Quality Resource Guide –

Maintenance for Patients with Implant-Supported Dental Restorations

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Page 3

resulted in improvement of the clinical parameters

and a temporary reduction of the microﬂora

around dental implants with mucositis at 24 hours.

However, there were no signiﬁcant inter-group

differences after 8 months .

One study concluded

that peri-implant mucositis could be resolved with

professional cleaning in conjunction with either a

0.2% chlorhexidine mouth rinse or application of

1% chlorhexidine gel topical antimicrobial agent.

Others have suggested no additional benefit of

chlorhexidine in patients with good oral hygiene

though.

While chlorhexidine use during implant

maintenance may be of some value, further research

is needed to demonstrate its long-term effects.

The use of conventional dental floss and “water

flossing” was evaluated in a study with 28 patients

having implant-supported crowns. Bleeding levels

at baseline, 14 days and 30 days were assessed.

Despite the small study size, the authors concluded

that patients using the water ﬂosser had statistically

signiﬁcant less bleeding on probing than patients

using conventional dental ﬂoss.

office

implant

maintenance

using

polytetraﬂuoroethylene (PTFE, Teﬂon) curettes

as hand instrumentation or a glycine powder air

polishing system, was compared.

The authors

evaluated probing depths, bleeding on probing and

microbiological samples at baseline, 1 week, and 4

weeks. Outcomes were better when using glycine

status is not present at an evaluation.

Non-attendance to maintenance visits and tobacco

smoking are described as negative factors for dental

implant longevity. It has been shown that heavy

smokers have a higher (36.3%) frequency of peri-

implant diseases compared to non-smokers.

Advanced age is not a contraindication to dental

implant therapy; however, careful consideration

needs to be given to a patient’s manual dexterity

and ability to execute proper oral hygiene. Further,

bone levels, good general health and careful

evaluation of medications taken by elderly patients

are critical for successful dental implant therapy .

If a frequent maintenance protocol is followed for

aging populations, there is high implant and implant

prosthesis survival.

Bruxism, characterized by clenching and grinding,

is a parafunctional habit that is believed to affect

the survival of dental implants. That assumption

is based primarily on clinical experience and

anecdotal reports, rather than evidence.

47,48

Bruxism,

however, should not be ignored until further high

quality evidence clarifies the issue. At this time, a

maintenance program to follow-up on progression

of the habit and compliance in the use of occlusal

splints is recommended.

Patients should be

encouraged to inform the clinician if symptomatology

related to bruxism occurs, and proper adjustment

of the occlusal splint should be verified periodically.

powder air polishing. Other dental curettes (plastic

or metal) have raised concerns due to residual

plastic left behind, or damage to the implant surface.

Thus, they are not recommended.

Glycine powder

air polishing also has shown to be more effective

than manual debridement with concomitant local

chlorhexidine application in reduction of probing

depths and dental plaque at 6 months.

The use

of erbium-doped yttrium aluminum garnet (Er:Yag)

lasers also has shown promising results.

44,45

In summary, brushing with a regular or electric

toothbrush, use of a triclosan/fluoride-containing

dentifrice and water flossing for daily oral hygiene

appear to be effective in cleaning dental implants.

Use of a chlorhexidine rinse may provide additional,

short-term, benefits. Professional maintenance

with glycine powder air polishing and frequent/

consistent visits to the hygienist/dentist are shown to

be beneficial (

Table 1

)

Other Risk Factors to

Consider During Maintenance of

Implant-Supported Restorations

It is important to emphasize that outcomes of

professional and at-home maintenance care for

healthy adult patients with implant-supported

restorations may be different than for patients with

acute or chronic oral and systemic diseases, the

elderly, smokers or bruxers. Subsequent maintenance

intervals should be adjusted if appropriate oral health

Table 1 - Guidelines for professional and at-home maintenance of patients with implant-borne restorations

•

Patients with implant-borne restorations (fixed or removable) should be advised to visit the dentist every 6 months. However, maintenance

visits should occur more often if patient is categorized as higher risk (elderly, impaired ability of performing good oral hygiene, restorative

factors, or a history of periodontitis, bruxism, smoking).

•

Chlorhexidine gluconate may be used as an adjunct to professional maintenance and in some cases home maintenance.

•

Instruments such as glycine powder air polishing system are recommended for professional cleanings.

•

Prosthesis components should be replaced if compromised function is diagnosed at professional maintenance visits. Prosthesis contours

should be carefully checked to make sure that they are not impeding proper at-home maintenance or causing traumatic occlusion.

•

An occlusal device should be considered and is recommended for patients that show signs of clenching or grinding. This device should be

inspected and cleaned at every maintenance visit.

•

Patients should be advised to brush twice daily with toothpaste containing fluoride or triclosan/fluoride and use hygiene aids such as

dental floss, water floss, electric toothbrushes, or regular soft brushes. Dental cleaning solutions should be used for removable restorations

supported by dental implants.