possibly creating an ingress for periodontal pathogens which can induce a host inflammatory response and cause bone resorption. (Coli and Sennerby, 2019). The clinical utility of probing around dental implants to determine peri-implant health has been questioned. It has been reported that probing depths as great as 6-9 mm can be associated with osseointegrated and healthy dental implants. As a result, using periodontal probing depths as a clinical indicator for implant health or peri-implant disease should be avoided by the practitioner (Coli and Senerby, 2019). It follows from the previous discussion that personal home care and consistent professional maintenance are critical in the success and longevity of endosseous dental implants. This is true especially in an environment with adjacent natural teeth; if affected by periodontal disease, natural teeth could act as a
reservoir for pathogenic bacteria (i.e., gram-negative anaerobic rods) and seed the peri-implant sulcus (Wilson, 2020). The physical characteristics of the peri-implant soft tissues are the focus of all oral hygiene instruction. The literature is equivocal about whether the presence or absence of keratinized tissue has any effect on the ingress of pathogenic bacteria into the tissues around dental implants. The controversial issue is about the necessity of keratinized tissue and its role in the maintenance of long-term peri-implant tissue health (Berglund, et al., 2018). One argument suggests that keratinized tissue surrounding implants may facilitate a patient’s ability to perform home hygiene. Thus, intervention may be indicated when a patient has no keratinized tissue around an implant and experiences a pull from a frenum or chronic peri-implant mucositis. To date, this argument has not been resolved.
EVALUATION
Research has not yet clearly defined specific evaluation criteria for obtaining clinical data around dental implants that would allow proper monitoring and prediction of early possible failure of osseointegrated dental implants. Currently, mobility is the best indicator and/or predictor of implant failure. As opposed to natural teeth, dental implants exhibit minimal clinically detectable movement because of the absence of a periodontal ligament. Therefore, healthy implants should appear nonmobile, even in the presence of peri-implant bone loss, provided an adequate amount of supporting alveolar bone Bleeding There is controversy as to the accuracy and significance of bleeding upon probing around dental implants. Presently, the literature indicates that bleeding on probing is an indicator of peri-implant disease because it can occur before histologic signs of inflammation or concurrently with other signs of implant failure (e.g., bone loss). Some research has suggested that bleeding on probing is associated with peri-implant disease, but additional studies are needed to determine how Radiographic evaluation Radiographic interpretation is one of the most useful clinical parameters for evaluating the status of an endosseous dental implant. Classic reports of dental implants indicate that an average horizontal crestal bone loss of 1.0 to 1.5 mm during the first year following prosthetic rehabilitation. The development of new implant surface technology and advanced placement techniques minimize the occurrence of progressive bone loss (Hutto and Liberman, 2020). Thus, progressive bone loss that exceeds these averages around a dental implant may be indicative of an ailing or failing implant. In addition,
exists. Implants may also experience early or delayed failures. It is for this reason that the dental team must monitor and evaluate implants over time (Hutto and Liberman, 2020). When monitoring the health of the peri-implant soft tissues, the practitioner and hygienist should be cognizant of changes in soft tissue color, contour, and consistency. A fistulous tract could indicate a pathologic process or impending implant fracture. local factors contribute to peri-implantitis. The inflammation of Peri-implant mucositis can be more severe compared to gingivitis around natural teeth and can be more challenging to treat. Early recognition of the biofilm and its removal are critical to avoid the progression to peri-implant mucositis (Wang, et al., 2017). However, as previously mentioned, routine probing is not recommended. there should be no evidence of peri-implant radiolucency during radiographic evaluation because such a rarefaction usually indicates an active (or past) infection and/or failure of osseointegration. Currently, it is advisable to take radiographs at defined intervals to identify changes in the implant site. Periapical radiographs are effective for this purpose, but they have limited ability to evaluate the implant site circumferentially. When available and appropriate, three-dimensional imaging can be used to further evaluate the peri-implant area for pathology (Pocket Dentistry, 2020).
PROFESSIONAL CLEANING AND HOME CARE
Instruments made of metal, such as stainless steel, should be used only on natural teeth; dental providers should not use these instruments to probe or scale dental implants. The rationale for this well-documented and often-stated injunction is that dental and surgical instruments made from this alloy are so hard that they can scratch, contaminate, or cause a galvanic reaction at the implant-abutment interface (Rapley, Swan, Hallmon, & Mills, 1990). Ideally, dental providers should use manual periodontal scalers fabricated from implant-safe materials, such as plastic, Teflon, gold-plated metals, and even wood. The manufacturer discourages sharpening gold-plated curettes because the gold surface can be chipped or damaged, exposing the hard metal underneath. For example, stainless steel instruments are harder than the titanium alloy used to fabricate implants; thus, they may abrade the implant surface, stripping off treatments such as hydroxyapatite (HA), because the instrument’s hardness is
greater than that of the titanium alloy from which the implant is fabricated. Most dental instruments used to clean implants can cause damage to the implant surface. Effective cleaning methods include sonic and ultrasonic instrumentation with oscillating plastic tips and air polishing while plastic implant instruments cause the least damage to the implant surface but are the least effective means of debridement (Hatfield, 2021). Ultrasonic, piezoelectric, or sonic scaler tips may mar the implant’s surface, leading to microroughness and plaque accumulation. The stainless steel tip may also lead to gouging of the implant’s polished collar. Some clinicians, however, advocate use of a sonic instrument with a plastic sleeve over the tip for scaling dental implants; this approach provides effective cleaning with reduced potential for damage to the implant. Air powder polishing units may also damage the implant surface, and dental providers should avoid using these during hygiene appointments. Even the use of baking soda powder in
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