Caring for your implants
Finished Treatment, What’s next?
Your smile, confidence, comfort and function will have been restored by implant treatment and for many patients this is life changing.
Caring for your implant thereafter is a collaborative endeavour. Regular visits to the hygienist and routine implant reviews are essential but so is daily oral hygiene. Even more so than for natural teeth.
If this collaborative approach is followed then you can expect an excellent long-term prognosis - for many patients a lifetime of treatment success.
The enemy is bacterial plaque just like for natural teeth. This is a creamy soft sticky covering.
Some patients have a degree of protection from gum disease whilst others are more susceptible to gum infection ( gingivitis and periodontitis). These patients need to be even more diligent in daily oral hygiene.
The hygiene team will help you identify an individual customised regime for cleaning around your implants, but there are some generic messages that are helpful:
The objective is to remove bacterial plaque from around the implants on a daily basis. Generally this can be achieved with dental floss or dental brushes in addition to routine oral hygiene measures like brushing and mouth washes.
The most effective way of cleaning individual implants is to use floss wrapped around the implant 360° floss.
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What is 360 degree flossing?
Implant hygiene is another area where good evidence is sparse and therefore, we must resort to following due process and common sense.
Hygiene around implants is largely about disturbing biofilm adhesion.
Fig.1 - 360 deg floss - wrapping the floss around the crown
We must respect the different physiology that we find in peri-implant tissues. Blood supply is poor and hemidesmosome attachment is weak. Peri-implant collagen fibres are circumferential, at best providing a cuff around crowns and abutments.
The aim here is to maintain healthy protective tissues above the rough implant surface to prevent / reduce bacterial and viral colonisation.
Although radiographs are limiting in that they only really show mesial and distal crestal bone levels they do help us visualise how deep the implant is in relation to the soft tissue cuff and the shape of the sub gingival contour that needs to be cleaned [See image left].
CBCT reviews are inappropriate due to the radiographic exposure and because the artefacts created around implants degrade the diagnostic value.
Fig.2 - TePe brushes have a place but watch out for a TePe shaped soft tissue defect in the aesthetic zone
The transition from oral mucosal level to implant is sometimes called a pocket - which it isn’t. Probing it is also complete nonsense as all we can hope to do is confirm where the implant is and do a lot of harm in the process.
So having armed ourselves with this understanding we teach patients to disturb this biofilm with whatever they can manage. Manual or electric brushing, micro brushes, floss, super floss, rubber points. There is a case for augmenting this process with simple antiseptics such as diluted bleach, bicarbonate of soda or peroxil.
Fig.3 - Cross the floss and gently pull so that it slips up into the narrower subgingival abutment or crown contour
One of the most effective techniques is 360 degree flossing.
Floss through the contacts with adjacent teeth or crowns and cross the ends over so that the floss wraps around the Implant crown.
As the ends of the floss are gently pulled, the floss will naturally slide to a narrower diameter and in so doing disturb the biomaterial adhesion.
Voila. I get patients to do this bi weekly and see amazing results.