Maintenance of dental implants

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Maintenance of Dental Implants

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Maintenance of dental implants

  1. 1. And Periodontal Maintenance Robert Cain, DDS
  2. 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. 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. 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. 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. 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. 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. 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. 9. Lack of periodontal ligament Circular gingival fibers around implants as opposed to perpendicular gingival fibers around teeth
  10. 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. 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. 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. 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. 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. 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. 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. 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. 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. 19. Clinical Examination radiographic examination current radiographs (based on diagnostic needs of the patient) radiograph number and frequency based on judgment of clinician
  20. 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. 21. Definition: Periodic evaluation of implants, surrounding tissue and oral hygiene, vital to the long-term success of the dental implant
  22. 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. 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. 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. 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. 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. 27. Periodontal Probes Plastic (Premier) Titanium (Salvin)
  28. 28. Ultrasonic scalers (Cavitron SoftTip)
  29. 29. Hand Instruments Plastic Scalers (Premier, Hu-Friedy)
  30. 30. Hand Instruments Titanium Scalers (A. Titan)
  31. 31. Polishing Fine Grit Prophy Paste Air abrasive with fine grit (Prophy Jet)
  32. 32. Questions?

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