Dental Implants: Oral Hygiene and Maintenance

Dentistry has become so exciting and challenging since predictability has been recognised for long-term dental implant and restoration success (Adell et al, 1981, Cox and Zarb, 1987, Albrektsson et al, 1981). As the number of patients selecting dental implants as a treatment option continues to grow, the dental team must accept the challenges of maintaining these sometimes complex restorations. The value of using conventional periodontal parameters to determine peri-implant health is not clearly evident in the literature (Orton et al, 1989). Therefore, it is paramount that the dental implant team understands the similarities and distinctions between the dental implant and the natural tooth. Subsequently, by examining the similarities and differences between a natural tooth and a dental implant, basic guidelines can be provided for maintaining the long-term health of the dental implant. Direct anchorage of alveolar bone to a dental implant body provides a foundation to support a prosthesis and transmits occlusal forces to the alveolar bone. This is the definition of osseointegration (Rateischak and Wolf, 1995). With the increased acceptance of dental implants as a viable treatment option for the restoration of a partially edentulous or edentulous mouth, the dental team is faced with maintaining and educating those patients. Recently, the focus of implant dentistry has changed from obtaining osseointegration, which is highly predictable, to the log-term maintenance health of the peri-implant hard and soft tissues. This can be achieved through appropriate professional care, patient cooperation, and effective home care (Meffert et al 1992). Patients must accept the responsibility for being cotherapists in maintenance therapy, so the dental team essentially must screen the potential implant patient. Diagnosis and treatment planning based on a risk-benefit analysis should be performed subsequent to a thorough medical, dental, headand-neck, psychological, tempromandibular disorder and radiographic examination (Meffert 1993). There is convincing evidence that bacterial plaque not only leads to gingivitis and periodontitis (Warrer et al, 1995), but also can induce the development of peri-implantitis (Lang and Karring, 1994). Thus, personal oral hygiene must begin at the time of dental implant placement and should be modified using various adjuctive aids for oral hygiene to effectively clean the altered morphology of the peri-implant region before, during, and after implant placement. For instance, interproximal brushes can penetrate up to 3mm into a gingival sulcus or pocket and may effectively clean the peri-implant sulcus (Balshi, 1986). In addition to mechanical plaque control, daily rinses using 0.1% chlorhexidine gluconate or Listerine (Ciancio et al, 1995) provide a welcome adjunct. Hygiene with dental implants is so tedious and critical to their long-term success that the patient and dental professional must exercise considerable effort. During the maintenance visit, Gregori Kurtzman, DDS, Private General Practice, Silver Spring, Maryland, USA.