Maintenance of Dental Implants
Implant dentistry has become more and more prominent in our everyday practice as patients are keen to have implant-borne prostheses than a conventional bridge work or removable dentures. One of the most important factors for long term success of dental implants is the maintenance of healthy peri-implant tissues.
Hygienist are now seeing more of their patients with dental implant and this is only going to increase in the future as implant therapy become cheaper. The role of the hygienist has increased in many ways with regards to dental implants. It is important for a hygienist to be able to diagnose peri-implantitis and to be have the knowledge to treat simple to moderate peri-implantitis and to monitor the health of dental implants in the long term as part of the patients regular maintenance.
How do you know when an implant has problems?
It is essential to be methodical when monitoring the peri-implant tissues at review appointments to spot the early signs of peri-implantitis. The clinical markers that are used to assess the presence and severity of inflammation around the implant are:
- plaque and calculus accumulation;
- inflammation of the peri-implant tissues;
- increase in peri-implant probing depths;
- bleeding on probing;
- suppuration from the peri-implant pocket;
- implant mobility;
- radiographic changes.
When probing peri-implant tissues it is essential that a light force is used (0.25 Ncm) to avoid trauma to the tissues. There is a parallel attachment of the junctional epithelium around the implant surface, therefore there is less resistance when probing around the implant. This will result in deeper peri-implant probing depths compared to probing around natural teeth. Peri-implant probing depths of implants placed in sites excluding the aesthetic zone range between 2-4 mm under healthy conditions. In the aesthetic zone where the implant is usually placed deeper, the probing depths are greater than the normal range. It is important to note that most implant systems show evidence of a small amount of marginal bone loss within the first year of function. Smoking has been shown to be a risk factor to affect the long-term prognosis of dental implants therefore it is essential to assess the health of the peri-implant tissues regularly in smokers.