Implant maintenance – fundamental for preventing peri-implant disease

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Anna Nilvéus Olofsson, DDS Specialist Paediatric Dentistry Odont. Lic., Manager Odontology and Scientific Affairs, TePe

Dental implants have revolutionised dentistry; however, this is not without complications. Approximately 12 million implants are placed globally every year, meaning that there is a large population of patients at risk of developing peri-implant disease. To create optimal conditions for a long-lasting result, these patients need individualised maintenance care based on a thorough risk assessment.

Laying the foundation for implant success 

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It is important to keep in mind that implant treatment begins before the actual placement of the implant. Firstly, it needs to be decided whether rehabilitation with dental implants is the best treatment option for the individual. Secondly, it needs to be assured that supportive therapy is readily accessible. It is critical to inform the patient about the need for life-long maintenance and optimal self-performed plaque control, as well as potential risks. Thus the foundation for a successful treatment outcome is laid already at this stage.

The mere placing of implants poses a risk for disease development, due to the build-up of a biofilm at the implant surface, and peri-implant diseases are common. Peri-implant disease is a collective term for peri-implant mucositis, an inflammatory lesion that resides in the peri-implant mucosa, and peri-implantitis, a condition also involving the supporting bone. 

Individually tailored maintenance is crucial

The prevention of disease development or recurrence must be the primary goal of a maintenance programme. Such a programme needs to be individually tailored to the patient’s risk profiling, which should be re-evaluated over time. Poor oral hygiene and smoking are repeatedly mentioned as risk factors for the development of peri-implant disease. A history of periodontitis and on-going periodontitis are risk factors, although patients successfully treated for periodontitis who adhere to a periodontal maintenance programme are not automatically classified as risk patients. Other risk factors are submucosal residual cement, poorly controlled diabetes, and having more than three dental implants.

There is no consensus concerning the ideal interval between maintenance recall visits. The optimal interval differs with the patient’s risk profile and capability of self-performing oral hygiene in accordance with the recommendations. While education starts before placing the implant, coaching and education must be prevalent throughout the maintenance programme.

Assessment and treatment

During maintenance visits, it is important to assess the patient’s level of self-performed oral hygiene and search for signs of disease such as redness, swelling, and bleeding on gentle probing, which, according to sources, is the key parameter for diagnosing peri-implant mucositis. Detecting early signs of peri-implant disease is of considerable concern to avoid disease progression. Peri-implant mucositis is a reversible disease, but, left untreated, it can progress into peri-implantitis. The treatment of peri-implant mucositis involves mechanical debridement of the implant surface, reinforcement of optimal oral hygiene, and, antiseptic rinses as adjunctive therapy.

Control of the biofilm building up at the implant surfaces is significantly important for peri-implant health. Poor oral hygiene is considered a critical risk factor, whereas good plaque control is vital for success and predictability of peri-implant treatment. 

Guiding the patient to proper self-care 

To meet different oral hygiene needs, a broad spectrum of cleaning devices is available. Interdental brushes of adequate size or floss are recommended for the inter-implant area. For other sites, it is recommended to use a regular toothbrush in combination with speciality brushes according to the patient’s needs. It is the therapist’s responsibility to guide the patient to the most suitable devices, educate the patient on their usage, and ensure that the patient masters the technique for future health and success. It is then up to the patient to perform daily oral home care in accordance with the therapist’s instructions. 

Raising awareness of the patient’s responsibility regarding a positive outcome needs to be part of the patient education. In order to facilitate the patient in performing good plaque control, the prosthetic suprastructure must be designed to allow cleaning around the implants. 

Considering this, it is evident that the patient is strongly dependent on the therapist and a well-designed maintenance programme. In a population with peri-implant mucositis, research shows that those not enrolled in a maintenance programme have a high incidence of peri-implantitis. A well-designed maintenance programme, including patient education, is therefore a prerequisite for preventing disease development and progression.

Conclusion

The replacement of missing teeth with dental implants is a well-established and acknowledged treatment. Creating the very best conditions for the treatment is fundamental to preventing disease, and the long-term outcome depends on several factors, especially control of the biofilm. The patient relies on professional education, quality maintenance, and self-performed plaque control, which together pave the way for the long-lasting, ideally life-long, benefits of a successful implant rehabilitation.  

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