IMPLANT MANAGEMENT
Implant therapy has become standard in today’s dentistry. Unfortunately, not all offices are aware of the implant maintenance necessary to keep these implants in the mouth and healthy. Studies have shown that 4 out of 10 patients who received implants suffer from complications within a nine-year period.
So, what needs to be done to have continued success in our implant therapies? Proper maintenance. This includes detailed instructions on home care, identification of peri-implant mucositis, and periimplantitis, and how to deal with these complications.
Peri-implant mucositis is inflammation of the soft tissue. This can be caused by poor oral hygiene, poor restorative margins, subgingival plaque and/ or calculus or residual cement. It can also be a result of placing the implant in an area of inadequate keratinized tissue. If left untreated, this can lead to periimplantitis which involves bone loss, thread exposure and exudate. This is often a result of a change in the implant biofilm, titanium destabilization of the implant surface or even a history of previous periodontitis. Once this begins, it is very difficult to stop the process and have a good long-term prognosis for implant stability.
Once diagnosed, several therapies can be provided.
1. Traditional therapy was to debride the site with titanium instruments. Flushing the site with chlorhexidine and the use of oral antibiotics. Even with this therapy, most implants required further surgical intervention.
2. Surgical intervention included flap reflection, debridement, cement removal, recontouring of the implant surface, osseous recontouring or osseous regeneration. Some therapists also used chlorhexidine rinses, citric acid, hydrogen peroxide and fluorides to treat the implant site. Unfortunately, no chemotherapeutic has been found to be superior to normal saline. In fact, chlorhexidine can have cytotoxic effects on the healing of the tissues. So, LESS therapy is actually MORE for treating periimplantitis.
3. Current guidelines include regular 3-month maintenance, diagnosis, removal of prostheses on a regular basis for proper cleansing, and radiographic monitoring.
4. If therapy is needed, then it should be specific to the problem. If the problem is soft tissue, do you need additional keratinized tissue (soft tissue grafting) around the implant? If bone loss is present, do you need to open the tissues, clean the site and regenerate (bone grafting). Do you need to check the occlusion and the margins of the restorations?
5. Maintenance should include the use of electric toothbrushes, waterjets, antimicrobial varnishes, the cleansing of the fixed and removable prostheses and the replacement of screws for screw retained fixtures.
Even with these preventions, implant failure can still occur. Closer maintenance will increase the life span of implants and hopefully they will become forever prostheses.
Best wishes for a happy and healthy New year!
Dr. Nancy A. Barnett and staff