implant maintenance.pptx

Implant Maintenance  Maintenance of functional implant Periodic evaluation of implants, surrounding tissue and oral hygiene, vital to the long-term success of the dental implant For the first year after treatment, recall maintenance visits should be scheduled at 3- month intervals and...

Implant Maintenance  Maintenance of functional implant Periodic evaluation of implants, surrounding tissue and oral hygiene, vital to the long-term success of the dental implant For the first year after treatment, recall maintenance visits should be scheduled at 3- month intervals and then adjusted to suit the patient's needs. Once the implants have been placed in the edentulous region routine maintenance, recall evaluations and radiographs are necessary to insure the long life of these restorations, and this need the team of dental implant specialists. These procedures are usually performed at selected intervals to assist the patient in maintaining oral implant health. With time, the emphasis for long-term success of implant has changed from a focus on the surgical phase of treatment to obtaining osseointegration and, now, recently, towards the long-term maintenance health of the peri-implant hard and soft tissues. The long-term success of implants is dependent upon both the patient's maintenance of effective home care and on the dental team's administration of professional prophylaxis procedures in the dental office. Examination of Implant I-Patient history II-Clinical examination III-Investigation and X-ray  Step by Step Medical and Dental History Look for changes in systemic risk factors (i.e. diabetes, smoking, medications) New restorations, missing teeth which may change occlusal relationships. Extraoral clinical examination Intraoral clinical examination oral soft tissue evaluation tooth mobility, fremitus, occlusion caries restorative factors (fracture or defective) other factors (open contacts)  Step by step Dental implant examination: Presence of plaque and calculus Probing depths Bleeding on probing Implant stability Occlusal evaluation Other signs and symptoms of disease. Radiographic examination (the level of the peri-implant crestal bone)  1- Evaluation of Biofilm Control Poor biofilm control is associated with peri-implant disease. Visually The importance of good oral hygiene should be stressed even before implants are placed, and peri-implant oral hygiene for biofilm control should begin as early as possible after the implant is exposed to the oral cavity.  Methods for Patient Oral Hygiene A cotton tip, cotton gauze, or soft toothbrush can be used to gently remove biofilm from healing abutments or provisional restorations during the early postoperative phase of healing. Before implant osseointegration, the use of powered toothbrushes should be avoided. The rubber tip stimulator can be used to stimulate blood flow.  AIRFLOW® is the unique approach for regular implant maintenance providing efficient and safe biofilm removal. AIRFLOW® with PLUS powder is minimally invasive with no risk of scratching implant surfaces, abutments or prosthesis. AIRFLOW® using PLUS powder is comfortable and safe around soft tissues.  2- Evaluation of Peri-Implant Health and Disease Peri-implant mucosal health is characterized by pink, firm, and well-adapted gingival tissue. Peri-implant disease is associated with clinical erythema, edema, and loss of tissue tightness around the implant. In the setting of keratinized, attached mucosa, a gingival seal or gingival cuff is established around the implant. However, the presence of keratinized, attached gingiva, which can facilitate oral hygiene, is not a requisite for periimplant health if biofilm is well controlled.  Peri-implant Probing Bleeding on probing at implant sites can indicate inflammation in the peri-implant  Scaling Removal of dental biofilm and calculus from implant components exposed to the oral environment. All metal instruments, including metal curettes and scalers, and ultrasonic scalers increase the surface roughness of polished titanium. The use of plastic, Teflon-coated, and carbon and gold- coated curettes and nonmetal ultrasonic tips. Titanium implant scalers  Polishing The prosthesis and abutments may be selectively polished with a rubber cup and nonabrasive polishing paste such as aluminum oxide, tin oxide, acidulated phosphate sodium fluoride (APF) -free prophy paste, and low abrasive dentifrice after hard deposits have been removed  3- Stability Measures The assessment of implant stability or mobility is an important measure for determining whether osseointegration is being maintained. An implant can exhibit significant bone loss and remain stable. Conversely, if implant mobility is detected, it is likely that the implant is not surrounded by bone; Mobility is highly specific for the detection of implant failure or lack of osseointegration.  3- Stability Measures Two noninvasive techniques for evaluating implant stability are impact resistance (e.g., Periotest) and resonance frequency analysis (RFA). Originally designed to evaluate tooth mobility quantitatively, the Periotest is a noninvasive electronic device that provides an objectaive measurement of the reaction of the periodontium to a defined impact load applied to the tooth crown.  3- Stability Measures Another noninvasive method used to measure the stability of implants is resonance frequency analysis , which uses a transducer that is attached to the implant or abutment. A steady-state signal is applied to the implant through the transducer, and the response is measured. An increase in RFA value indicates increased implant stability, whereas a decrease indicates loss of stability. Mobility remains the cardinal sign of implant failure, and detecting mobility is therefore an important parameter.  4- Implant Percussion Tapping an implant's healing abutment or restoration with an instrument produces a sound that can help determine its osseointegration. A solid resonating sound and the absence of pain usually indicate osseointegration. A dull sound can indicate that the implant is fibrous encapsulated  5- Evaluation of Implant Restorations Implant superstructures, and restorations should be fabricated to accommodate and facilitate oral hygiene (embrasure spaces made to allow passage of a proxy brush) After delivery, cement retained implant restorations should be thoroughly evaluated for residual excess cement, which must be removed.  5- Evaluation of Implant Restorations During follow-up visits, implant restorations should be carefully examined for heavy contacts, fractures, loose screws. Occlusion should be adjusted accordingly to prevent implant overload and fractures of implant parts. In patients with oral parafunctions and heavy occlusal forces, occlusal guards are recommended to protect implants and restorations. 6- Radiographic Examination Intraoral periapical radiographs should be taken at implant placement, at abutment connection, and at final restoration. The radiographic examination remains one of the primary tools for detection of failed or failing implants in routine clinical evaluations. To monitor marginal or peri-implant bone changes. Periapical radiographs have excellent resolution and, when taken perpendicular to an implant, can provide valuable details  Peri-Implant Mucositis and Peri- Implantitis Peri-mucositis is the inflammatory reaction of the soft tissues surrounding an implant, with no signs of loss of supporting bone. This reversible condition is clinically characterized by the presence of bleeding on probing and/or suppuration, which are usually associated with probing depths ≥4 mm. Peri-implantitis has been described as a destructive inflammatory process around an osseointegrated implant that leads to peri- implant pocket formation and progressive loss of supporting bone.  Peri-Implant Mucositis Peri-implant mucositis can be effectively treated with nonsurgical mechanical therapy. Treatment requires complete removal of supramucosal and submucosal biofilm, calculus, and deposits using curettes, ultrasonic scalers, and polishing cups with prophy paste. Antimicrobials (e.g., chlorhexidine irrigation, mouthrinse) can be used with mechanical debridement to enhance treatment outcome.  Peri-Implantitis The treatment of peri-implantitis includes nonsurgical and surgical interventions Nonsurgical interventions consist of antimicrobial rinse and irrigation, local antibiotics, ultrasonic debridement, mechanical debridement. Surgical treatment includes full-thickness flap elevation for access, followed by degranulation, surface debridement by mechanical instruments, surface decontamination with laser or antimicrobials, and bone augmentation. for peri-implantitis is most effective or to allow specific recommendations for the use of locally or systematically administered antibiotics.