by Kyle Trammell, D.M.D. — Newsletter Article
Protecting your patient’s investment in their dental implant is important to you. For this edition of our newsletter, we reviewed articles that highlight current philosophies of care in preventive and periodontal maintenance procedures for dental implants. We have included a reference list and have posted this article with links on our blog; please visit http://www.trammellperio.com and click on for dental professionals.
Exam, Assessment & Monitoring
As with any procedure in dentistry, there is not a single hygiene maintenance technique for dental implants that is universal. Clearly the experts agree that a thorough assessment of the oral condition and consideration of the patient’s overall health are the first steps we must always take before treatment. We know, for example, that systemic health issues such as diabetes can affect the patient’s ability to heal.
A general rule of thumb is to avoid periodontal probing of the dental implant site for the first three months after placement to avoid disturbing the perimucosal seal. The standing theory is that probing too soon could introduce pathogens and compromise success of the implant. An exception would be if evidence of peri-implantitis, such as bleeding, inflammation, bone loss, pain or mobility exists which warrants further investigation.
When circumstances justify probing, a plastic probing instrument is recommended to reduce the risk of scratching the implant surface and potential trauma to the perimucosal seal.
Recording and monitoring probing depths after the initial three months and in 3-month intervals is standard. Principles of co-diagnostic dentistry apply in managing the health of the bone and soft tissue and their role in dental implant success.
DID YOU KNOW?
Acidulated Phosphate Fluoride (APF) products are contraindicated for use with dental implant patients as they may etch the surface of the implants.
Our typical recommendation for dental implant patients is to maintain a 3-month hygiene recall schedule to monitor progress, healing and implant integration. This is especially true in the presence of risk factors or home care and plaque control challenges. We usually continue the 3-month recall cycle for 18-24 months; the patient can return to 6 month recall if healing and periodontal assessments appear normal.
Identify the type of implant and level of exposure. This combined data and assessment is critical to determining your approach to care. Is the implant abutment smooth or rough? What area of the implant is visible upon examination? Until recent years, the primary approach to debridement of the implant and restoration was to use plastic instruments. The goal here was to avoid scratching or gouging the implant surface, which would make the implant surface more conducive for plaque growth.
Many implant systems now have a completely roughened surface extending to most of the coronal portion of the implant fixture, making a case for metal instrumentation with the strength to remove calculus deposits. Since the majority of dental implants are made of titanium, titanium instruments and titanium-coated instruments are certainly stronger and some would argue are more bio-compatible than plastic instruments, which may introduce plastic debris or residue into the site. I personally prefer gold-tipped instruments or titanium; I have also found that plastic instruments are not strong enough to do an adequate job in removing hard deposits.
Ultrasonic Scalers. When used with proper precautions and a plastic covering that prevents gouging of the implant surface, ultrasonic scalers may be used to debride exposed supragingival and subgingival areas of the dental implant in most cases.
Air Polishing. Debridement of the implant prosthesis with air abrasion is acceptable, with caution to avoid trauma to the soft tissue. Note that repeated use can alter the surface of the dental implant.
The long term success of a dental implant relies heavily on the combination of timely periodontal maintenance, effective home care and good overall patient health. As dental health care providers, we have a professional stake in supporting our patients not only with clinical procedures, but with education and resources to help them maintain their oral health and protect their investment. A well-rounded approach to examination, protocols and instrumentation supported by continual learning has become the current competency for management of dental implants in periodontics today.References American Academy of Periodontology. Academy Report. Dental Implants in Periodontal Therapy. Volume 71, Number 12. http://www.joponline.org/doi/pdf/10.1902/jop.2000.71.12.1934 Bains VK, Bains R, Gupta S. Maintaining the dental implants: Importance in long-term success. J Dent Implant 2013;3:62-6. http://www.jdionline.org/downloadpdf.asp?issn=0974-6781;year=2013;volume=3;issue=1;spage=62;epage=66;aulast=Bains;type=2 Hempton, Timothy. et. al. Implant Maintenance. Techniques and tools for effective debridement of artificial anatomy. Dimensions of Dental Hygiene; January 2011; 9(1): 58-61.http://www.dimensionsofdentalhygiene.com/print.aspx?id=10235 Wingrove, Susan S. Dental implant maintenance: the role of the Dental Hygienist and Therapist. Dental Health September 2011; Volume 50 No 5 of 6. http://www.pdtdental.com/documents/2012Gen/Dental-implant-maintenance-the-role-of-the-Dental-Hygienist-and-Therapist.pdf