Dental implants are gaining more and more popularity among patients and dental providers. Many implants are being placed everyday in USA and in the world. The represent a tool in the hands of the dentist that can solve many problems when the natural dentition in failing or classic treatment does not provide long term expectations. Even though dental implants do not suffer from the same pathologies as teeth, they are prone to suffer from the so-called peri-implantitis.

This inflammatory and infectious process determines problems of bone resorption and gum inflammation around the implant, that can eventually lead to implant loss. The most important step to avoid peri-implantitis is to prevent it by correct professional and patient oral hygiene. This article reports the most important questions and answers on implant maintenance extracted and adapted from a book chapter “Patient’s plaque control around implants (Clinical Cases in Implant Dentistry Wyley Blackwell. Edited by Karimbux N. DMD, MMSc, Weber HP. DrMedDent. 2017)“ by the same author.

Should implants be cleaned similarly as natural teeth?
Studies demonstrated that an effective and accurate oral hygiene technique prevents an increase in the severity of gingival inflammation if performed at least once every 24 hours. Nonetheless it appears that often patients have not been taught accurate plaque removal techniques and some have difficulties with manual dexterity. It is usually recommended that a patient with implants perform oral hygiene based on their individual needs between 1-2 times a-day. Devices that are effective in removing plaque from a crown on a natural tooth will be also effective in removing plaque on an implant crown.

However, there are differences found in the shape of implant crowns when compared with a natural tooth. Thus, although plaque control techniques for dental implant supported restorations are generally similar to traditional oral hygiene procedures on natural teeth, modifications are dependent on the crown design.

Is there a contraindication to using toothpaste when cleaning implants?
The agents contained in these pastes are multiple and they offer different functions (i.e. detergents, abrasives, polishing agents, binders, humectants, water, flavoring, coloring agents, active ingredients such as fluoride, anti-plaque, anti-calculus, desensitizing). It has been noted that the abrasives in the dentifrice mainly cause hard tissue damage when proper brushing technique is not practiced. However, there has been no evidence suggesting contraindication of toothpaste for patients with dental implant prosthesis.

What brushing technique(s) should be used?
Various studies demonstrated that different brushing techniques are almost similar in plaque removal efficacy. Cleaning the gums around the implant may be more challenging for the patient because the weaker nature of the implant gums compared to teeth. It is recommended a thorough instruction from the professional dental provider in order to customized the technique for every case and patient. The wrong technique may create damage and problems on the implant. Some studies have suggested that electric toothbrushes might be more better than the manual brushes, however the most important factor is the technique used not whether the brush is powered with a battery or by hand.

What is the optimum stiffness of the bristles of a toothbrush and why?
There are many different toothbrushes available in the market. Some have harder bristles some very soft. However, it is generally recommended to prescribe soft bristle toothbrushes to avoid damage of the gingival tissue around teeth and implants and to better access the areas around the implant gums. The shape of the toothbrush is not so important. The important step is how to use it in the right way.
What interproximal oral hygiene aids are available to remove the biofilm from implants?

The oral hygiene aids for proper plaque removal around implant-supported restorations are the same as those commonly used for natural teeth. Dental floss, interdental brushes and rubber tips can be used safely around dental implants, and just as with natural dentation, it should be customized on an individual basis. The patient’s manual dexterity, the design of the prosthesis, and the type of the prosthetic component must be taken into consideration when customizing interproximal hygiene techniques.

Dental floss: It is generally recommended to use floss around implant restorations for each individual unit, once or twice daily, doing plaque control techniques the same as for natural teeth. The number of times per day to use floss depends upon the patient’s susceptibility to peri-implant inflammation.

Super Floss®

Super Floss®: It is known that the use of regular dental floss can be extremely difficult when attempting to remove plaque deposits in implant supported Fixed Partial Dentures. The great advantage of Super Floss® stands in its stiff end that can be introduced between the crowns.

Interproximal brush: Also known as interdental or proxy brush is used as an effective device in plaque removal in the interproximal tooth surfaces. It is important to select the brush head of an appropriate size to fit into the interproximal area without creating damage to the soft tissue and to the root surface. In order to minimize the risk of hard tissue abrasion it is also advised to avoid the use of dentifrice with an interproximal brush. The brush should be replaced whenever the filaments appear to be deformed.

Toothbrush

Proxibrush

 

Despite the strong structure of dental implants, they should be respected and treated like a normal tooth. Even though patients are the responsible for everyday oral hygiene, implants should be evaluated regularly by a periodontist and dental hygienist to complement their cleaning.

-By Lorenzo Mordini DDS, MS

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