To preserve the aesthetics and function of implant restorations for a long time, effective control of the bacterial biofilm is necessary during the various stages of implant treatment. The Ivoclar Vivadent Implant Care program has been devised to meet the specific requirements of bacteria control in complex superstructures. Products for professional use at the dentist's surgery and at home support the measures taken to ensure the sound condition of high-quality implants.
Ambitious goals
Bacterial biofilm and inflammatory processes in the oral cavity may endanger the implants and related superstructures. Effectively controlling bacteria and preventing inflammation in the mouth is therefore crucial. To achieve this, professional care in the dental practice and adequate measures at home must go hand in hand. For a treatment strategy to be promising, the special requirements that arise during the various treatment stages and from the complex structures and individual factors specific to each patient must be met.
The following structures need to be treated:
- complex structural components
- demanding peri-implant tissue
- existing natural teeth
- tooth replacements
- gingiva and mucous membrane.
Multiple goals have to be achieved in the process:
- preventing mucositis
- preventing peri-implantitits
- assuring the quality of the implant restoration
- preserving oral health
- maintaining oral function and aesthetics.
Coordinated concept
The Implant Care program from Ivoclar Vivadent specifically accommodates the special requirements that arise during all stages of implant treatment along with lifelong aftercare. The coordinated concept includes products for regular professional cleaning and targeted bacteria control. Ingredients, delivery form, handling and application of the Implant Care products are suited to the specific requirements of implant restorations.
Antibacterial mouth rinse
The bacteria count in the oral cavity needs to be reduced prior to the implantation stage. During this phase, the patient is usually advised to use an antibacterial mouth rinse for one or two days prior to the surgical procedure. Such a solution is usually applied immediately before each treatment also in the dental practice (fig 1). The ready-for-use mouth rinse Cervitec Liquid ensures optimum distribution of the active components in the entire oral cavity. The product contains 0.1 per cent chlorhexidine with xylitol and an essential oil. Cervitec Liquid is in no way inferior to products with a higher chlorhexidine concentration when it comes to bacteria control. Corresponding studies confirm a comparable effectiveness against a wide spectrum of germs. As a product's taste has a decisive influence on the success of a treatment, Cervitec Liquid provides a basis for ensuring patients will use the product over the entire treatment period (fig 2). The taste of Cervitec Liquid is much milder than that of other popular products, and this has a highly beneficial effect on patient compliance. Cervitec Liquid is a suitable alternative to products with a much stronger taste, which tend to cause unpleasant irritation of the mucous membrane. This is particularly important during the period immediately after implantation, when the wound should not be subjected to mechanical stress.
For the further course of treatment during the healing phase or after insertion of the superstructure, chlorhexidine may be administered in alternative ways, for instance as a varnish or a gel.
Protective varnish
The Implant Care program includes a varnish system for use in the dental practice. The protective varnish Cervitec Plus with one per cent chlorhexidine and one per cent thymol should be applied after professional cleaning of the superstructures and teeth. The varnish system effectively protects sites that are exposed to an increased risk by sealing them. Furthermore, the proven active ingredients reduce the count of harmful bacteria. Cervitec Plus exhibits excellent flow and wetting properties. Thus, areas which are difficult to access, for instance healing caps, anchors or bars, can be specifically treated (fig 3). As Cervitec Plus exhibits a relatively low sensitivity to humidity, the application is very time-saving. A thin clear coat of the varnish is applied to the surfaces and polymerized in just a few seconds; the clear varnish does not interfere with the aesthetics in the anterior region (fig 4). The concentration of the active ingredient is approximately 10 times higher when the varnish has dried. Patients should not rinse directly after the application to enhance the effect. The thin coat will not interfere with the snug fit of bar-retained restorations.
Weak spots on natural teeth or restorations should also be treated. Retention niches acting as a potential hideout for harmful bacteria can thus be controlled. Applying the varnish regularly in the surgery offers the benefit of professionally accompanying the measures to maintain implant restorations. Manual dexterity and/or patient compliance are often not sufficient to look after sensitive areas with the required accuracy.
At-home implant care
Professional supervision does not by any means make meticulous at-home dental care superfluous, particularly as the success of an implant restoration requires measures that go beyond normal dental care. An oral hygiene regimen including the application of Cervitec Liquid or Cervitec Gel containing 0.2 per cent chlorhexidine and 900 ppm fluoride supports the professional treatment. The accumulation of plaque and the harmful bacteria count are reduced and inflammation of the gingiva or mucous membrane subside.
The gel can be easily integrated into the daily routine; it can be applied directly on the gingiva, mucous membrane or the inner aspect of the removable denture. The special tube design with a thin nozzle facilitates the application on an interdental brush or dental floss. The smooth consistency of the gel makes it easier to apply in the interproximal areas (fig 5) or bar constructions. Tooth brushing with Cervitec is very easy: Simply use the gel instead of toothpaste in the evening (fig 6): the supply of fluoride is ensured. In the morning, the teeth should be brushed as usual with the normal toothpaste. If this regimen is observed, neither⇐ ⇔discolouration nor changes in taste are to be expected. As the rough surface of the tongue may act as a breeding ground for bacteria, patients should be instructed to distribute the gel with the tooth brush also on their tongue. Practical experience has shown patients perceive the taste of Cervitec Gel as much more pleasant than that of other chlorhexidine-containing gels. This is a crucial aspect which should not be underrated, as it promotes patient compliance and thus enhances the effectiveness of the treatment.
Professional cleaning
Regular professional tooth cleaning is an integral aspect of the dental treatment for patients who have received implants. Effective measures which prevent traumatisation of the sensitive tissue and maintain high-quality surfaces are required. Professional tooth cleaning is particularly gentle if the fine Proxyt prophy pastes are applied with a soft cup-shaped polisher, which adapts its shape to the individual surface structure (fig 7). The paste features a low Relative Dentin Abrasion (RDA) value of seven and contains xylitol. Unnecessary roughening and irritation of the gingival margin is prevented. If more stubborn tartar has formed, the more abrasive Proxyt paste with a higher RDA value of 36 is the appropriate choice. Finishing with the fine paste creates smooth surfaces which offer fewer contact possibilities for bacterial biofilm.
Disclosing of the biofilm
As the bacterial biofilm tends to form at sites where it is not easily recognised by patients and which are also difficult to clean, it is very handy to render problematic zones visible during the initial examination or when advising patients. The disclosing liquid plaque test is an easy-to-use and at the same time impressive tool for this purpose. The bacterial biofilm appears fluorescent when irradiated with any customary curing light, for example bluephase from Ivoclar Vivadent. Only the affected areas glow, which allows the problematic sites to be precisely localized (fig 8). Unsightly discolouration of the tongue, gingiva or mucous membrane does not occur.
Long term
The Implant Care products support the success of the implant restoration throughout all the stages of treatment and significantly contribute to the long-term quality assurance.
The most crucial aspect of the program is that it specifically takes the requirements of implant restorations into account.
References available on request.