CONTINUING EDUCATION
Oral hygiene and dental implant maintenance: part 1 Dr. Gregori M. Kurtzman, along with Debbie Zafiropoulos, discusses appropriate professional care and effective patient oral hygiene for maintenance of implants Introduction Implant usage has become a common treatment modality in dentistry as a predictable long-term replacement of single teeth or full arches demonstrating restoration success.1-3 As the number of patients selecting dental implants as a treatment option continues to grow, the dental team must accept the challenges of maintaining these sometimes complex restorations. Those maintenance challenges also involve the patients and their home care. Proper monitoring and maintenance are essential to ensure the longevity of the dental implant and its associated restoration through a combination of appropriate professional care and effective patient oral hygiene.4,5 So, maintaining implants is a double-edged sword with the dental team and patient both contributing to its long-term success or failure. The value of using conventional periodontal parameters to determine peri-implant health is not clearly evident in the literature.6-8 Therefore, it is paramount that the dental implant team understands the similarities and distinctions between the dental implant and natural tooth. Subsequently, by examining the similarities and differences between a natural tooth and a dental implant, basic guidelines can be provided for maintaining the long-term health of the dental implant. Direct anchorage of alveolar bone to a dental implant body provides a foundation to support a prosthesis and transmits
Educational aims and objectives
This article aims to show the dental team’s challenges of maintaining implants and involving patients in the home care process.
Expected outcomes
Implant Practice US subscribers can answer the CE questions on page 27 or take the quiz online at implantpracticeus.com to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can: •
Identify some causes of peri-implant diseases.
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Realize the similarities and distinctions between the dental implant and natural tooth to provide basic guidelines for maintaining the long-term health of the dental implant.
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Realize how hygiene treatment, especially in certain areas, is integral to maintaining the implant.
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Realize scheduling needs for a hygiene re-care schedule depending upon the reason for and timing of the implant.
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Realize some differences in the connection of natural teeth or implants to the surrounding tissues for assessment of periodontal health.
occlusal forces to the alveolar bone. This is the definition of osseointegration.9,10 With the common acceptance of dental implants today as a viable and routine treatment option for the restoration of a partially edentulous or fully edentulous mouth, the dental team is faced with maintaining and educating those patients. Recently, the focus of implant dentistry has changed from obtaining osseointegration, which is highly predictable, to long-term maintenance and health of the peri-implant hard and soft tissues. This can be achieved through appropriate professional care, patient cooperation, and effective home care.11-14 Since frequently the tooth or teeth are lost due to a lack of patient maintenance, the goal is to prevent old habits from
Gregori M. Kurtzman, DDS, MAGD, FPFA, FACD, FADI, DICOI, DADIA, is in private general practice in Silver Spring, Maryland. He is a former Assistant Clinical Professor at University of Maryland in the department of Restorative Dentistry and Endodontics and a former AAID Implant Maxi-Course assistant program director at Howard University College of Dentistry. He has lectured internationally on the topics of restorative dentistry, endodontics, implant surgery and prosthetics, removable and fixed prosthetics, and periodontics. Dr. Kurtzman has over 750 published articles globally. He has earned Fellowship in the AGD, ACD, ICOI, Pierre Fauchard, ADI, Mastership in the AGD and ICOI, and Diplomate status in the ICOI and American Dental Implant Association (ADIA). A consultant and evaluator for multiple dental companies, Dr. Kurtzman has been honored to be included in the “Top Leaders in Continuing Education” by Dentistry Today annually since 2006. He can be reached at dr_kurtzman@maryland-implants.com Debbie Zafiropoulos, EFDA, RDH, is the CEO of the OralED Institute, a Partner in Education for the Wellness Dentistry Network, an instructor with MoradoASC, and certified GBT Trainer for EMS-NA. Zafiropoulos works with top corporate companies in health, creating and delivering live and online educational programs to a worldwide audience. As a soughtafter key opinion leader and author, she is determined to deliver programs of forward motion in prevention, science, and technology. In 2016, Zafiropoulos was a recipient of the SUNSTAR Award of Distinction. In 2017, she was recognized as one of the Top 25 Women in Dentistry for her advances in research and prevention of HPV-related oral cancer.
22 Implant practice
re-emerging that could lead to periodontal issues around the implant and its potential loss. Patients must accept the responsibility for being co-therapists in maintenance therapy, so the dental team essentially must screen the potential implant patient.
Peri-implant challenges Peri-implant diseases are prevalent, and prevalence of peri-implantitis increases over time. These might not be highly associated since the instances are influenced by distinct variables, which can include changes in the patient’s systemic health, the patient’s medications, and changes in the patient’s home care or ability to maintain oral hygiene.15 Periimplant disease affects a significant number of implants. It is important to understand the difficulties in diagnosis of these diseases and risk factors, so that they may be modified to reduce the potential for disease occurrence or progression. Diagnosis and treatment planning based on a risk-benefit analysis should be performed subsequent to a comprehensive medical, dental, head-andneck, psychological, temporomandibular disorder, and radiographic examination.16 Convincing evidence exists that bacterial plaque not only leads to gingivitis and periodontitis,17,18 but also can induce the development of peri-implantitis.10 Thus, personal oral hygiene must begin at the time of dental Volume 14 Number 1