Recall
Recall and ongoing maintenance care
If the primary care team is responsible for ongoing maintenance care of the implant and its restoration, a suitable recall interval should be established. This should be based on their initial findings (see Initial examination), any specific directions from the clinical team who placed the implant, and should take into account the needs and wishes of the patient.
Recall appointments should be scheduled at least annually for all patients with implants. However, those with specific risk factors, such as smoking, sub-optimally controlled diabetes, those with complex restorations which are hard to clean or those with additional needs may require to be seen more often. Patients with a history of periodontitis may be more susceptible to peri-implant disease and the recall interval for maintenance care should be scheduled to reflect this.
Implant-specific monitoring and maintenance should be carried out at each recall visit as detailed below:
Assess the level of oral hygiene around an implant supported restoration.
- Visually assess the soft tissue health and the presence or absence of inflammation around the implant.
Probe around the implant, and restoration if it is fixed, to determine:
- the presence of bleeding on probing and/or suppuration;
- the presence of excess residual cement;
- the presence of submucosal plaque and calculus deposits.
Note that topical or local anaesthetic can be used if probing around an implant is painful.
Measure and record peri-implant probing depths, at four to six sites around the implant where possible, using fixed landmarks, and compare to baseline measurements.
N.B. The BPE is not appropriate for the assessment of dental implants.
Review personal oral hygiene and, where necessary, provide personalised oral hygiene advice and instruction to assist and encourage the patient to improve their oral hygiene skills as well as their understanding of the value of good self-care routines (see Oral hygiene).
Encourage the use of implant-specific oral hygiene aids such as implant floss and interdental brushes.
Where applicable, give smoking cessation advice (see Smoking cessation).
Remove supramucosal and submucosal plaque and calculus deposits, where present, using an appropriate method. Remove submucosal excess residual cement, when possible, if this is detected. Use this opportunity to highlight to the patient areas where supramucosal deposits are detected.
- Supra- and submucosal deposits can be removed using conventional instruments. Additional training may be required.
When clinically indicated (e.g. where there is evidence of inflammation around the implant), perform radiographic examination of the implant to assess bone levels, using periapical radiographs taken using the long cone paralleling technique.
- Routine radiographic assessment of implants is not recommended.
Assess the patient’s risk for disease progression (see Risk assessment tool), based on their medical history, known risk factors, periodontal status (e.g. degree of residual periodontal pocketing, levels of inflammation, levels of previous disease) along with levels of plaque control, and use this to inform future recall intervals for maintenance care.