Reducing the likelihood of peri-implantitis

14 December 2022

Charmaine Matthew explains the essentials behind good oral care.

As a dental professional, preventing complications is always key to successful treatment outcomes and patient satisfaction. Because of this, teaching your patients excellent oral hygiene techniques, and monitoring their hygiene at regular appointments is a priority. This is particularly important for patients who have gingivitis, periodontitis or who are receiving dental implants.

With the popularity of dental implant treatment rapidly increasing, it is more important than ever for clinicians to understand how to prevent complications from developing. Dental implants are often chosen as they provide a long-lasting solution for missing teeth, but they will need appropriate care and maintenance for successful osseointegration.

Bacterial plaque and peri-implantitis

In a healthy mouth, plaque and soft tissues maintain a balance. However, changes during the disease process transform healthy dental plaque into a pathogenic biofilm. When bacterial plaque is allowed to build up, microbial homeostasis can break down. This change in the mouth means ecological stability is disrupted and, consequently, disease develops. Major ecological pressure alongside a low pH, sugar-rich diet, as well as a low saliva flow create the perfect conditions for disease progression. An obvious symptom of oral disease is inflammation of the soft tissue in response to bacterial plaque. Gingival crevicular fluid is increased in response to the inflammation of the periodontal tissues – this leads to a rise in the local pH, which in turn allows bacteria to grow even more.

Bacterial plaque not only causes gingivitis and periodontitis, but can also lead to the development of peri-implantitis. As well as this, a previous history of periodontitis, poor oral hygiene, and smoking are considered potential risk factors for peri-implantitis development. Peri-implant diseases are common, with between 28 per cent and 56 per cent of patients developing peri-implantitis. So clinicians should be sure patients are aware of the need to remove plaque effectively and look out for any signs of inflammation, gingival bleeding and pus, as well as pain, which may indicate peri-implantitis development.

The impact of the dental team and patient

Preventing peri-implantitis always needs to be a collaborative effort between the dental team and the patient. Ensure that your patient feels as if they are part of a project which aims to achieve lasting oral health and prevent infection. If they feel that a rigorous cleaning routine is achieving something, even if they cannot see immediate results, they will be more likely to keep it up.

Dental hygienists in particular are crucial in the prevention of like peri-implantitis – promoting and improving the oral health of individuals, families, and groups in society. Mechanical debridement and oral hygiene instruction provided by dental hygienists are crucial in the treatment of peri-implant diseases, however, clinicians should also see whether the implant retained crown or prosthetic allows sufficient access for optimal at-home hygiene. Follow up appointments for patients with dental implants are vital for monitoring oral hygiene and peri-implant diseases.

So, while the dental team plays a key role in the guidance of implant stability after osseointegration, the proper maintenance of the peri-implant soft tissue, and therefore the prevention of peri-implantitis is predominantly in the hands of the patient. It may be useful to place affected patients on a supportive therapy programme to aid their implant placement recovery and schedule regular dental appointments for the professional removal of biofilm deposits from implant sites. And, prevention is often simpler than treatment, so maintained support should begin from the time of dental implant placement, and should be long-lasting. For many patients, it may be helpful to recommend tools for use in conjunction with their brushing and interdental cleaning, such as interproximal brushes, and oral rinses containing chlorhexidine for enhanced cleaning.

Targeted prevention

To elevate patients’ oral hygiene routines, particularly when recovering from dental implant placement, you can recommend that they use the Curasept ADS Implant Pro Oral Rinse – available from J&S Davis. Its anti-bacterial, anti-inflammatory and anti-plaque formula contains 0.2 per cent chlorhexidine and is effective at protecting implants from the build-up of plaque. It also boasts of the patented Anti Discolouration System – to dramatically reduce the risk of staining.

Post-dental implant placement, it’s crucial to ensure the proper preventative methods are in place for successful integration and to minimise the risk of developing peri-implantitis. The dental team have an important role to play in preventing infection by educating the patient on proper oral hygiene while monitoring signs of peri-implantitis. However, the patient must maintain high standards of oral hygiene at home for successful outcomes. Ensure your patients are effectively removing plaque from their mouths, especially around the implant site. An oral rinse is a fantastic addition to your patients’ oral hygiene routines, providing an extra layer of protection from peri-implantitis development.

References available on request.