As a dental professional, preventing complications is always key for successful treatment outcomes and patient satisfaction. Because of this, teaching your patients excellent oral hygiene techniques, and monitoring their hygiene at regular appointments is a priority. This is particularly important for patients who have gingivitis, periodontitis, or who are receiving dental implants.
With the popularity of dental implant treatment rapidly increasing,[i] it is more important than ever for clinicians to understand how to prevent complications from developing. Dental implants are often chosen as they provide a long-lasting solution for missing teeth, but they will need appropriate care and maintenance for successful osseointegration.i
Bacterial plaque and peri-implantitis
In a healthy mouth, plaque and soft tissues maintain a balance. However, changes during the disease process transform healthy dental plaque into a pathogenic biofilm.[ii] When bacterial plaque is allowed to build up, microbial homeostasis can break down. This change in the mouth means ecological stability is disrupted and, consequently, disease develops. Major ecological pressure alongside a low pH, sugar rich diet, as well as a low saliva flow create the perfect conditions for disease progression.[iii] An obvious symptom of oral disease is inflammation of the soft tissue in response to bacterial plaque. Gingival crevicular fluid is increased in response to the inflammation of the periodontal tissues – this leads to a rise in the local pH, which in turn allows bacteria to grow even more.ii
Bacterial plaque not only causes gingivitis and periodontitis, but can also lead to the development of peri-implantitis.[iv] As well as this, previous history of periodontitis, poor oral hygiene, and smoking are considered potential risk factors for peri-implantitis development.[v] Peri-implant diseases are common, with in between 28% and 56% patients developing peri-implantitis.[vi] So clinicians should be sure patients are aware of the need to remove plaque effectively, and look out for any signs of inflammation, gingival bleeding and pus, as well as pain, which may indicate peri-implantitis development.
The impact of the dental team and patient
Preventing peri-implantitis always needs to be a collaborative effort between the dental team and the patient. Ensure that your patient feels as if they are part of a project which aims to achieve lasting oral health and prevent infection.[vii] If they feel that a rigorous cleaning routine is achieving something, even if they cannot see immediate results, they will be more likely to keep it up.
Dental hygienists in particular are crucial in the prevention of diseases like peri-implantitis – promoting and improving the oral health of individuals, families, and groups in society. Mechanical debridement and oral hygiene instruction provided by dental hygienists are crucial in the treatment of peri-implant diseases, however, clinicians should also see whether the implant retained crown or prosthetic allows sufficient access for optimal at-home hygiene. Follow up appointments for patients with dental implants are vital for monitoring oral hygiene and peri-implant diseases.vii
So, while the dental team plays a key role in the guidance of implant stability after osseointegration, the proper maintenance of the peri-implant soft tissue, and therefore the prevention of peri-implantitis is predominantly in the hands of the patient.[viii]
It may be useful to place affected patients on a supportive therapy programme to aid their implant placement recovery and schedule regular dental appointments for the professional removal of biofilm deposits from implant sites.viii And, prevention is often simpler than treatment, so maintained support should begin from the time of dental implant placement, and should be long lasting. For many patients, it may be helpful to recommend tools for use in conjunction with their brushing and interdental cleaning, such as interproximal brushes, and oral rinses containing chlorhexidine for enhanced cleaning.iv
Targeted prevention
To elevate patients’ oral hygiene routines, particularly when recovering from dental implant placement, recommend they use the Curasept ADS Implant Pro Oral Rinse – available from J&S Davis. Its anti-bacterial, anti-inflammatory and anti-plaque formula contains 0.2% chlorhexidine and is effective at protecting implants from the build-up of plaque. It boasts of the patented Anti Discolouration System – to dramatically reduce the risk of staining. The Curasept ADS Implant Pro Oral Rinse also contains sodium DNA and hyaluronic acid for the prolonged balance of tissue fluids and to support healing and tissue repair.
Post dental implant placement, it’s crucial to ensure the proper preventative methods are in place for successful integration and to minimise the risk of developing peri-implantitis. The dental team have an important role to play, preventing infection by educating the patient on proper oral hygiene while monitoring signs of peri-implantitis. However, the patient must maintain high standards of oral hygiene at home for successful outcomes. Ensure your patients are effectively removing plaque from their mouths, especially around the implant site. An oral rinse is a fantastic addition to your patients’ oral hygiene routines, providing an extra layer of protection from peri-implantitis development.
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[i] Rehman, Ilyaas, Fatima Elmahgoub, and Christine Goodall. “Evaluation of the information provided by UK dental practice websites regarding complications of dental implants.” British Dental Journal 230.12 (2021): 831-834. https://eprints.gla.ac.uk/245048/2/245048.pdf
[ii] Seneviratne, Chaminda Jayampath, Cheng Fei Zhang, and Lakshman Perera Samaranayake. “Dental plaque biofilm in oral health and disease.” Chinese Journal of Dental Research 14.2 (2011): 87. http://www.quintpub.com/userhome/cjdr/cjdr_2011_02_s0087.pdf
[iii] Marsh, Philip D. “Dental plaque as a biofilm and a microbial community–implications for health and disease.” BMC Oral health. Vol. 6. No. 1. BioMed Central, 2006. https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-6-S1-S14
[iv] Kurtzman, Gregori, and L. H. Silverstein. “Dental implants: oral hygiene and maintenance.” Implant Dent Today 1.3 (2007): 48-53. http://www.centrefordentalimplant.com/wp-content/uploads/2011/11/Dr.-Gregori-M.-Kurtzman.pdf
[v] Pranskunas, Mindaugas, et al. “Influence of peri-implant soft tissue condition and plaque accumulation on peri-implantitis: a systematic review.” Journal of oral & maxillofacial research 7.3 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100642/pdf/jomr-07-e2.pdf
[vi] Lindhe, Jan, Joerg Meyle, and Group D of the European Workshop on Periodontology. “Peri‐implant diseases: consensus report of the sixth European workshop on periodontology.” Journal of clinical periodontology 35 (2008): 282-285.
https://biblio.ugent.be/publication/515604/file/516754.pdf
[vii] Caporaso, Lucia, et al. “The Importance of The Dental Hygienist in Implantology: A Narrative Review.” Journal of Multidisciplinary Applied Natural Science 2.1 (2022): 19-22. https://pandawainstitute.com/journal/index.php/jmans/article/download/94/62
[viii] Pranskunas, Mindaugas, et al. “Influence of peri-implant soft tissue condition and plaque accumulation on peri-implantitis: a systematic review.” Journal of oral & maxillofacial research 7.3 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100642/pdf/jomr-07-e2.pdf
