General care of dental implants
General care of dental implants
Bone remodelling around the head of the implant occurs following placement and restoration. After the adaptive phase, bone levels in stable patients enter a steady state where crestal bone loss of no more than 0.2 mm annually should be expected.121 If osseointegration is successful, implant loss is rare and, with effective personal and professional maintenance, most patients can hope to retain their implants for many years.
As with teeth in the natural dentition and control of periodontal diseases, effective self-performed oral hygiene and regular monitoring of the peri-implant tissues are key to the prevention of peri-implant disease. The complexity of the restoration and the presence of risk factors will influence the level of maintenance required.
Regular review and maintenance of implants enables the clinician to:
- prevent inflammation developing around an implant;
- identify any problems at an early stage, when treatment is more straightforward;
- provide support for the restorative aspects of the prosthesis;
- enhance the overall longevity of the implant and prosthesis.
Key recommendation
For patients with dental implants, provide implant-specific maintenance care to reduce the risk of peri-implant disease.
(Strong recommendation; low certainty evidence)
Current evidence suggests that provision of implant-specific maintenance care results in increased implant survival rates and is more effective at preventing peri-implant disease (primary prevention) compared to no maintenance care.117, 118 The certainty of the evidence is considered to be low due to the observational nature of most of the included studies. However, this guidance includes a strong recommendation in favour of the intervention because of the increased risk of peri-implant disease and implant loss if implant-specific maintenance care is not provided. In addition, regular monitoring of a patient’s oral health status, with treatment provided where required, is standard practice.
The Delivering Better Oral Health (DBOH) toolkit7 states that implants should be monitored regularly, with soft tissue health checked both visually and by probing. It suggests monitoring of plaque, inflammation, probing depths (compared to baseline measurements), checking for bleeding and the presence of pus, and removal of supra- and submucosal plaque and calculus from the implant surfaces and restoration. DBOH also suggests the recall interval for maintenance care should be based on the peri-implant and periodontal status of the patient. The EFP Prevention and treatment of peri-implant diseases guideline10 recommends that patients should be informed of the importance of effective home care and adhering to supportive peri-implant care to reduce the risk of peri-implant diseases. It also recommends that the dental team provides regular supportive peri-implant care. Glycaemic control, smoking cessation and oral hygiene interventions are also recommended, where appropriate.
As part of the ongoing care of implants, radiographs are used to monitor bone stability over time. A periapical radiograph aligned using the long cone paralleling technique should be taken at the time of superstructure connection. A further periapical radiograph, aligned using the long cone paralleling technique, should be taken at one year following this as a baseline for monitoring future changes in the bone level. Routine radiographic monitoring is not required unless there are clinical signs of infection and inflammation.
Further details on the development of the recommendations in this guidance can be found in Methodology.