Implant maintenance and the importance of oral hygiene: A review of the literature
Dental implants have been around for hundreds of years. The earliest evidence is from about 600 AD, with the Mayan population using pieces of shells to replace missing teeth.1 Within the last 50 years, the art of placing dental implants has been perfected to a 97% success rate and has become the gold standard for replacing edentulous areas.
Yet there is still a misconception among patients, such as them thinking that dental implants cannot decay and therefore don’t need the attention and maintenance that traditional teeth require. Because of this, more information is needed on the importance of proper oral hygiene, routine dental visits, and alveolar care for patients with dental implants. Here I’ll evaluate recent data on this topic and address the need for information on the importance of implant maintenance and oral hygiene.
Dental implants are considered the most reliable and efficient tooth replacement option. Their use has become a standard practice in dentistry not only as single unit replacements, but also partial and full-arch replacements with the addition of partial and full dentures.
Dental implants have a high success rate of 97% over 10 years and have a decreased rate of caries in adjacent teeth.1 However, there are contraindications for use in specific patients, and some patients may be at a higher risk for implant loss depending on certain conditions. Additionally, there are several ways to prevent implant loss, including reduction of immunological imbalances, proper oral hygiene, and proper cleaning techniques by their dental provider. Not all patients are aware of the importance of maintenance and oral hygiene, and more must be done for dental hygienists to properly educate the public.
Analysis of dental implants
Although dental implants are the most efficient route for tooth replacement, failure does happen, and contraindications do exist. One of the most common causes of failure is inflammation caused by the activation of the patient's immune system, and patients who have a preexisting immunological imbalance can be considered contraindicated for implant placement. Some of these contraindications related to immunological imbalances are uncontrolled diabetes, HIV, AIDS, and chemotherapy.
For example, patients who are currently undergoing chemotherapy should wait, if possible, until treatment is completed to have dental implants placed. During treatment, a patient’s immune system efficiency decreases, with a slower production of immune cells. Immune cells play a critical part in maintaining homeostasis by regulating the balance of positive and negative bacteria as well as viruses and other important tasks. Without the help of these immune cells, a body is less able to fight off harmful oral bacteria, and thus an increase in inflammation occurs.2
With this increased inflammation, patients are susceptible to peri-implantitis, which is inflammation around the dental implant affecting the alveolar structures. Peri-implantitis can lead to disturbance in the osseointegration process of the dental implant and if left untreated, can lead to implant loss.
Another way dental implants fail is when patients lack proper oral hygiene. Patients who are educated about proper oral hygiene and use maintenance methods often have better implant outcomes. Oral hygiene behaviors include a wide variety of methods to reduce bacteria, such as tooth brushing, flossing, interproximal brushing, and mouth rinsing.
Another factor that contributes to the reduction of oral bacteria is how often these methods are performed. People who use more methods more frequently tend to have a lower community periodontal index (CPI) score, which indicates a lower presence of the oral bacteria that causes peri-implantitis and subsequent implant failure.
Although all methods of oral hygiene have some effect on lowering someone’s CPI score, the most effective method is tooth brushing twice daily, which lowers the likelihood of peri-implantitis by 70% to 80%. Second to this is tooth brushing twice daily with the addition of daily dental flossing.3
Dental professionals play a key part in implant maintenance and retention with the type of instruments they use to clean implants. Regular visits to a dental provider for routine cleanings help to remove the bacterial biofilm on the dental implant. Removing this biofilm helps prevent peri-implantitis. There are a multitude of different scalers that dental professionals use to remove biofilm, and some have better outcomes for removal than others depending on the material.
When dental professionals use glass-filled resin scalers instead of resin-graphite, carbon fiber, or titanium, there’s scratches to the dental implant are significantly reduced. It’s important to note that any type of defect, such as a scratch along a dental implant, creates an environment for bacteria to colonize and further increases the risk of peri-implantitis. This is a key part in dental implant retention.4
For dental professionals to share this knowledge with patients, they must have a proper curriculum before practicing dentistry. Dental hygienists are oral health specialists who are key players in educating patients and providing preventive services. An integral part of US dental hygiene program standards is to prepare graduates to assess and maintain dental implants.
A survey evaluated how prepared dental hygiene graduates feel to provide dental implant maintenance. Most survey respondents, 98%, stated they received didactic instruction on dental implants. However, less than half, 45%, responded they had some form of laboratory instruction on dental implants. This is a staggering percentage of dental hygienists who felt underprepared to provide dental implant maintenance care to their patients.5
Conclusion
Dental implantology is a vast field in dentistry that is growing to combat tooth loss. This increased knowledge helps improve the quality of life of patients via mechanical means as well as self-esteem. The retention of dental implants is very important. Although implants are largely successful, there are still complications such as peri-implantitis that cause implant failure.
It is important to understand the oral bacteria present as well as its impact on the immune system. We need to understand how we can prevent these bacteria from colonizing dental implants through oral hygiene. The continued growth in dental education can lead to more successful maintenance of dental implants.
References
1. Gupta R. Dental implants. August 8, 2023. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470448/
2. Rahnama-Hezavah M, Mertowska P, Mertowski S, et al. How can imbalance in oral microbiota and immune response lead to dental implant problems? Int J Mol Sci. 2023;24(24):17620. doi:10.3390/ijms242417620
3. Choi YK, Kim EJ. Oral health status of Korean adults with implants according to their use of oral hygiene products: results from a nationwide population-based study (2013-2015). J Periodont Implant Sci. 2020;50(4):268-277. doi:10.5051/jpis.1904700235
4. Hasturk H, Nguyen DH, Sherzai H, et al. Comparison of the impact of scaler material composition on polished titanium implant abutment surfaces. J Dent Hyg. 2013;87(4):200-211. jdh.adha.org/content/87/4/200
5. Gentry AC, Gurenlian J, Freudenthal JJ. (2021, December 1). Implant maintenance curriculum content in dental hygiene education. J Dent Hyg. 2021;95(6):36-45. https://jdh.adha.org/content/95/6/36
