Supportive care and maintenance of dental implants
By Jenny Walker Dip DH, DT and Kathryn Mayo DipDH, FAETC
Dental implants have become the gold standard for restorations that look, feel, and function like natural teeth. However, while demand for implants continues to rise, there is growing evidence of the susceptibility of implant patients to peri-implant diseases, including peri-mucositis and peri-implantitis, which may result in implant failure.
Dental hygienists and therapists play an integral role in the early detection of implant diseases and the provision of individualised patient care in the maintenance protocol. Therefore, awareness of risk factors for peri-implant disease and early disease detection is essential for appropriate management.
A team approach to implant therapy, and education on the importance of supportive care for patients is paramount from the outset. This should include, but is not limited to, periodontal assessments, risk assessments and gaining patient consent, ensuring the patient is fully informed of the recommended post therapy supportive care commitment before embarking on their implant journey.
Research has shown that patients who receive supportive implant therapy are associated with a lower incidence of peri-implant disease. Patients without regular maintenance might exhibit a 4.25-fold increased risk for peri-implantitis and therefore supportive therapy should be considered essential.1 In maintenance therapy, collecting the necessary baseline data to refer back to is key to enabling the clinician to identify early signs of peri-implant disease. Biofilm-induced peri-implant mucositis is a reversible condition and a precursor to peri-implantitis, so it is crucial that peri-mucositis is detected as early as possible, in an effort to reverse it.
Implant maintenance includes professional mechanical plaque removal (PMPR) to remove dental plaque biofilm and plaque retentive factors on natural teeth and dental implants both supra and sub-gingivally/marginally. PMPR is an essential component for plaque control, particularly in patients with full-arch fixed implant supported prostheses.2
Air polishing (with low abrasive, soft powders) is a highly efficient method of disrupting biofilm around dental implants. It evokes the least surface alteration of any mode of instrumentation, providing a minimally invasive approach for access around and underneath implant prostheses and structures. It is an extremely simple, quick, and comfortable treatment that is very well accepted by patients and may also contribute to recall compliance.
Ultrasonic devices have certain applications for use around implants, particularly in peri-implantitis where the device may work well on implant threads. It should be noted that any ultrasonic utilising stainless steel tips will significantly alter the implant surface, therefore a ‘benefit versus harm’ approach should be adopted. Plaque retentive factors on implants are generally less tenacious than on natural teeth and when considering potential surface alteration, using on low power is recommended.
The NSK Varios Combi Pro is a device that combines ultrasonic scaling and powder therapy for highly effective implant maintenance. The Varios Combi Pro has detachable chambers and handpieces making it easy to switch between supragingival (enamel only) application to remove staining and subgingival application to disrupt biofilm below the gumline. In the case of implants only the sub-gingival chamber is used in conjunction with appropriate powder.
It is the role of the whole dental team to support patients throughout the implant journey, encouraging them to maintain optimal home biofilm control and long-term engagement with supportive care programmes. The team should also respond to changes in risk factors which may occur with increasing age and adapt their approach accordingly to ensure implant longevity. While retention of natural teeth should be prioritised, dental implants offer a solution for missing teeth which can significantly enhance a patient’s quality of life.
References
- Frisch E, Vach K, Ratka-Krueger P. Impact of supportive implant therapy on peri-implant diseases: A retrospective 7-year study. J Clin Periodontol 2020; 47:101–109.
- Yang J, Jia P, Yue Z et al. Microbiological and clinical evaluation of ultrasonic debridement with/without erythritol air polishing during supportive periodontal therapy in arches with full-arch fixed implant-supported prostheses: protocol for a randomised controlled trial. BMJ Open 2021; doi:10.1136/bmjopen-2021-053286.
