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Instrumenting the Dental Implant

The safe use of ultrasonic scaling in implant maintenance.

Osseointegrated implant dentistry has become a viable option for natural tooth replacement in both partially and fully edentulous patients. Effective preventive care is critical to the long-term success of dental implants. Due to the increasing acceptance of implants, dental hygienists need to know how to best provide care for peri-implant tissues using the appropriate instruments available, such as implant ultrasonic scalers.

Maintaining Dental Implants

Maintaining dental implants is similar to providing dental hygiene care for natural teeth. In the etiology of periodontal disease, bacteria affect peri-implant tissues and the periodontium tissues around natural teeth in a comparable manner. If left untreated, periodontal diseases involve an inflammatory response and the eventual breakdown of supporting tissues.1-4 After placement, the tissue attachment apparatus around an implant can be impaired by the presence of bacterial plaque.5 There is also a greater risk of disease around the implant if periodontitis exists in the surrounding natural teeth because they act as a reservoir for periodontal pathogens.6

Mucositis is a bacterial infection causing inflammation of the surrounding soft tissue. Peri-implantitis occurs when the inflammation extends beyond the soft tissue and reaches the level of the bone surrounding the implant.7-10 In order to prevent these conditions from occurring, implant maintenance therapy is necessary to sustain tissue health.

Using Ultrasonics

Maintenance treatment may include the use of ultrasonic scalers, which provide irrigation and removal of soft and hard deposits with less hand fatigue for clinicians.11 However, ultrasonic scaling tips are traditionally made of metal, which may scratch the titanium implant surface. The roughening of implant surfaces increases plaque retention, which in turn, compromises periodontal health.12 In order for ultrasonic scaling tips to be used safely on dental implants, they are manufactured out of plastic or carbon, instead of metal. Numerous studies have focused on post-treatment surface roughness using scanning electron microscopy (SEM). The findings have determined no damaging effect from the use of these scaling instruments.13-17

Implant Ultrasonic Inserts

In general, the implant ultrasonic scaler should be activated in the same manner as an all-metal ultrasonic scaler. The following techniques should be incorporated:18

  1. The power of the ultrasonic unit should be kept at a low setting.
  2. The point of the tip should never be placed directly on the implant, but rather the side of the tip is applied with light pressure.
  3. Overlapping horizontal, vertical, or oblique strokes should be used.

See Table 1 for more information on the ultrasonic tips that are currently available for use on dental implants.

Implant dentistry has become the standard of care for tooth loss replacement. Periodontal health can determine the longevity of an implant and can only exist as a result of ideal supragingival and subgingival plaque control. Professional maintenance by the dental hygienist is an essential element in implant care. Ultrasonic inserts specifically designed for dental implants give the hygienist another option in providing optimal treatment.


  1. Adell R, Lekholm U, Rockler B, Brånemark PI, Lindhe J, Eriksson B, Sbordone L. Marginal tissue reactions at Osseointegrated titanium fixtures. A 3-year longitudinal prospective study. Int J Oral Maxillofac Surg. 1986;15:39-52.
  2. Apse P, Ellen RP, Overall CM, Zarb GA. Microbiota and cervicular fluid collagenase activity in the osseointegrated dental implant sulcus: a comparison of sites in edentulous patients. J Perio Res. 1989;24:96-105.
  3. Mombelli A, van Oosten MAC, Schurch E, Lang N. The microbiota associated with successful or failing Osseointegrated titanium implants. Oral Micro Immun. 1987;2:145-151.
  4. Mombelli A, Buser D, Lang NP. Colonization of Osseointegrated titanium implants in edentulous patients. Early results. Oral Micro Immun. 1988;3:113-120.
  5. Koth DL, McKinney RV, Steflik DE. Microscopic study of hygiene effect on peri-implant gingival tissues. J Den Res. 1988;IADR abstr:639.
  6. Meffert RM. Periodontitis vs. peri-implantitis: the same disease? The same treatment? Crit Rev Oral Biol Med. 1996;7:278-291.
  7. Berglundh T, Lindhe J, Marinello C, Ericsson I, Liljenberg B. Soft tissue reaction to de novo plaque formation on implants and teeth. An experimental study in the dog. Clin Oral Impl Res. 1992;3:1-8.
  8. Lang NP, Bragger U, Walther D, Beamer B, Kornman KS. Ligature-induced peri-implant infection in cynomolgus monkeys. Clinical and radiographic findings. Clin Oral Impl Res. 1993;4:2-11.
  9. Lindhe J, Berglundh T, Ericsson I, Liljenberg B, Marinello C. Experimental breakdown of peri-implant and periodontal tissues. A study in beagle dogs. Clin Oral Impl Res. 1992;3:9-16.
  10. Schou S, Holmstrup P, Stolze K, Hjorting-Hansen E, Kornman KS. Ligature-induced marginal inflammation around Osseo?integrated implants and ankylosed teeth. Clinical and radiographic observations in cynomolgus monkeys (Macaca fascicularis). Clin Oral Impl Res. 1993;4:12-22.
  11. Wilkins EM. Clinical Practice of the Dental Hygienist. 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2009:655-656.
  12. Speelman JA, Collaert B, Klinge B. Evaluation of different of methods to clean titanium abutments. A scanning electron microscopic study. Clin Oral Impl Res. 1992;3:120-127.
  13. Sato S, Kishida M, Ito K. The comparatice effect of ultrasonic scalers on titanium surfaces: an in vitro study. J Periodontol. 2004;75:1269-1273.
  14. Kawashima H, Sato S, Kishida M, Yagi H, Matsu?moto K., Ito K. Treatment of titanium dental implants with three piezoelectric ultrasonic scalers: an in vivo study. J Periodontol. 2007;78:1689-1694.
  15. Matarasso S, Quaremba G, Coraggio F, Vaia E, Cafiero C, Lang NP. Maintenance of implants: an in vitro study of titanium implant surface modifications subsequent to the application of different prophylaxis procedures. Clin Oral Impl Res. 1996;7:64-72.
  16. Rühling A, Kocher T, Kreusch J, Plagmann HC. Treatment of subgingival implant surfaces with Teflon®-coated sonic and ultrasonic scaler tips and various implant curettes. An in vitro study. Clin Oral Impl Res. 1994;5:19-29.
  17. Bailey GM, Gardner JS, Day MH, Kovanda BJ. Implant surface alterations from a nonmentallic ultrasonic tip. J West Periodontol Periodontal Abstr. 1998;46:69-73.
  18. Branam S. Implants and Inserts. Available at: Accessed March 18, 2009.

From Dimensions of Dental Hygiene. April 2009; 7(4): 32-33.

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