As hygienists know, dentistry is constantly evolving as new research is published and different products and emerging technologies become available. With this new information, we adapt our patient care to provide the best services we can to our patients. Over the past few decades, dental implants have become a routine part of dentistry, with more patients seeking implants as a tooth replacement option. As more patients have implants placed, more research is conducted, including countless case studies. One of the topics I cover every year in class with first-year dental students is implant maintenance. Each year, it amazes me how much new information has emerged about implants and how much editing is needed to provide the most relevant information to my students. This article will debunk some of the myths I learned in dental hygiene school and heard over the years about implant maintenance, as well as offer some practical tips to provide the best implant care for patients.
Myth no. 1: Don’t probe around implants, but if you do, use a plastic probe
Like most myths, there is usually some amount of truth to it that gets misinterpreted. Some authors in the past didn’t recommend routine periodontal probing of dental implants. However, more recent literature indicates that routine probing does not harm the implant or peri-implant tissues. Some implant surgeons recommend waiting approximately three months after abutment connection to ensure the postoperative healing is complete before probing. After the final restoration has been installed, initial probing should be completed to establish a baseline measurement to compare with future implant probing depths.1
Commercially available plastic probes have been used for probing around implants for many years. Recent literature allows for the use of conventional metal probes if probing pressures are kept light to avoid penetrating through the perimucosal seal and damaging titanium implant surfaces. In fact, a smaller probe diameter is a more important factor to consider for increased accuracy and decreasing the likelihood of trauma as opposed to probe material. Although conventional metal probes can be used, plastic probes are more flexible, which can be helpful for navigating around bulky contours and angles often found around implant restorations.2
Myth no. 2: Always use plastic scalers around implants
Previous research suggested that scratching the implant surface caused biofilm to adhere to rough surfaces, being a significant cause of implant failure. This led to a recommendation of only plastic or polymer instruments being used on titanium surfaces around implants. However, further investigation has shown that residues left on implants may play a role in eventual implant failure. This includes calculus deposits, cement, or debris left behind from forceful use of polymer instruments.
A 2020 survey of more than 2,000 dental hygienists revealed that a majority (60%) used plastic scalers around implants, but only 7% felt that they were effective.3 It is important to be able to effectively instrument around the implant surface to remove deposits around implants without scratching the titanium surface or leaving harmful residue from the plastic instruments behind. Therefore, the new guidelines from the American College of Prosthodontics state that instruments with like metals, such as titanium-on-titanium, should be used to instrument implant surfaces to avoid leaving any residue behind. Glycine powder can also be used to air polish implants.4
Myth no. 3: Implants aren’t natural teeth, so they don’t require as much care
This one is more of a patient misconception. But it is crucial to educate our patients about peri-implant mucositis and peri-implantitis. If a patient is interested in implants but has subpar home care with signs of periodontal disease, it is important to address this and explain how they can have the same issues with implants as they do with natural teeth, except potentially even more rapidly progressing. Several systematic reviews indicate that peri-implantitis is found more frequently in patients with a history of periodontitis compared to patients without a history of periodontitis.⁵
Lastly, research has concluded that smoking poses an increased risk for peri-implantitis.5 It is necessary to inform implant patients of the importance of regular maintenance visits, along with regular probing and radiographs at least once a year, for monitoring signs of peri-implant disease.
Myth no. 4: Implants only fail because of poor oral hygiene
In addition to the previously noted risk factors for peri-implant diseases, biomechanical overload can also be a major factor in implant failure. Implants are capable of withstanding normal bite forces. However, in patients with bruxing and clenching habits, the implant may not be able to handle the excessive parafunctional load. Because dental implants do not have a periodontal ligament, the occlusal forces are transmitted directly to the surrounding peri-implant bone.6 For this reason, occlusion should be assessed regularly to ensure uniform stress distribution along the entire length of the implant. Implant-related complications can occur even in the absence of plaque, potentially leading to implant failure.7
Conclusion
Implants are a common finding in many dental practices, especially as more general dentists are starting to place them. As more implant studies begin to surface, it is a must to stay up-to-date on best practices for implant maintenance. Implants should be probed routinely to assess for increasing probing depths and any signs of bleeding or suppuration. Radiographs showing the bone level should also be exposed at least once a year to monitor for signs of bone loss progression. Scaling around implants using titanium scalers should be performed at maintenance visits to remove any harmful deposits surrounding the implant, just as you would do for natural teeth. Occlusion should also be checked to monitor for signs of biomechanical overload.
Lastly, it is imperative to educate patients on the importance of keeping their implants clean, just as with natural teeth, and provide instructions on interdental aids to use around implants. It is critical to debunk any myths to help our patients keep their implants for many years to come.
Editor's note: This article appeared in the March 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Peri-implant mucositis and peri-implantitis: a current understanding of their diagnoses and clinical implications. Periodontol. 2013;84(4):436-443. doi:10.1902/jop.2013.134001
- Protopopova MS. A Prospective Randomized Clinical Trial on Accuracy of Plastic Periodontal Probes Compared to Conventional Metal Probes Around Dental Implants. University of Colorado at Denver ProQuest Dissertations & Theses. Order No. 10249574 ed. University of Colorado at Denver; 2017.
- Zellmer IH, Couch ET, Berens L, Curtis DA. Dental hygienists’ knowledge regarding dental implant maintenance care: a national survey. J Dent Hyg. 2020;94(6):6-15.
- Bidra AS, Daubert DM, Garcia LT, et al. Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations. J Am Dent Assoc. 2016;147(1):67-74. doi:10.1016/j.adaj.2015.12.006
- Klokkevold PR, Han TJ. How do smoking, diabetes, and periodontitis affect outcomes of implant treatment? Int J Oral Maxillofac Implants. 2007;22(7):173-202.
- Rungsiyakull C, Rungsiyakull P, Li Q, Li W, Swain M. Effects of occlusal inclination and loading on mandibular bone remodeling: a finite element study. Int J Oral Maxillofac Implants. 2011;26(3):527-537.
- Sadowsky SJ. Occlusal overload with dental implants: a review. Int J Implant Dent. 2019;5(1):29. doi:10.1186/s40729-019-0180-8
