maintenance of dental implants

Maintenance of Dental Implants

And Periodontal Maintenance

Robert Cain, DDS

Objectives

Review components of Dental ImplantsReview rational for Periodontal MaintenanceReview protocol for maintenance of Dental ImplantsReview instruments and techniques used for Dental Implant maintenance

Components of Dental Implants

Implant or Fixture.It is the intraosseous component of the implantMay be either “screw type (with thread)” or “press fit” (smooth surface)Usually made of either commercially pure titanium or a titanium alloy


May have one or more various surface coatings made of hydroxyapatite, plasma sprayed, or other proprietary surface “rougheners” all of which are designed to increase the microscopic surface area of the implant surface. Or in some older types, they may have a smooth surface.

Implant or FixtureThere is an internal connection to which the abutment components are attached. The connection may be external or internal hex, spline, Morse taper, press fit, etc. Usually there is a threaded component to which a screw attaches and secures the connectionThis portion of the implant is usually not accessible in routine maintenance, unless there has been bone loss and gingival recession or unless it is a transmucosal implant design.


AbutmentIt is the component of the implant that attaches to the implant connection either though a screw retention, or press fit or a combination of both.It is usually the “transmucosal” component of the implant system.With crown restorations, it is the portion that establishes the emergence profile from the round implant to the “tooth shape” of the toothMay be made of titanium, stainless steel, zirconia, gold, etc.


AbutmentMay be used to connect crowns, RPD’s, FPD’s, bar overdentures, Locator attachments, etc.Is usually the only part, along with the restoration, that the hygienist will have access to during routine maintenance


RestorationIs the functional portion of the implant systemMay be either a crown, FPD, RPD, attachment for a denture, etc.Should be maintained as you would any intraoral dental device.

What makes Implants different than teeth?

Lack of periodontal ligamentCircular gingival fibers around implants as opposed to perpendicular gingival fibers around teeth

Periodontal Maintenance

Definitionstarts after completion of active periodontal therapycontinues at varying intervals for the lifetime of the dentitionperformed by a dentist or dental hygienist under the supervision of DDSPeriodontal Maintenance is the preferred term over previously used terms supportive periodontal therapy, periodontal recall or periodontal recare


Biologic Rationaleit is not possible to predict when or if progression of periodontal disease will occurperiodontal maintenance allows for periodic monitoring and professional plaque removalpersonal plaque control alone, in periodontal patients, has not been shown to control attachment losssome periodontal patients have progressive disease despite the best efforts of patient and cliniciansperiodontal maintenance allows for detection of these particular patients


Biologic Rationalestudies have shown that patients who have had at least periodic maintenance lost fewer teeth, shallower PD, and less BOP than those that did not have regular maintenancedata suggests that most patients with a history of periodontal disease should be maintained at least 4X/year. Those that did had a decreased likelihood of progressive disease than those that didn’t


Biologic RationalePeriodontal maintenance procedures suppress components of periodontal subgingival microfloraPeriodontal pathogens may return to baseline levels within days or months. Generally 9 – 12 weeks


Therapeutic Goalsto prevent or minimize recurrence of disease progression in patients with periodontal diseaseto prevent or reduce the incidence of tooth or implant loss by periodic monitoring and careto increase the probability of locating and treating other conditions or disease found within the oral cavity


Parameters of CareUpdate and Review Medical and Dental History

Look for changes in systemic risk factors (i.e. diabetes, smoking, medications related to xerostomia)New restorations, missing teeth which may change occlusal relationships


Clinical ExaminationExtraoral examinationIntraoral examination

oral soft tissue evaluationoral cancer evaluationtooth mobility, fremitus, occlusioncariesrestorative factors (fracture or defective)other factors (open contacts)


Clinical Examinationperiodontal examination

probing depthsbleeding on probingpresence of plaque and calculusfurcation invasionsexudate and other signs and symptoms of diseasemicrobial testing if indicatedgingival recessionattachment levels


Clinical Examinationdental implant examination

probing depthsbleeding on probingpresence of plaque and calculusprosthesis component evaluationimplant stabilityocclusal evaluationother signs and symptoms of disease

Periodontal Evaluation

Clinical Examinationradiographic examination

current radiographs (based on diagnostic needs of the patient)radiograph number and frequency based on judgment of clinician

Periodontal Evaluation

Maintenance Treatment Proceduresremoval of plaque and calculusbehavioral modifications

oral hygiene instructionscompliance to PM intervalsrisk factor counselingScaling and root planning if indicatedOcclusal adjustment if indicatedUse of antimicrobial agents/irrigationUse of root desensitizers if indicatedSurgery if indicated

Communication and Planning


Definition: Periodic evaluation of implants, surrounding tissue and oral hygiene, vital to the long-term success of the dental implant


Evaluation parametersPresence of plaque or calculusClinical appearance of the peri-implant tissuesRadiographic appearance of implant structuresRadiographic signs of cement or subgingival calculusStability of prostheses and implantsProbing depthsOcclusal evaluationPresence of bleeding or exudatePatient comfortMaintenance interval


Considerations for Dental Implant MaintenanceTitanium and HA-coated surfaces are frequently scarred and pitted with metal or ultrasonic instrumentsTopical anti-microbials, manual or electric toothbrushes, or polishing with a rubber cup with a fine paste produce minimal surface alterationsPlastic instruments produce no significant surface changes


Zirconia abutmentsThe newest type of abutment and crown material being used primarily in the esthetic zoneZirconium oxide is harder (1200 Mpa fracture toughness) than titanium or stainless steelNo current research on damage to zirconia surface with SS or Ti instruments except that zirconia will abrade the instruments and leave black marks


Considerations for Dental Implant MaintenanceMetal instruments produce significant surface changesTitanium tipped instruments can produce more surface changes than stainless steelAir Abrasives produce similar changes to stainless steel instruments, but allow more fibroblast attachment


Treatment RecommendationsUse Plastic or Titanium InstrumentsPlastic Ultrasonic Tips (judicious use of metal if necessary)Air-powder abrasives are OK if indicatedPolishing with a rubber cup with fine pasteSubgingival irrigationPatient oral hygiene instructions

Instrumentation for Dental Implants

Periodontal ProbesPlastic (Premier)Titanium (Salvin)


Ultrasonic scalers (Cavitron SoftTip)


Hand InstrumentsPlastic Scalers (Premier, Hu-Friedy)


Hand InstrumentsTitanium Scalers (A. Titan)


PolishingFine Grit Prophy PasteAir abrasive with fine grit (Prophy Jet)

Thank You for your attention and letting me speak to you today.

Questions?

maintenance of dental implants

Health & Medicine

periodontal patients

dental implant maintenance

implant surface

periodontal recall

periodontal recare

history of periodontal

implant connection

implant loss