As dental hygienists, it is important that we educate our patients on the negative effects of bruxism, proper home care, effective removal of biofilm, calculus, and cement to reduce peri-implantitis. Utilizing the proper chairside technologies will enable our patients to reduce their risk of implant failure.
TOSS THE PLASTIC
Not every instrument is safe to use on instruments. In fact, plastic instruments can compromise the implant by leaving plastic particles on the implant. Studies conducted by Mann et al., found, “Metal scalers produce defects in titanium implant surfaces and load and power are important factors in the damage caused. Plastic-coated scaler probes cause minimal damage to implant surfaces but can leave plastic deposits behind on the implant surface.”~~1,2
Debriding with a titanium scaler on a titanium implant has been shown to avoid compromising the implant and remove destructive debris.~~3,4 Medical-grade titanium instruments, which prevent any scratching or residue on the implant, with a resin handle can be found through Paradise Dental Technologies (PDT).
Backed by clinical studies demonstrating effectiveness and safety, Susan Wingrove, RDH, created the Wingrove Titanium Implant to properly remove debris from “narrow-based bulbous crowns, wide-based crowns, locater abutments, Hader bars, exposed threads and cement removal.”~~5 Hu-Friedy offers a titanium, teal-colored anodized titanium to assist with proper acuity.~~6 American Eagle offers medical-grade titanium that is surrounded by a lightweight handle to prevent hand fatigue while removing implant-compromising debris.~~7
Clinical studies demonstrate that a titanium implant is more likely to be affected by corrosion in a low pH environment.8Educating patients to reduce the amount, frequency, and duration in which they consume foods and drinks that are acidic in nature will not only help to reduce the risk of tooth decay, but will also help reduce the risk of compromising the patient’s implant investment. Understanding the ingredients of a product, as well as the efficacy of the product, is the responsibility of the dental provider. Therefore, home-care products that are recommended to our patients should be of neutral pH.
CloSYS mouth rinse balances the pH of the mouth, and is free of dyes, gluten, sulfates, triclosan, and alcohol. The active ingredient, stabilized chlorine dioxide, “exhibited strong bactericidal activity with killing of most test organisms within a matter of minutes.”~~8 Studies conducted by Dr. Robert Wirthlin demonstrate that CloSYS surpassed the kill rate of chlorhexidine within the first minute when destroying A. naeslundii and P. micros (both involved in periodontal disease).9CloSYS also had the same kill rate as chlorhexidine after five minutes for Strep. mutans and A. viscosus.~~9 The ability to extinguish bacteria that can compromise the tissue and bone surrounding the implant, without increased stain and taste, allows the most sensitive patients to achieve a healthier mouth.
It is important that we educate our patients on the negative effects of bruxism, proper home care, effective removal of biofilm, calculus, and cement to reduce peri-implantitis. Utilizing the proper chairside technologies will enable our patients to reduce their risk of implant failure.
REPLACE THE PROPHY CUP
Biofilm, calculus, and residual cement compromise the longevity of the implant.~~10,11 Glycine-based powder can be used subgingivally with a titanium-tipped prophy jet to remove destructive debris. The very fine “perio” powder is typically in a neutral flavor.
Studies conducted by Flemmig et al, investigated the efficacy and safety on subgingival air polishing with glycine powder. The 30 patients who participated in the were diagnosed with chronic periodontitis, which included pocket depths of 4-9 MM.~~12
Subgingival glycine powder was administered in deep pockets followed by SRP, and patients were monitored at day 10 and 90 days post-treatment. The results demonstrated the subgingival total P. gingivalis counts in the oral cavity were significantly reduced after full-mouth GPAP. The study compared to SRP at day 90, where the “total P. gingivalis counts in the oral cavity were significantly reduced after full-mouth GPAP compared to SRP at day 90.”~~12 Therefore, the results demonstrate more effective removal of subgingival biofilm, when compared to SRP alone, in patients with moderate to severe periodontal disease.~~12
Acteon offers a titanium-tipped a prophy jet called the Air-N-Go. Equipped with two modes, “Supra function for supra-gingival polishing: daily prophylactic polishing. Perio function for subgingival polishing: maintenance, periodontal and peri-implant treatments.”~~13 The tip was designed with implants in mind, as it is safe and effective to use against the titanium implant. The natural glycine-based powder features low abrasiveness that removes biofilm while preserving the treated surfaces.
Hu-Friedy offers the Air-Flow Handy that also attaches to the slow speed of the unit. A plastic subgingival tip is placed on the end to allow the powder to go subgingival with the Perio Powder.~~13 The Air-Flow Perio Powder is made from glycine, is 25 microns, and is ideal for the removal of subgingival biofilm. The Air-Flow Classic Powder is 40 microns to allow for increased comfort in supragingival stain removal.~~13
Additionally, Dentsply Sirona also offers Tap-On Technology to improve foot ergonomics and a prophy mode that alternates between air polish and rinse.~~14 The automated purge function allows the clinician to perform other tasks while the system flushes itself. All tips and handles are autoclavable.
WATER FLOSSERS FOR THE WIN
Clinical studies comparing traditional floss with a water-based flosser demonstrate a significant decrease in bleeding for those utilizing a water flosser.~~15 Effectively removing biofilm around implants with a powerbrush and interproximal aids will help to prevent peri-implantitis. Studies conducted by Magnuson et al., compared decrease in bleeding of two groups of patients, comparing the reduction of BOP when using traditional floss and a water flosser.~~15 The results demonstrated a 81% reduction of BOP in water flosser users compared to 33.3% reduction of BOP in the floss group.
When it comes to complying with the recommendation for a specialist consult, patients often require multiple reminders to receive the initial consult. Often, the urgency to have extensive treatment with a new provider is what inhibits the patient from being compliant with the consult. MouthWatch allows the provider to capture still intraoral images, create a video tour of the patients’ condition, share radiographs, and expediting the initial consult with the patient.16 The specialist has the ability to review all data needed and begin to generate a comprehensive treatment plan. This mode of consultation allows the patient to have an overview of the treatment needed and allows the first visit to the office to be much more productive.
Equipping our patients with the proper tools and education to achieve proper oral health is essential to disease prevention. Increasing our own chairside knowledge of the proper way to maintain implants, as well as contraindications of product recommendations will allow our patients to have greater success in implant longevity. Patients invest a significant amount of time and money for an implant that a dental provider has recommended. As dental hygienists, we play an important role in providing preventive education to protect this investment. Let’s empower our patients to have gingival health and longevity of the implants they invest in!