Maintenance of Dental Implants

1. And Periodontal Maintenance
Robert Cain, DDS

2. Review components of Dental Implants
Review rational for Periodontal Maintenance
Review protocol for maintenance of Dental
Implants
Review instruments and techniques used for
Dental Implant maintenance

3. Implant or Fixture.
It is the intraosseous
component of the implant
May be either “screw type
(with thread)” or “press fit”
(smooth surface)
Usually made of either
commercially pure titanium
or a titanium alloy

4. May have one or more
various surface coatings
made of
hydroxyapatite, plasma
sprayed, or other
proprietary surface
“rougheners” all of
which are designed to
increase the microscopic
surface area of the
implant surface. Or in
some older types, they
may have a smooth
surface.

5. Implant or Fixture
There is an internal connection
to which the abutment
components are attached. The
connection may be external or
internal hex, spline, Morse
taper, press fit, etc. Usually
there is a threaded component
to which a screw attaches and
secures the connection
This portion of the implant is
usually not accessible in routine
maintenance, unless there has
been bone loss and gingival
recession or unless it is a
transmucosal implant design.

6. Abutment
It is the component of the implant
that attaches to the implant
connection either though a screw
retention, or press fit or a
combination of both.
It is usually the “transmucosal”
component of the implant system.
With crown restorations, it is the
portion that establishes the
emergence profile from the round
implant to the “tooth shape” of the
tooth
May be made of titanium, stainless
steel, zirconia, gold, etc.

7. Abutment
May be used to connect
crowns, RPD’s, FPD’s, bar
overdentures, Locator
attachments, etc.
Is usually the only part,
along with the
restoration, that the
hygienist will have access
to during routine
maintenance

8. Restoration
Is the functional
portion of the implant
system
May be either a
crown, FPD, RPD, attac
hment for a
denture, etc.
Should be maintained
as you would any
intraoral dental
device.

9. Lack of periodontal
ligament
Circular gingival
fibers around
implants as
opposed to
perpendicular
gingival fibers
around teeth

10. Definition
starts after completion of active periodontal
therapy
continues at varying intervals for the lifetime of the
dentition
performed by a dentist or dental hygienist under
the supervision of DDS
Periodontal Maintenance is the preferred term over
previously used terms supportive periodontal
therapy, periodontal recall or periodontal recare

11. Biologic Rationale
it is not possible to predict when or if progression
of periodontal disease will occur
periodontal maintenance allows for periodic
monitoring and professional plaque removal
personal plaque control alone, in periodontal
patients, has not been shown to control
attachment loss
some periodontal patients have progressive disease
despite the best efforts of patient and clinicians
periodontal maintenance allows for detection of
these particular patients

12. Biologic Rationale
studies have shown that patients who have had at
least periodic maintenance lost fewer
teeth, shallower PD, and less BOP than those that
did not have regular maintenance
data suggests that most patients with a history of
periodontal disease should be maintained at least
4X/year. Those that did had a decreased likelihood
of progressive disease than those that didn’t

13. Biologic Rationale
Periodontal maintenance procedures suppress
components of periodontal subgingival microflora
Periodontal pathogens may return to baseline
levels within days or months. Generally 9 – 12
weeks

14. Therapeutic Goals
to prevent or minimize recurrence of disease
progression in patients with periodontal disease
to prevent or reduce the incidence of tooth or
implant loss by periodic monitoring and care
to increase the probability of locating and treating
other conditions or disease found within the oral
cavity

15. Parameters of Care
Update and Review Medical and Dental History
Look for changes in systemic risk factors (i.e. diabetes,
smoking, medications related to xerostomia)
New restorations, missing teeth which may change
occlusal relationships

16. Clinical Examination
Extraoral examination
Intraoral examination
oral soft tissue evaluation
oral cancer evaluation
tooth mobility, fremitus, occlusion
caries
restorative factors (fracture or defective)
other factors (open contacts)

17. Clinical Examination
periodontal examination
probing depths
bleeding on probing
presence of plaque and calculus
furcation invasions
exudate and other signs and symptoms of disease
microbial testing if indicated
gingival recession
attachment levels

18. Clinical Examination
dental implant examination
probing depths
bleeding on probing
presence of plaque and calculus
prosthesis component evaluation
implant stability
occlusal evaluation
other signs and symptoms of disease

19. Clinical Examination
radiographic examination
current radiographs (based on diagnostic needs of the
patient)
radiograph number and frequency based on judgment
of clinician

20. Maintenance Treatment Procedures
removal of plaque and calculus
behavioral modifications
oral hygiene instructions
compliance to PM intervals
risk factor counseling
Scaling and root planning if indicated
Occlusal adjustment if indicated
Use of antimicrobial agents/irrigation
Use of root desensitizers if indicated
Surgery if indicated
Communication and Planning

21. Definition: Periodic evaluation of implants,
surrounding tissue and oral hygiene, vital to the
long-term success of the dental implant

22. Evaluation parameters
Presence of plaque or calculus
Clinical appearance of the peri-implant tissues
Radiographic appearance of implant structures
Radiographic signs of cement or subgingival calculus
Stability of prostheses and implants
Probing depths
Occlusal evaluation
Presence of bleeding or exudate
Patient comfort
Maintenance interval

23. Considerations for Dental Implant Maintenance
Titanium and HA-coated surfaces are frequently
scarred and pitted with metal or ultrasonic
instruments
Topical anti-microbials, manual or electric
toothbrushes, or polishing with a rubber cup with a
fine paste produce minimal surface alterations
Plastic instruments produce no significant surface
changes

24. Zirconia abutments
The newest type of abutment
and crown material being used
primarily in the esthetic zone
Zirconium oxide is harder (1200
Mpa fracture toughness) than
titanium or stainless steel
No current research on damage
to zirconia surface with SS or Ti
instruments except that
zirconia will abrade the
instruments and leave black
marks

25. Considerations for Dental Implant Maintenance
Metal instruments produce significant surface
changes
Titanium tipped instruments can produce more
surface changes than stainless steel
Air Abrasives produce similar changes to stainless
steel instruments, but allow more fibroblast
attachment

26. Treatment Recommendations
Use Plastic or Titanium Instruments
Plastic Ultrasonic Tips (judicious use of metal if
necessary)
Air-powder abrasives are OK if indicated
Polishing with a rubber cup with fine paste
Subgingival irrigation
Patient oral hygiene instructions

27. Periodontal Probes
Plastic (Premier)
Titanium (Salvin)

28. Ultrasonic scalers (Cavitron SoftTip)

29. Hand Instruments
Plastic Scalers (Premier, Hu-Friedy)

30. Hand Instruments
Titanium Scalers (A. Titan)

31. Polishing
Fine Grit Prophy Paste
Air abrasive with fine grit (Prophy Jet)

32. Questions?