Hygiene maintenance in implant patients

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Wisdom’s Lorraine Pretty outlines the important of oral hygiene maintenance to dental implant patients

It is essential that dental professionals work with patients undergoing implant therapy to form a comprehensive oral hygiene maintenance plan for the long-term success of treatment. Regardless of whether a patient is partially or completely edentulous, their decision to seek implants and dedicate the associated time and finance, is hopefully an indicator that they will commit to maintaining their oral hygiene. It is for the dental team to support that patient and provide the necessary education and tools to achieve the common objective.

Dental implants have truly revolutionised the field of cosmetic dentistry over the last few decades and given a new lease of life to many patients who have struggled with tooth loss and removable prostheses. Patients who opt for implants are amazed at how natural their new teeth look and how they can once again resume their normal lives in terms of eating, speaking and self-esteem. However, to maintain these benefits and ensure long term, or even life-long success, it is essential that the patient understands their role with regards to on-going maintenance.

Educating the patient
A patient with one or multiple implants needs to realise that they have invested in their oral health. Even before deciding on implant therapy, the patient should be made aware of the commitment required to make treatment a viable option for them. In fact, the success of the treatment can be directly impacted by the patient’s oral health behaviours, which they need to understand. They should also comprehend that although the implant has solved a problem at that point in time, it is not the end of the issue. Implants can fail and there is always the slight possibility that it might not be repairable or replaceable. The need for thorough home care cleaning and regular professional visits should be reaffirmed at every possible opportunity − as well as the need to abstain from smoking if this is relevant to the patient in question.

The risk of peri-implantitis is another aspect that should be discussed with the patient in understandable terms, ensuring they appreciate their daily responsibility in maintaining an effective homecare routine. It has been suggested that between 12-22% of implant patients experience peri-implantitis, with many more (up to 48% [1]) experiencing it in the milder form of mucositis [2]. Patients who are at particularly high risk, such as those with pre-existing chronic periodontitis, should be identified and monitored closely before and after surgery – some studies have demonstrated that pre-existing infection can act as pools for periopathogens, which can then spread to implants [3-4]. Others who are classed as at high risk include smokers and those with poor control of their diabetes [5].

All this will not only help protect the implant from failure, but also protect the profession from potential complaints or litigation in the future.

Tools and techniques
As part of the home care regime, guidance and practical demonstrations should be provided for every device and technique suggested. Before advising on an adjunctive aid, one must ensure that it is suitable for use around implants to avoid causing any unnecessary damage. There is a large market for these products now, with a wide choice and varying benefits. Soft toothbrushes, both manual and electric, interdental brushes, end tuft brushes, floss or dental tape designed specifically for use with implants comprise the usual “armoury” for home care maintenance.

Many patients find that interdental brushes are more user-friendly than floss or dental tape. If dexterity is an issue, floss can be cumbersome, ineffective and de-motivational for the patient. In contrast, when the correct size and shape interdental brush is used, there is proof that they are a highly effective tool for reducing interproximal plaque [6]. Wire-free Wisdom Clean Between Interdental Brushes also ensure reduced risk of damage while cleaning around implants compared to wire brushes, and are clinically proven to help reduce gingival disease [7-8]. Featuring a flexible, tapered design with micro-fine rubber filaments, they slide easily between the teeth, are gentle on the gums and available in three sizes to suit every space.

Implant therapy is now very much a part of mainstream dental treatment and is an everyday occurrence in most dental practices. New and improved adjunctive products, designed specifically to make implant maintenance easier for the patient, are emerging on the market all the time. It’s important that you and your team remain abreast of these new solutions and the clinical studies supporting their safety and effectiveness. In doing so, you can have the utmost confidence that you’re recommending the right products to the right patients, and giving their implant treatment the very best chance for success.

Author


Lorraine Pretty has been working at Wisdom for 16 years, originally looking after Private Label. In 2006 she began working on the development of the new range of interdental products, after recognising the need for innovative products that would make interdental care easier. She is now the Marketing Manager for Private Label and Interdentals and is responsible for a wide range of interdental products – many of which are specifically designed for the professional sector.
To find out more, visit www.wisdom-toothbrushes.com or call 01440 714800.

References
[1] Roos-Jansa˚ker AM, Lindahl C, Renvert H, Renvert S. Nine- to fourteen-year follow-up of implant treatment. Part II: Presence of peri-implant lesions. J Clin Periodontol 2006;33:290-295.
[2] Mir-Mari J, Mir-Orfila P, Figueiredo R, Valmasade-Castellon E, Gay-Escoda C. Prevalence of peri-implant diseases. A cross-sectional study based on private practice environment. J Clin Periodontol. 2012 May;39(5):490-4. doi: 10.1111/j.1600-051X.2012.01872.x.
[3] Ong CTT, Ivanovski S, Needleman IG, Retzepi M, Moles DR, Tonetti MS, et al. Systematic review of implant outcomes in treated periodontitis subjects. J Clin Periodontol. 2008;35(5):438-62.
[4] Papaioannou W, Quirynen M, Van Steenberghe D. The influence of periodontitis on the subgingival flora around implants in partially edentulous patients. Clin Oral Implants Res. 1996;7(4):405-9.
[5] Lang NP, Berglundh T; Working Group 4 of the Seventh European Workshop on Periodontology. Periimplant diseases: where are we now? – Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol. 2011;38(11 Suppl):178-81.
[6] A Comparison of the Efficacy and Ease of Use of Dental Floss and Interproximal Brushes in a Randomised Split Mouth Trial Incorporating an Assessment of Subgingival Plaque. Noorlin I, Watts TL. Oral Health Prev Dent 2007; 5: 13-18.
[7] Yost et el, Interproximal gingivitis and plaque reduction by four interdental products. J Clin Dent. 2006;17(3):79-83.
[8] Prof. Dr. Petra Ratka-Krüger et al, Clinical trial of a metal-free interdental brush. University Medical Centre Freiburg, Germany. Pub Nov 2010.