HYGIENE INSTRUCTIONS
Pre implant treatment appointment
The Hygienist is usually the first professional
delivering treatment to the prospective implant patient.
Routine periapical and panoramic radiographs followed by thorough
perio charting and evaluation of the tissue for tone, color and
texture are prerequisites before starting implant treatment.
Note any exudate, edema and erythema. Adverse
conditions need to be addressed and resolved before
the implant is placed.
Post implant treatment appointment
Fig. 1
Peri-implant tissue appears clinically much like
a natural tooth, but the implant and abutment have
no attached transseptal fibers (BioHorizons® is the only implant
manufacturer offering a implant product line with
Laser-Lok® designed
for epithelial attachment, Fig.1) and the
implant is surrounded by a soft sulcus, lined with crevicular
epithelium. Only a circular fiber complex of
keratinized or non keratinized gingiva forming a
perimucosal seal and no periodontal ligament are
present.
Fig. 2
For diagnostic purposes and legal concerns it
is important to establish and record baseline reference
markers soon after delivery of the final restoration.
Periapical and or panographic radiographs are a
diagnostic tool to confirm a initial height of bone
assessment around the implant and to verify seating
accuracy (Fig.2, incompleat seat) of the restorative components.
The radiograph needs to be taken perpendicular to the
long axis of the implant to be of diagnostic value.
Probing depth of the peri implant sulcus can be
much greater than a natural tooth without being
a indicator for periodontal pathology, but bleeding,
swelling or exudate are indicators of periodontal
disease around implants as much as it is for
natural teeth.
Fig. 3
Probing of the sulcus should be performed gently as
not to penetrate the connective tissue. A metal perio
probe is acceptable for probing purposes. Debridement
of the implant restoration can be accomplished with plastic
(Implant Prophy +®, AIT Dental),
resin (ImplaKlean™, PacDent®) or graphite (Premier®)
scalers and sonic (Quixonic™, Dentsply, Midwest) scalers with plastic tips.
Although plastic, resin and graphite instruments have a tendency to abrade
and leave instrument debris embedded on implant component surfaces (Fig.3).
Fig. 4
PDT developed
specialized titanium instruments (Wingrove) that do not damage or
leave debris embedded on component surfaces (Fig.4). Standard stainless
steel scalers and ultrasonic instruments are contra indicated for implant
restorations because they might permanently compromise the smooth polish
of the abutment and restoration. Special soft tipped plastic tips for
ultrasonic cleaners may be utilized. Rubber cups with a nonabrasive
toothpaste or tin oxide are appropriate for polishing purposes. Coarse or
medium grit polishing pastes are not recommended.
Fig. 5
Plaque and calculus (Fig.5) quantity and location need to be
noted during the charting procedure as well as tissue
tone, color and texture. Inflammation, edema, erythema,
swelling, bleeding and exudate indicate the need for
intervention. Mobility of the restorative complex could
mean failure of the implant itself, abutment screw
loosening or prostheses debonding. Each of these
issues warrants immediate remedial procedures. Chronic
screw loosening, porcelain fracture, excessive
occlusal wear, denture sores or purulence need to be
closely evaluated to prevent implant failure.
Fig. 1 courtesy of
BioHorizons®
Fig.3 and 4 courtesy of Paradise Dental Technologies, Inc