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