Clinical Practice Recommendations for the Maintenance of Implant

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Water Irrigators chlorhexidine when peri-implant inflammation is observed, in addition Perio & Implant Centers The Team for Water irrigating devices are to debridement and other improved of the Monterey Bay (831) 648-8800 personal plaque control measures. Jochen P. Pechak, DDS, MSD in Silicon Valley (408) 738-3423 useful, especially when delivering mobile app: www.GumsRusApp.com For a patient who has invested antimicrobials, such as chlorhexidine web: GumsRus.com or diluted ordinary household in an implant to replace a missing bleach, to the implants and any tooth or teeth, regular, effective adjacent teeth. maintenance, in addition to regular checks of the retentive elements, Water irrigator tips can be tm with replacement as needed, is PDL Figure 6. Glycine-based modified by heating them up and critical to long-term success. subgingival air polishers bending them into a curve in order to debride the implant surface PerioDontaLetter access the palatal/lingual surfaces of Jochen P. Pechak, DDS, MSD, Periodontics, Implant & Laser Dentistry Winter more thoroughly than other implant restorations. These areas are Flossing available methods. often difficult to access using standard The “criss-cross” flossing technique tips because of the angle of the can help remove plaque biofilm implant. subgingivally around implants more Clinical Practice Home Care Rinses and effectively than the technique used to floss natural teeth. Recommendations for the Electric toothbrushes are Topical Agents Using this technique, the floss is recommended for implants and implant Maintenance of Implant-Based Mouth rinses may help maintain placed through both contacts, mesial supported prosthetic devices. Our new Associate peri-implant health. Most published and distal, then crossed over at the Interdental brushes without twisted Periodontist, Dr. Bembey Restorations articles recommend the use of buccal. grew up in India, where metal centers are effective in plaque Flossing is then performed in a she earned her removal. shoe-shine like motion around the bachelors degree in ental implants have proven plaque control than natural teeth. dentistry and practiced Regardless of the type of prosthesis, implant. Non-woven floss is to be a reliable replacement We cannot always apply to dental as a general dentist for for natural teeth, but their brushing twice a day is recommended. recommended for this technique, as three years. D implants the same methods we Rather than trying to brush a removable woven floss may shred and leave She completed her shape and contours are very different have used for the past century for appliance, which is not usually behind fibers. dental training at the UCLA School of from natural teeth. home care and professional dentistry, where she earned multiple effective, dropping it in a solution of awards including Clinical Excellence in There are many different implant- in-office maintenance for natural denture cleanser or chlorhexidine twice Conclusion the Field of Periodontics, and Excellence supported restorations, many of teeth. a week will work more effectively. in Comprehensive Dental Care. which retain plaque to varying Peer-reviewed published literature Fig. 8 She completed specialty training in It should be impressed on every degrees, and are difficult to access to indicates that the incidence of peri- dental implant patient that, like teeth, periodontics and dental Implants at Nova Southeastern University School of effectively remove bacterial plaque. implant disease may be as high as dental implants are subject to the Dental Medicine, Ft. Lauderdale, where It is clear that implants require twenty percent after seven years in progression of inflammatory disease. she became a Periodontist, and earned Consequently, regular and more her masters of science in dentistry. She entirely different methods of function. Patients who have systemic importantly, effective disease control is a board certified Diplomate of the American Board of Periodontology. methods, as well as regular Dr. Bembey is proficiently trained in professional care, is essential to all aspects of dentistry, including LANAP Figure 1. Failure to maintaining long-term dental health. Laser and surgical periodontal therapy. remove subgingival Fig. 9 She is extensively trained in procedures cement has created a of periodontal bone regeneration, very uncertain PDL tm PRP/PRF, IV Sedation, and soft and hard Figures 8 and 9. In contrast tissue grafting, including sinus grafting prognosis for this and placement of dental implants. implant. Figure 7. Irrigation tips can to natural teeth, criss-cross Dr. Bembey is passionately committed be heated to customize them (shoeshine) flossing can be to providing her patients with the best for better patient access for very effective for plaque treatment options available, and believes in working as a team with the restorative home care compliance. control around implants. dentist.

Dr Pechak is a board certified Periodontist embracing the evolution of better options with a focus on minimally-invasive techniques for gum disease, oral 21 Upper Ragsdale Drive • Monterey, CA 93940 • (831) 648-8800 • [email protected] surgery, dental implants, and implant-supported dentures. As a CE provider for the State of California, he lectures and hosts educational events for Dentists, Jochen P. Pechak, DDS, MSD 516 W. Remington Drive, Suite 5A • Sunnyvale, CA 94087 (408) 738-3423 • [email protected] dental teams and the community of Dental Hygienists. He is the Founder and Director of a chapter of the Seattle Study Club network, as well as our Hygiene Diplomate, American Board of Periodontology Study Club. Please contact us if you wish to be a part of our continuing education series, in which CEU’s are earned. mobile app: GumsRusApp.com • website: GumsRus.com • Dr. Pechak’s direct email: [email protected] risk factors, including diabetes and depths (PD) greater than 4–5mm, and dental health at the time of smoking, exhibit an even greater progressive bone loss (BL) greater contemplated implant surgery. This incidence of peri-implant disease. than 2–3mm. provides a baseline against which It is incumbent upon the dental team The findings indicated that to compare progressive changes in to develop customized methods of conversion to peri-implantitis was the status of the implants. It is plaque removal and to encourage a strongly correlated with poor plaque suggested that peri-implant health regular schedule of in-office visits for control, bleeding on probing, probing and radiographic bone levels be implant maintenance. depths and lack of regular documented within three to six maintenance. months of implant restoration. The presence of uncontrolled At the time of office visits for Implant Assessment periodontitis associated with natural teeth implant maintenance, the following was also correlated to peri-implantitis. should be carefully evaluated: According to the 2017 World It is critical that implants not be placed • Overall peri-implant tissue health Workshop of the American Academy in patients with uncontrolled • Effectiveness of plaque control of Periodontology (AAP) and periodontitis, and it is critical to assess • Inflammatory changes and exudate the European Federation of overall oral health when implant when probing or palpating Periodontology (EFP), classic signs supported restorations are planned. peri-implant tissues of peri-implantitis are: plaque- It is advised that clinicians placing • The presence of calculus or Figure 4. Implants are tremendously Figure 5. Therapeutic intervention is associated inflammation, probing dental implants assess the level of residual cement successful, but not without patient cooperation. complicated by the presence of implant threads In addition to inadequate home care, the lack and a roughened implant surface. Removal of Fig. 2 Fig. 3 of attached gingiva creates a significant risk the biofilm is critical to stabilize or create new factor. If implants are showingbone. signs of infection, more damage will occur from not instrumenting the threads than cleaning them even if it results in a scratched implant surface. They are already corroded! • Mobility or pain Professional without eliciting a host-inflammatory • Evidence of radiographic bone Maintenance response. The powder is placed loss around the implant subgingivally • Presence or lack of adequate Instrumentation and then drawn out slowly and keratinized gingiva activated to decontaminate the • Excessive occlusal forces Once the loss of attachment implant surface. • Condition of the prosthesis, reaches the level of the threads, Because implant surfaces are often including wear, chipping or ordinary stainless-steel instruments rough, these air polishers allow fractures can be used to clean the implant debridement of the implant surface • Optimal function since they are already corroded. more thoroughly than other available An ongoing systematic approach to Some clinicians prefer titanium methods. The focus is on the removal the evaluation of implant health will instruments or diamond-coated of biofilm from the entire implant ensure early recognition of peri- ultrasonic inserts. surface. implant disease, permitting rapid A scientific panel of numerous clinical intervention. professional dental organizations, Polishing and Fluoride It is recommended that full-arch together with the American Dental Implant, abutment and restorative fixed restorations be removed once a Association (ADA), recently surfaces can be safely polished with a year to assess the status of the published clinical practice guidelines rubber cup and prophy paste. The supporting tissues and the prosthesis. for implant maintenance. prophy paste chosen should have When the prosthesis is removed, it is This panel found that the evidence minimal abrasiveness to protect the possible to observe contours that make strongly supports the use of glycine- surfaces from further damage. plaque removal difficult, and permit based subgingival air polishers If fluoride is being used to protect corrections to be made. At this time, it around dental implants, and dental surrounding natural teeth, the choiceof Figures 2 and 3. This patient chose to try to maintain the implant without any therapeutic is further recommended to replace the implant supported prostheses. a pH neutral sodium fluoride will intervention. Three years later, the implant has failed, and resultant massive bone loss creates retentive screws. If adverse occlusal These air polishers use glycine minimize titanium corrosion. At times, minimal treatment options. forces are noted, an occlusal guard powder which dissolves within the anti-microbial, chlorhexidine-thymol may be recommended. peri-implant sulcus, or pockets, and varnish may be helpful.

PerioDontaLetter, Winter risk factors, including diabetes and depths (PD) greater than 4–5mm, and dental health at the time of smoking, exhibit an even greater progressive bone loss (BL) greater contemplated implant surgery. This incidence of peri-implant disease. than 2–3mm. provides a baseline against which It is incumbent upon the dental team The findings indicated that to compare progressive changes in to develop customized methods of conversion to peri-implantitis was the status of the implants. It is plaque removal and to encourage a strongly correlated with poor plaque suggested that peri-implant health regular schedule of in-office visits for control, bleeding on probing, probing and radiographic bone levels be implant maintenance. depths and lack of regular documented within three to six maintenance. months of implant restoration. The presence of uncontrolled At the time of office visits for Implant Assessment periodontitis associated with natural teeth implant maintenance, the following was also correlated to peri-implantitis. should be carefully evaluated: According to the 2017 World It is critical that implants not be placed • Overall peri-implant tissue health Workshop of the American Academy in patients with uncontrolled • Effectiveness of plaque control of Periodontology (AAP) and periodontitis, and it is critical to assess • Inflammatory changes and exudate the European Federation of overall oral health when implant when probing or palpating Periodontology (EFP), classic signs supported restorations are planned. peri-implant tissues of peri-implantitis are: plaque- It is advised that clinicians placing • The presence of calculus or Figure 4. Implants are tremendously Figure 5. Therapeutic intervention is associated inflammation, probing dental implants assess the level of residual cement successful, but not without patient cooperation. complicated by the presence of implant threads In addition to inadequate home care, the lack and a roughened implant surface. Removal of Fig. 2 Fig. 3 of attached gingiva creates a significant risk the biofilm is critical to stabilize or create new factor. If implants are showingbone. signs of infection, more damage will occur from not instrumenting the threads than cleaning them even if it results in a scratched implant surface. They are already corroded! • Mobility or pain Professional without eliciting a host-inflammatory • Evidence of radiographic bone Maintenance response. The powder is placed loss around the implant subgingivally • Presence or lack of adequate Instrumentation and then drawn out slowly and keratinized gingiva activated to decontaminate the • Excessive occlusal forces Once the loss of attachment implant surface. • Condition of the prosthesis, reaches the level of the threads, Because implant surfaces are often including wear, chipping or ordinary stainless-steel instruments rough, these air polishers allow fractures can be used to clean the implant debridement of the implant surface • Optimal function since they are already corroded. more thoroughly than other available An ongoing systematic approach to Some clinicians prefer titanium methods. The focus is on the removal the evaluation of implant health will instruments or diamond-coated of biofilm from the entire implant ensure early recognition of peri- ultrasonic inserts. surface. implant disease, permitting rapid A scientific panel of numerous clinical intervention. professional dental organizations, Polishing and Fluoride It is recommended that full-arch together with the American Dental Implant, abutment and restorative fixed restorations be removed once a Association (ADA), recently surfaces can be safely polished with a year to assess the status of the published clinical practice guidelines rubber cup and prophy paste. The supporting tissues and the prosthesis. for implant maintenance. prophy paste chosen should have When the prosthesis is removed, it is This panel found that the evidence minimal abrasiveness to protect the possible to observe contours that make strongly supports the use of glycine- surfaces from further damage. plaque removal difficult, and permit based subgingival air polishers If fluoride is being used to protect corrections to be made. At this time, it around dental implants, and dental surrounding natural teeth, the choiceof Figures 2 and 3. This patient chose to try to maintain the implant without any therapeutic is further recommended to replace the implant supported prostheses. a pH neutral sodium fluoride will intervention. Three years later, the implant has failed, and resultant massive bone loss creates retentive screws. If adverse occlusal These air polishers use glycine minimize titanium corrosion. At times, minimal treatment options. forces are noted, an occlusal guard powder which dissolves within the anti-microbial, chlorhexidine-thymol may be recommended. peri-implant sulcus, or pockets, and varnish may be helpful.

PerioDontaLetter, Winter Water Irrigators chlorhexidine when peri-implant inflammation is observed, in addition Perio & Implant Centers The Team for Water irrigating devices are to debridement and other improved of the Monterey Bay (831) 648-8800 personal plaque control measures. Jochen P. Pechak, DDS, MSD in Silicon Valley (408) 738-3423 useful, especially when delivering mobile app: www.GumsRusApp.com For a patient who has invested antimicrobials, such as chlorhexidine web: GumsRus.com or diluted ordinary household in an implant to replace a missing bleach, to the implants and any tooth or teeth, regular, effective adjacent teeth. maintenance, in addition to regular checks of the retentive elements, Water irrigator tips can be tm with replacement as needed, is PDL Figure 6. Glycine-based modified by heating them up and critical to long-term success. subgingival air polishers bending them into a curve in order to debride the implant surface PerioDontaLetter access the palatal/lingual surfaces of Jochen P. Pechak, DDS, MSD, Periodontics, Implant & Laser Dentistry Winter more thoroughly than other implant restorations. These areas are Flossing available methods. often difficult to access using standard The “criss-cross” flossing technique tips because of the angle of the can help remove plaque biofilm implant. subgingivally around implants more Clinical Practice Home Care Rinses and effectively than the technique used to floss natural teeth. Recommendations for the Electric toothbrushes are Topical Agents Using this technique, the floss is recommended for implants and implant Maintenance of Implant-Based Mouth rinses may help maintain placed through both contacts, mesial supported prosthetic devices. Our new Associate peri-implant health. Most published and distal, then crossed over at the Interdental brushes without twisted Periodontist, Dr. Bembey Restorations articles recommend the use of buccal. grew up in India, where metal centers are effective in plaque Flossing is then performed in a she earned her removal. shoe-shine like motion around the bachelors degree in ental implants have proven plaque control than natural teeth. dentistry and practiced Regardless of the type of prosthesis, implant. Non-woven floss is to be a reliable replacement We cannot always apply to dental as a general dentist for for natural teeth, but their brushing twice a day is recommended. recommended for this technique, as three years. D implants the same methods we Rather than trying to brush a removable woven floss may shred and leave She completed her shape and contours are very different have used for the past century for appliance, which is not usually behind fibers. dental training at the UCLA School of from natural teeth. home care and professional dentistry, where she earned multiple effective, dropping it in a solution of awards including Clinical Excellence in There are many different implant- in-office maintenance for natural denture cleanser or chlorhexidine twice Conclusion the Field of Periodontics, and Excellence supported restorations, many of teeth. a week will work more effectively. in Comprehensive Dental Care. which retain plaque to varying Peer-reviewed published literature Fig. 8 She completed specialty training in It should be impressed on every degrees, and are difficult to access to indicates that the incidence of peri- dental implant patient that, like teeth, periodontics and dental Implants at Nova Southeastern University School of effectively remove bacterial plaque. implant disease may be as high as dental implants are subject to the Dental Medicine, Ft. Lauderdale, where It is clear that implants require twenty percent after seven years in progression of inflammatory disease. she became a Periodontist, and earned Consequently, regular and more her masters of science in dentistry. She entirely different methods of function. Patients who have systemic importantly, effective disease control is a board certified Diplomate of the American Board of Periodontology. methods, as well as regular Dr. Bembey is proficiently trained in professional care, is essential to all aspects of dentistry, including LANAP Figure 1. Failure to maintaining long-term dental health. Laser and surgical periodontal therapy. remove subgingival Fig. 9 She is extensively trained in procedures cement has created a of periodontal bone regeneration, very uncertain PDL tm PRP/PRF, IV Sedation, and soft and hard Figures 8 and 9. In contrast tissue grafting, including sinus grafting prognosis for this and placement of dental implants. implant. Figure 7. Irrigation tips can to natural teeth, criss-cross Dr. Bembey is passionately committed be heated to customize them (shoeshine) flossing can be to providing her patients with the best for better patient access for very effective for plaque treatment options available, and believes in working as a team with the restorative home care compliance. control around implants. dentist.