Without adequate care before and after an implant has been placed, patients risk the treatment failing. Months of care and expense could be put to waste. A failed implant treatment can also be extremely distressing for both patient and clinician.[i]
The most frequent yet avoidable factor for implant failure is infection, and it can set in at any time throughout the implant’s life.[ii] Commonly, issues arise as a result of inflammatory conditions that can affect the bone and soft-tissue surrounding the implant, degrading its stability. The two most prevalent infections are peri-implant mucositis and peri-implantitis; the former displays inflamed soft tissue and can be controlled, but it is assumed to develop into the latter leading to irreversible bone loss.[iii], [iv]
Patients should be aware of poor habits that may increase the prevalence of infection, and it is a clinician’s responsibility to advise cessation. In turn, encouragement should be provided to build new habits that are tailored to life with a dental implant.
Tobacco use
Smoking tobacco has been known to adversely affect the dentition for some time, yet 13% of the UK population has kept up the habit until as recently as 2021.[v] For implant stability we need to look past teeth staining and assess tobacco’s larger risks. Smokers are more susceptible to peri-implant bone loss and have a higher rate of implant failure.[vi] Simply recognising that a patient carries this habit could forecast eventual bone loss, and unsuccessful treatment as a result.vi
This is not to say that a smoking habit dooms an implant to failure immediately, in fact a variety of studies commonly report survival rates ranging from 80 to 96% – however, this is commonly significantly lower than the rate for non-smokers.[vii]
To maximise the success of an implant, patients should cease smoking for a period before and after the implant placement. At a minimum, stopping smoking a week before and for two months after the treatment could allow the body time to facilitate osseointegration with minimal risk of infection.[viii] As peri-implantitis can occur years after an implant has been placed, the absolute cessation of the habit is ideal to provide the greatest chance at long-term success.
Poor oral hygiene
While smoking can be a difficult habit to break, your patients may need to build a new one – an effective oral hygiene routine to specifically protect an implant. Plaque control is a critical factor for the maintenance of an implant, as it is for natural teeth.[ix]
It’s common knowledge, even amongst patients, that proper maintenance that clears harmful plaque can diminish the impact of periodontal diseases. However, it is fundamental to differentiate periodontitis, the most extreme form of gum disease, and peri-implantitis. The former contributes to generalised bone loss in the oral cavity, whereas peri-implantitis is site-specific.[x] An accumulation of harmful biofilm can cause both, and patients may have either one of the issues, or the two can co-exist. There is evidence to suggest that patients with periodontitis or a history of the disease have an increased risk of developing peri-implantitis.[xi]
Patients could prevent or treat peri-implantitis as a site-specific issue with a dedicated gel to minimise inflammation and target pathogens. Similarly, patient administered plaque control with an interdental brush allows for targeted care that can reduce inflammation in peri-implant soft tissue.xi
From the get go
We know that the soft tissues around a dental implant can be susceptible to infection at any time, but protection of the surgical site is likely to require unique care early on.[xii] The wound will likely be extremely delicate, and sutures should not be tampered with to maximise a healthy recovery.
NHS guidance recommends that patients do not brush this site for a week following treatment, and instead use a chlorhexidine mouthwash twice a day to reduce plaque build-up.[xiii] Aggravating the implant site using an ordinary toothbrush could disturb a clot[xiv] and create the opportunity for infection.
Throughout the treatment and recovery process, members of the dental team should regularly monitor patients to ensure that their dental implant is healing well. It also creates the opportunity to ensure bad habits, such as smoking and aggressive brushing, have been cut back, and instead replaced with brilliant routines tailored to implant care.
Clinicians could also aid their patient’s journey to recovery by providing products that are trusted to make a difference, especially in the early days of recovery. The Curaprox Implant Kit provides exactly this. In the set, patients can find a range of powerful Perio Plus+ products that utilise chlorhexidine and all-natural Citrox® to target pathogens. This includes the Regenerate Mouthwash, for comprehensive care after surgery, and the Focus Gel for localised care. Three specialised tooth brushes with ultra-fine filaments are included for gentle care after healing, amidst so many more items dedicated to implant care.
Patients should have implants that will last them many years, but if infection strikes, failure could come about sooner than they realise. With the right habits in place, and the support of the dental team, they could have a brilliant smile that stays for a very, very long time.
For more information, please visit www.curaprox.co.uk
[i] Ireland, R. S., Palmer, N. O., Lindenmeyer, A., & Mills, N. (2012). An investigation of antibiotic prophylaxis in implant practice in the UK. British dental journal, 213(8), E14-E14.
[ii] Kochar, S. P., Reche, A., & Paul, P. (2022). The etiology and management of dental implant failure: a review. Cureus, 14(10).
[iii] Schwarz, F., Derks, J., Monje, A., & Wang, H. L. (2018). Peri‐implantitis. Journal of clinical periodontology, 45, S246-S266.
[iv] European Federation of Periodontology, (2019). Peri-implant health, peri-implant mucositis and peri-implantitis. (Online) Available at: https://www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/New_Classification/Guidance_Notes/report-04.pdf [Accessed August 2023]
[v] Office for Health Improvement & Disparities, (2022). Local tobacco control profiles for England: statistical commentary, December 2022 update. GOV.UK, (Online) Available at: https://www.gov.uk/government/statistics/local-tobacco-control-profiles-december-2022-update/local-tobacco-control-profiles-for-england-statistical-commentary-december-2022-update [Accessed August 2023]
[vi] Windael, S., Vervaeke, S., De Buyser, S., De Bruyn, H., & Collaert, B. (2020). The long-term effect of smoking on 10 years’ survival and success of dental implants: A prospective analysis of 453 implants in a non-university setting. Journal of clinical medicine, 9(4), 1056.
[vii] Marcantonio, C., Nicoli, L. G., Marcantonio Junior, E., & Zandim-Barcelos, D. L. (2015). Prevalence and possible risk factors of peri-implantitis: a concept review. J Contemp Dent Pract, 16(9), 750-7.
[viii] Kasat, V., & Ladda, R. (2012). Smoking and dental implants. Journal of International Society of Preventive & Community Dentistry, 2(2), 38.
[ix] Todescan, S., Lavigne, S., & Kelekis-Cholakis, A. (2012). Guidance for the maintenance care of dental implants: clinical review. J Can Dent Assoc, 78(1), 107.
[x] Monje, A., Insua, A., & Wang, H. L. (2019). Understanding peri-implantitis as a plaque-associated and site-specific entity: on the local predisposing factors. Journal of clinical medicine, 8(2), 279.
[xi] Fu, J. H., & Wang, H. L. (2020). Breaking the wave of peri‐implantitis. Periodontology 2000, 84(1), 145-160.
[xii] Ardakani, M. R. T., Esfahrood, Z. R., & Shidfar, S., (2019). The Modified Continuous Double Locking Suture: A Novel Suturing Approach in Dental Implant Surgery. Journal of” Regeneration, Reconstruction & Restoration”(Triple R), 4(4), 148-150.
[xiii] Guy’s and St Thomas’ NHS Foundation Trust, (2021). After having a dental implant, (Online) Available at: https://www.guysandstthomas.nhs.uk/health-information/dental-implants/after-having-dental-implant [Accessed August 2023]
[xiv] Bennett, C. (2014). Postoperative care after dental implant placement. Dental Nursing, 10(6), 326-329.
