Penam Periodontics - Evidence based Personalized Periodontics

Plaque Control and Implants.

The major risk factor for late implant loss is Poor Plaque Control and the resultant low grade infection around the implant – much like occurs in periodontal disease. Plaque control issues seem to occur in three basic ways:

  1. Poor oral hygiene by the patient:
  2. Having implant or implant components that prevent patient from cleaning of the implant; and
  3. Having implants attachment mechanisms which facilitate plaque accumulation between the implant and the tooth related implant components.

Calculate your risk.

Poor patient oral hygiene should be addressed prior to implant placement. If we see this issue we will try to improve the cleaning before we give the go ahead to having the surgery. Poor oral hygiene is associated with a 10-14 fold increase in late implant loss at 10 years and associated with higher bone loss rates around implants. The faster rates of bone loss occur in patients with poor oral hygiene and in subjects who are smokers or have periodontal disease.

Implant Component associated poor oral hygiene. For many years it has been known that placement of an ill fitted crown will result in inflammation and bone loss around natural teeth, especially in patients with periodontitis. This very same event occurs around implants. In a recent study it was found that implants with poorly cleanable implant crown components were 2 fold more likely to exhibit bone loss. The rate of bone loss over a 10 year period correlated with the presence of these uncleanable implant components. It is therefore very important that when your implant crowns or other attachments are placed that the dentist who places them makes sure that they are easily cleanable. If you can’t clean them: ask to be shown how to or alternatively ask the dentist to change to componentry to allow you to clean them.

Implant types which may allow greater plaque accumulation. Certain of the older implants have design issues that allow them to move slightly during use which allows bacterial plaque to get into small micro-crevices between the components. There is nothing the patient can do about this – it is a maintenance issue for the dentists who placed them. Our practice does not place these types of implants.

Maintenance and Oral Hygiene instruction.

At our maintenance visits we update the medical history and identify high risk situations and we examine the implant sites to assess: the amount of plaque, the amount of inflammation, whether there is bleeding or suppuration (pus) and the probing depth around the implant to give us a measure of the stability of the site. We will also assess the stability of the surrounding tissues and whether there is any hard gum tissue around the implant. Similarly we will assess if there is any mobility in the crown components and whether there is any excess bite force on the implant crowns. A small x-ray will be taken every couple of years to assess whether there is deterioration of the bone levels.

Home Care Oral Hygiene

It is imperative that patients understand their role and responsibility in maintaining their implants. We will initiate a home care oral hygiene program prior to placement of the implant. The home care program is not a great deal different from that we use for patients with periodontal disease. Home care devices and aids that we may recommend include: Tooth brushing, Interdental brushes, end-tuft brushes, and dental floss (There are two varieties with inbuilt brush-like sections). Home care instructions will be customized and vary with implant/component designs and their accessibility.

© Penam Investments Pty Ltd 2020.

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