Personalized Implant Care for Optimal Longevity

Implant maintenance should be tailored to each patient given his or her dental and medical histories. For example, patients with a history of periodontitis should maintain a 3-month recare regimen, as they are more susceptible to peri-implantitis. Otherwise healthy patients should be seen every 6 months at the very least.¹ At these appointments, clinicians are encouraged to evaluate the implant and prosthesis. Sites should be visualized, probed, and palpated for signs of infection, such as pocketing, bleeding, or suppuration.

The presence of any calculus, cement, or occlusal interferences should be assessed and removed. Radiographs should be taken yearly or if tissue conditions deteriorate.² Patients should be forewarned of any failing implants that may require removal so they can make informed decisions about future replacement.

Self-care regimens have also evolved with new evidence. As floss remnants were increasingly found in peri-implant sulci, a preclinical study was developed; it showed that misfit implant-abutment connections and exposed implant threads had significantly greater floss residue at the implant collar.³ Waterjets removed supra- and subgingival plaque and improved tissue indices better than floss in short-term findings.⁴

Patients with full-arch, implant-borne restorations should be advised how to clean their prosthesis twice daily with different hygiene aids. Fixed appliances should be removed, cleaned extraorally, and reinserted with new prosthetic screws at the actual maintenance visit (when deemed necessary to do so).

Clinicians should use hygiene instruments compatible with the specific implants, abutments, and prostheses.¹ After proper isolation, use of low-abrasion subgingival air polishers with glycine powder can remove the superficial biofilm. Titanium scalers with Rockwell C hardness of 28 to 31 or titanium piezo tips are then used for further debridement and to prevent scratching of the implant itself.

Restorations are polished with prophy paste before applying an antimicrobial varnish in the mucosal seal.⁵ Use of a time-release varnish containing 1% chlorhexidine diacetate and 1% thymol has been shown to slow bacterial leakage from the implant-abutment interface in vitro.⁶

This protocol can be adapted to treat peri-implant mucositis. In fact, a randomized controlled trial demonstrated that such varnish significantly reduced pocketing and bleeding around peri-implant mucositis lesions when used as part of a daily self-care regimen.⁷

References

1. Bidra AS, Daubert DM, Garcia LT, et al. Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations. J Prosthodont. 2016;25(Suppl 1):S32–S40. 
2. Mombelli A. Maintenance therapy for teeth and implants. Periodontol 2000. 2019;79:190–199. 
3. Montevecchi M, Valeriani L, Franchi L, Sforza NM, Piana G. Evaluation of floss remnants after implant flossing in three different implant conditions: a preclinical study. Int J Oral Maxillofac Implants. 2021;36:569–573.
4. Magnuson B, Harsono M, Stark PC, Lyle D, Kugel G, Perry R. Comparison of the effect of two interdental cleaning devices around implants on the reduction of bleeding: a 30-day randomized clinical trial. Compend Contin Educ Dent. 2013;34:2–7.
5. Wingrove SS. Safe, effective, in-office implant maintenance. In: Peri-Implant Therapy for the Dental Hygienist. Hoboken, NJ: Wiley-Blackwell; 2013.
6. Besimo CE, Guindy JS, Lewetag D, Meyer J. Prevention of bacterial leakage into and from prefabricated screw-retained crowns on implants in vitro. Int J Oral Maxillofac Implants. 1999;14:654–660.
7. Hallström H, Lindgren S, Twetman S. Effect of a chlorhexidine-containing brush-on gel on peri-implant mucositis. Int J Dent Hyg. 2017;15:149–153.

This information originally appeared in Saltz A. Evolving management of peri-implant disease. Decisions in Dentistry. 2021;7(11)16-21.