this issue.

Occasionally, proper healing is delayed, often in smokers or older people. In such cases, air can be forced into the subcutaneous tissues by the increased pressures in the mouth during a dive. This condition could further delay the healing process and can be uncomfortable.

Pain can impede the ability to hold the mouthpiece in place; a loosely held regulator during submersion can present a possible drowning hazard. One consultant also cautioned on returning too early to diving based on the softness of the lower jawbone (mandible) after a wisdom tooth extraction. The end of the mandible remains fragile until it’s fully healed. Additionally, it is subject to fracturing when pressure is placed on the bone, such as when gripping a regulator in place.

Theoretically, if there is still some localized swelling (edema), offgassing of nitrogen from the area during decompression could be impaired. Although decompression illness in a small area of the jaw seems unlikely, we have insufficient data to be sure.

Finally, some types of pain medicine (those containing codeine, oxycodone or other narcotics) could promote nitrogen narcosis and impair performance and judgment underwater. Both consultants agreed that if you still have symptoms, diving is not a good idea.

Guidelines for diving after most dental surgery include waiting for:

1) A minimum of four to six weeks or until the tooth socket or oral tissue has sufficiently healed to minimize the risk of infection or further trauma;

2) Medication to control pain resulting from the surgery has been discontinued and there is no risk of drug interaction with nitrogen; and

3) The diver can hold the regulator mouthpiece without pain or discomfort for a period of time sufficient to perform a planned scuba dive.

Source https://scubaboard.com/community/threads/diving-after-a-dental-implant.212423/

Source https://www.justgottadive.com/dive_resources/technical_articles/diving-after-dental-work

Source https://scubaboard.com/community/threads/how-long-after-tooth-extraction.528020/

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