CHAPTER 29 Maintenance and Hygiene
All implant patients must carefully follow a regimen of postinsertion orders. Most patients who request implants lost their teeth because of decay or periodontal disease. By habit, they may be among the least conscientious of patients. Therefore, before implant surgery, the dental surgeon must impress upon them the importance of home care and maintenance. Implants undergo tissue breakdown and bone loss more quickly than natural teeth. Patients who receive implants must show a voluntary change in behavioral pattern. They must be followed carefully to ensure that they continue to maintain the implants and prostheses. They also should be instructed to report any problems to their dentist promptly.
After both implant surgery and insertion of the prosthesis, appointments should be made to see the patient at 1, 2, 4, 12, and 24 weeks. (These time periods may be altered in light of the patient’s oral hygiene practices or other prevailing circumstances.) At recall appointments, the prostheses and their attachments are evaluated for function, esthetics, and stability, and they are removed and replaced if necessary. The implants should be examined radiographically for radiolucencies at least at 1-year intervals. Periapical and, when needed, panoramic films should be taken, following a standardized radiographic technique. The implants should be inspected for mobility at each recall appointment. If the prosthesis is the fixed-detachable type, the mesostructure bar or full superstructure prosthesis should be removed before the implants are assessed. An instrument handle can be used on the buccal and lingual surfaces of each implant abutment in a gentle attempt to rock the abutment back and forth.
Medizintechnik’s electronic mobilometer, the Periotest M (Fig. 29-1), is available through Salvin Dental Specialists (Charlotte, North Carolina). This instrument detects the level of mobility of root form implants. Readings from −7 to +18 indicate movement that is too imperceptible to be detected clinically. When mobility readings are +9 or above, implants with even the best of radiographic findings must be evaluated and treated.
FIGURE 29-1. A, Medizintednik’s Periotest mobilometer (Periotest M) consists of a wand that is used intraorally and a console that gives readings digitally and by electronic voice. B, For proper use, the wand must be parallel to the floor and placed at right angles to the implant or tooth in question.
The Periotest M offers a more reliable method of diagnosing implant status, because it measures subclinical mobility in a reproducible manner. It uses an ultrasonically vibrating probe to assess micromobility. The device has been used in a number of applications since it was introduced in 1983 to determine the periodontal status of natural teeth. It has proved an effective tool for evaluating implant stability from second-stage surgery through all subsequent stages of management. Some dentists have even claimed to use it to balance and fine-tune the forces of occlusion. In vitro evaluations of the Periotest M revealed no statistically significant difference in measuring perio test values (PTVs) from operator to operator. High levels of repeatability between different Periotest M units also have been shown.
However, the Periotest M often fails to detect saucerization of bone. Radiographs show the bone levels of implants more accurately. The Periotest M also does not detect bone loss until it is quite advanced.
Based on these findings, the Periotest M can be seen as a reliable tool for diagnosis of the stability of implants, and it also can be used to evaluate the salvageability of an implant with advanced bone loss. However, it fails to diagnose an implant with progressive bone loss, because its values are unchanged until the bone loss is virtually complete. Therefore, the information gained from the Periotest M must be combined with other clinically acquired information (e.g., periapical radiographs) to determine the true status of an implant.
Mobility is recorded as for natural teeth on a follow-up record form (see Appendix J). Tissue color and tone are inspected and recorded using the Löe and Silness index. Muhlemann’s index is satisfactory for recording any bleeding.
The sulcular oral flora found in the mouths of patients with periodontal disease has been isolated from the peri-implant environment. If saucerization or other bone loss is suspected to have affected implant host sites and />