Dental implants are possibly the best solution for replacing lost teeth. In the absence of one’s own teeth, inserting new dental roots (implants) in the maxilla is the most natural, reliable, comfortable and aesthetic way to once again benefit from a fixed dentition. Dr. J. Cambra

Implantology is considered to be a major breakthrough in modern dentistry. One of the biggest challenges we face today is getting implants to remain in the mouth for long periods of time.

The most common problems implants can have once integrated are peri-implant diseases: peri-implant mucositis and peri-implantitis. Mucositis involves inflammation of the soft tissues and mucosa surrounding implants, without signs of bone loss; its progression to peri-implantitis involves inflammation of the tissues surrounding implants along with bone loss, which ultimately could lead to the loss of the implant.

Evidence exists proving that biofilms are the main causal factor of peri-implant
disease. 

Maintenance and monitoring 

Once implant-prosthetic treatment has been performed, patients should carry out maintenance and monitoring to ensure treatment success and retain implants throughout their lives.

This maintenance programme has two main parts:

1.   Regular check-ups (every 6 months or even quarterly) with your dentist / hygienist for removing dental plaque build-up (oral biofilm), prosthetic surface polishing and examination of the tissues surrounding implants and prostheses.

2.   Proper daily oral hygiene at home to control dental plaque (oral biofilm). For this, patients need to have the following tools:

- Specialised toothbrushes designed to disrupt dental plaque on implants with the utmost precision in order to access the peri-implant sulcus. Depending on the area of the implant that needs to be accessed, we find: brushes with an angled handle neck, increasing accessibility to the implant, providing more efficient hygiene in areas that are normally hard to clean, such as the internal side of the anterior and posterior sections of the dental arches; sulcular brushes, with a linear, narrow brush head and soft filaments arranged in two rows that facilitate cleaning the gum line; monotuft brushes for implants, making it easier to access very small spaces that require detailed cleaning and maximum precision in prosthetic implant rehabilitation; and brushes with small brush heads and extra-soft filaments designed for delicate but thorough daily cleaning of mouths with implants, where gums require special care.

- Oral irrigation, considered an adjunct to toothbrushing, includes direct application of pulsating stream of water or other solution (chlorhexidine, cetylpyridinium chloride) enhancing the removal of oral biofilm that accumulates under bridges, around implants, crowns or fixed hybrid prostheses. The use of oral irrigators with chlorhexidine subgingivally has been proven to be effective in maintaining implants.

To eliminate biofilms from interproximal spaces, the use of dental floss and tape is also indicated. When bridges or full-arch prostheses are present, a dental threader is needed to help guide the floss or tape between the prosthetic spaces and the gums.

Interproximal brushes, because of their variety of sizes (diameter) and shapes (cylindrical or conical), can access the different spaces between your teeth.

To compliment mechanical removal of biofilm, adjunctive use of chemical agents (toothpastes and mouthwashes) is important.

Formulations containing chlorhexidine  + cetylpyridinium chloride are indicated for greater oral biofilm control and those containing 0.05% of cetylpyridinium chloride are indicated for maintenance. Antiseptics can inhibit biofilm growth and therefore ensure healthy plaque levels.