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Preventing Inflammation With Implant Maintenance

Implant maintenance is key to preventing inflammatory disease that may jeopardize implant health. With no proven strategies to combat peri-implantitis, prevention is integral to the long-term success of implant therapy.

Peri-implant mucositis and peri-implantitis are often associated with an inflammatory reaction to bacterial invasion within the peri-implant tissue. The first signs of peri-implant mucositis include bleeding on probing and/or suppuration, increased probing depth, redness, and swelling. These signs are recognizable upon careful clinical examination.1

The main purpose of the maintenance protocol for patients with implant-supported restorations is to prevent the onset of inflammatory disease, and, if applicable, halt the progression from peri-implant mucositis to peri-implantitis. This is key, as there are no predictable and reliable methods to treat peri-implantitis.

Costa el al2 showed that subjects who lacked monitoring of the peri-implant tissues and preventive maintenance were associated with a higher prevalence of peri-implantitis than patients who underwent maintenance therapy.

Supportive periodontal and implant maintenance has even more value if patients have a history of periodontitis. Roccuzo et al3 conducted a prospective study to evaluate the long-term results of implant therapy in patients with periodontitis. This study revealed that patients with a history of periodontitis have a higher incidence of implant loss and peri-implant disease. In addition, patients with a history of periodontitis who do not follow a maintenance schedule experience a significantly higher rate of implant failures.

FIGURE 1. Plaque accumulation around implants is associated with bone loss.
FIGURE 1. Plaque accumulation around implants is associated with bone loss.

Patients with implant-supported restorations clearly should have regular maintenance visits. At each appointment, a comprehensive evaluation should include reviewing the medical history, followed by updating periodontal and peri-implant charting, evaluating oral hygiene, and assessing occlusion. Because poor oral hygiene is a risk factor for peri-implant disease (Figure 1), emphasizing the importance of optimal self-care, along with patient education, should be a part of the maintenance visit.

Because there is no consensus regarding a definitive frequency for maintenance visits, maintenance treatment should be individualized according to each patient’s systemic and local risk factors. For patients with history of periodontitis with acceptable self-care, a 3-month recare interval is usually adequate. On the other hand, when there are no systemic or local risk factors, recare visits might be scheduled every 6 months. If patients still maintain some natural teeth, alternating maintenance therapy between a general dentist’s office and specialist’s office may be beneficial for patients. Careful attention to the presence of inflammation and peri-implant tissue health can help sustain the long-term success of implant-supported restorative treatment.4,5


  1. Peri-implant mucositis and peri-implantitis: a current understanding of their diagnoses and clinical implications. J Periodontol. 2013;84:436–443.
  2. Costa FO, Takenaka-Martinez S, Cota LO, Ferreira SD, Silva GL, Costa JE. Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up. J Clin Periodontol. 2012;39:173–181.
  3. Roccuzzo M, De Angelis N, Bonino L, Aglietta M. Ten-year results of a three-arm prospective cohort study on implants in periodontally compromised patient Part 1: implant loss and radiographic bone loss. Clin Oral Implants Res. 2010;21:490–496.
  4. Gay IC, Tran DT, Weltman R, et al. Role of supportive maintenance therapy on implant survival: a university-based 17 year retrospective analysis. Int J Dent Hyg. 2016;14:267–271.
  5. Armitage GC, Xenoudi P. Post-treatment supportive care for the natural dentition and dental implants. Periodontol 2000. 2016;71:164–184.

This information originally appeared in Hamada Y, Hill K, Chang J, John V. Strategies for implant maintenance. Dimensions of Dental Hygiene. 2019;17(8):18–24.

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