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Dental implants are a successful tool for the replacement of missing teeth. They help patients restore function and improve appearance. Like natural teeth, implants require patients to practice good daily self-care. If biofilm is not controlled on a daily basis, the tissue surrounding the implant can become inflamed leading to mucositis and peri-implantitis. A 2018 joint paper by the American Academy of Periodontology and the European Federation of Periodontology noted that peri-implant health requires the absence of inflammation including no bleeding on probing.1
An implant is a significant investment. It is essential to provide patients with the right tools and advice to maintain good peri-implant tissue health. The prosthetic design of the implant, especially the depth of the soft tissue cuff can make cleaning a challenge. Patients who struggled to use floss before having an implant will likely struggle to use it around the implant. It is estimated that about 50% of implant sites have mucositis and up to 40% may experience peri-implantitis.2 Few home care products have been tested for safety and efficacy around implants. One product that has is the Waterpik® Water Flosser (Picture 1). A 30-day study at the Tufts University School of Dental Medicine in Boston, MA, USA evaluated the effectiveness of a Water Flosser around dental implants for reducing bleeding on probing (BOP) as compared to the use of traditional string flossing.2
The study included subjects between the ages of 22 and 62 years. Each needed to have at least two BOP sites present. The subjects were computer randomised into two groups resulting in 22 implants per group. Examiners were blinded to the subject’s treatment group. Bleeding sites were comparable between the groups with 100% having BOP. All subjects received verbal instructions on product use. Those using string floss were directed to form a ‘C’ and move the floss up and down the surface several time. The Water Flosser was used at 60 psi. Individuals were shown to direct the tip at the gingival margin and interdental areas from both the buccal and lingual.2
All subjects used an American Dental Association (ADA) standard soft manual toothbrush and an ADA standard fluoride dentifrice. Group 1 used unflavoured, waxed string floss and Group 2 used a Waterpik®Water Flosser with the Plaque Seeker® Tip (Picture 2). This specialised tip has three nylon tufts to help cleansing around implants and other dental work. Both products were used one time per day.2
At the 30-day conclusion of the study, two subjects in the string floss group had withdrawn leaving 18 implants in the string flossing group and 22 implants in the Water Flossing group. The results found that 18 of 22 (81.6%) implants in the Water Flossing group experienced a reduction in bleeding compared to 6 out of 18 (33.3%) in the string flossing group. This represented 145% difference, which was statistically significant. No adverse events were reported for either group during the study.
The investigators concluded the Waterpik® Water Flosser is a safe and effective tool for reducing bleeding around implants. The results of this study are similar to other studies where the Water Flosser has been used on natural teeth and compared to string flossing.2
1. Renvert S, et al. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Periodontol, 2018; 89(Suppl 1):S304-S312.
2. Magnuson B et al. Comparison of the effect of two interdental cleaning devices around implants on the reduction of bleeding. A 30-day randomized clinical trial. Compend of Contin Educ in Dent 2013; 34 (Special Issue 8): 2–7.