Implant care has been a challenge and with more cases being reported as either having peri-implant mucositis or peri-implantitis it becomes even more important to emphasize the need for a structured implant care protocol.
Summary for peri-implantitis:
- Primary etiology of peri-implantitis is bacteria with activation of host immune response.
- Plaque accumulation in the OR for peri-implantitis is 9.25.
- Peri-implantitis is not self-limiting.
- Patients with a history of periodontitis have a higher incidence of biological problems.
- Design of prosthesis is very important – limited access for proper oral hygiene leads to peri-implantitis. Especially, emergence angle of >30° and convex profile.
- 20% of patients who do not follow maintenance programs have peri-implantitis.
- Peri-implantitis is higher in patients without maintenance (43.9%) than with maintenance (18%). Bottom line maintenance reduces the incidence of peri-implantitis.
Peri-implantitis is common in patients with Poor Oral hygiene, History of Periodontitis, Poor Design of crown.
Solution: Meticulous Maintenance schedule.
Basic recommendations:
- Have baseline radiographic and probing measurement after completion of implant-supported prosthesis.
- Have 2 or more peri-implant maintenance program for implant patients. A minimum of every 5-6 months/year.
To-Do List - At each maintenance visit:
Radiographic review
If no inflammation is detected
a. Coronal polishing with rubber cup and low abrasive paste.
If inflammation is detected following may be required
a. Scaling and Root planing for removal of plaque and calculus.
b. Implant debridement.
If submucosal cement or over-contoured crown detected
a. Remove submucosal cement and
b. Recontour the crown contour for adequate oral hygiene.
Oral hygiene Aids that can be used:
| 1. Powered toothbrush | 2. Water flosser |
| 3. Airflow system | 4. Interdental brushes |
| 5. End tuft brush | 6. Stiff-end dental floss threaders 6a. Crisscross to wrap around the implant/tooth and moved back and forth. |
