Long-term implant care

Your implant is healed! Now what?

Once an implant has successfully integrated with bone, the false tooth (crown) or false teeth (crowns and bridges) may be fitted. But you will need long-term implant care. They are not like an air-to-air missile; Fire and forget! This article deals with all the issues we address with our patients to ensure they understand exactly what is required of them and of their regular dentist.

Introduction

The implant is supported by jaw bone and is surrounded by gum. Both these tissues will remain healthy in the future only if the patient maintains the necessary level of cleaning at home and their dentist or dental hygienist provides the appropriate standard of preventive dental care including professional cleaning, home care advice and regular assessment of the bone level by taking dental X-rays. This article is really a thorough “Patient Guide” to ensure all our implant patients, and prospective implant patients understand what is required in order to enjoy the successful outcome of their implant treatment for many years to come.

OUR PATIENT GUIDE

The patient will make all the difference

The principal contribution a patient will make towards the long-term success of implant treatment is to maintain the implant surface and the attached crown or abutment surface as free of plaque (also known as biofilm) as possible. Hence it is the effectiveness of cleaning which will be the most important factor in determining the future success or failure of implant treatment. This is not just a commitment to daily brushing but also a commitment to detailed cleaning in specific ways as demonstrated to the patient by our dental hygienist, Sharon Everett and the patient’s dentist or hygienist in the future.

Every patient is different; their anatomy and the size of the spaces between teeth varies from tooth to tooth and from person to person and so particular cleaning routines will be developed with each patient by Sharon and this patient-specific system should be followed exactly to ensure a meticulous standard of plaque control is achieved.

Our Support

In order to help all our implant patients, we now arrange a FREE appointment with Sharon, our hygienist, for her to demonstrate what should be done and the dental cleaning aids that are most appropriate to each individual patient’s situation. This routine will be designed specifically for each individual implant site to follow daily in the future.

To support patients in their home cleaning, they should also receive professional cleaning of their implant and natural teeth periodically to ensure that no accumulations of plaque are allowed to gather and no deposits of calculus (tartar) build up and thereby contribute to the establishment of gum inflammation and hence the development of bone destruction, known as Peri-implantitis, a form of gum disease that can occur around dental implants.

What is Peri-implantitis?

Bone destruction around an implant is known as “Peri-implantitis” and is really no different to what you may know as gum disease. The same disease exists around natural teeth in susceptible patients and is then known as “Periodontitis”. Both conditions are caused by the inflammatory destruction of the bone surrounding the implant or a tooth.

The first sign of Peri-implantitis will be a mild redness to the gum margin around the implant, possibly accompanied by a little bleeding after thorough brushing or flossing. This is known as “Peri-implant mucositis” and is the equivalent to Gingivitis around a natural tooth. This is the first stage in the disease process and shows that there has been an accumulation of plaque (know also as biofilm) at the site where bacteria produce toxic chemical waste products that cause the adjacent gum to become inflamed. At this initial stage of the disease process, no bone has been destroyed and therefore the condition IS REVERSIBLE.

After a short time with continuous inflammation present, the nature of the inflammation changes from a protective inflammation directed against the bacteria and their waste products to a destructive inflammation that results in the breakdown of the bone supporting the tooth or implant. If no treatment is provided this will become progressively more severe and infection will occur with further bone destruction taking place. This is then known as Peri-implantitis. This IS NOT REVERSIBLE.

Self-monitoring of implants

When patients clean around teeth and implant(s), they should check for any bleeding, or any appearance of redness that may suggest inflammation is present. Other signs of problems would include tenderness of the gum, darkening of the gum margin, and discharge of any fluid from the gum margin when applying gentle pressure on the gum with a finger. Any of these signs must be reported to the dentist urgently as they may indicate the beginning of Peri-implantitis.

Some Statistics on oral hygiene and smoking

If patients fail to maintain the necessary standard of cleaning they are 14 times more likely of developing Peri-implantitis involving bone loss around implants than a patient who cleans well. If, in addition to failing to maintain adequate cleaning, a patient smokes, then the risk factor jumps to 3-4 times that of a non-smoker; in other words, to a staggering 42 times that of a normal non-smoker with good cleaning. The message is clear, it is strongly advised that patients with implants should not smoke and should maintain the best cleaning possible.

Responsibility

It has to be remembered, once we have completed our surgical placement of the implant and careful management of the surrounding soft tissues, it is the patient who has the long-term task of maintaining the environment of the teeth and implant so that they can enjoy the long-term benefits of implant treatment. It is advised that in addition to home care and their own daily cleaning, patients with implants should attend for 3-4 cleans a year with a dental hygienist.

We are always here to help our patients

Remember, in addition to the patient’s own regular dentist and hygienist, we are always here to offer help and advice concerning the implants we have placed, if asked. Routine prevention is better than treatment or cure for any problem. Infection will detract from the appearance we have achieved. Also, any infection in the gum will increase the risk of bone loss around the implant, infection in the bone around the implant and failure of the implant.

Arrange a Preventive Appointment with Sharon

All our implant patients are strongly encouraged to make their FREE 30 minute appointment with Sharon Everett on any Tuesday or Thursday to initiate a future implant care plan. By getting her help and advice right from the start, patients can make arrangements for the maintenance of their implant so that they may enjoy a trouble-free future and realise the benefits that dental implant therapy can offer.

All patients still need routine dental check-ups

The remainder of the teeth still need routine dental checks and care that the regular dentist can offer for the long-term maintenance of other natural teeth. It is important that everyone attend every year for routine dental examination and annual or biennial X-rays, depending on the patients age or decay risk group, to check for dental decay between teeth and to look for signs of bone loss from gum disease around both natural teeth and implants.

We now advise that an additional X-ray should be taken every 12 months by the regular dentist of the implant(s) to keep a close watch on the bone level around the implant threads. This will then act as an early warning system for any bone loss and if such bone loss is detected, corrective treatment can be initiated to ensure continued bone loss is avoided.

A dental check up also allows screening for general health, gum disease and oral cancer. All these are sound reasons why everyone, both young and old, should have regular dental checks throughout life.

The first X-ray of the implant

One month after the implant is loaded (has a crown or denture placed on top), a dental X-ray should be taken by the regular dentist to provide a baseline view of the bone at the start of the implant’s life. It is this film that will be the yardstick against which future bone levels are compared. We ask that our implant patients request that these films are sent to us by email by their regular dentist for our records.

Recent research findings show

Patients who have received implant therapy in the past have been recalled for examination in a number of international studies. The results are now showing that unless implant patients are given regular dental care including professional cleaning and oral hygiene advice, the bone levels around implants reduce with time.

The degree of bone loss in those patients who fail to get the professional support they need is disturbing. The results do vary between studies but even so, the findings are that between 50 and 90% of implants are found to have inflammation around the adjacent gum. Furthermore, between 15 and 43% of all implants were found to have suffered from bone loss with continued inflammation present.

If you have invested in or are planning to invest in advanced and complex treatment

A patient’s investment in advanced and complex implant treatment requires future maintenance and servicing just as if they had bought a complex piece of equipment, like a new car. Periodic servicing will ensure they get the best out of their investment. Long-term success is what we all want and with the correct approach and care, it will be achieved.

Contact the friendly team at NQ Surgical Dentistry today on (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 4812