Dr. Gregori M. Kurtzman, along with Debbie Zafiropoulos, discusses in-office and at-home dental implant care
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mplant maintenance requires both professional services (routine recall appointments) as well as good home care by the patient to minimize issues related to biofilm accumulation and the resulting peri-mucositis that can result. Cleaning of implants and their prosthetics need different approaches than natural teeth and their prosthetics.
Professional cleaning of instrumentation: an overview Instruments made of metal such as stainless steel should be limited to use on natural teeth and not to probe or scale dental implants. The rationale for this well-documented conclusion is that the hardness of this metal can cause scratches, contamination, or a galvanic reaction at the implantabutment interface.1,2 Ideally, hand periodontal scalers for cleaning dental implants can be made of plastic, Teflon™, gold-plated, or wood (Figures 1 and 2).3,4 When using gold-plated curettes, the manufacturer recommends not sharpening these hygiene instruments, as the gold surface could be chipped exposing the hard metal underneath this coating. Stainless steel scaling instruments may abrade the implant surface, stripping off any surface treatment such as hydroxyapatite (HA) as the instrument’s hardness is greater than the titanium alloy the implant is fabricated from (Figure 3). Other cleaning armamentarium contraindicated for use with dental implants are air
Educational aims and objectives
This self-instructional course for dentists aims to show information and techniques regarding maintenance of implants for both in-office and at-home processes.
Expected outcomes
Implant Practice US subscribers can answer the CE questions by taking 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 different instrument materials that reduce damage to dental implants.
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Realize the positive role disclosing solutions can make on biofilm education.
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Recognize the importance of implant education for patients with implants.
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Identify some characteristics of air-polishing technology.
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Identify some at-home care products that have benefits for dental implants.
powder abrasive units, flour or pumice for polishing, and sonic and ultrasonic scaling units.5,6 Ultrasonic, piezo, or sonic scaler tips may mar the implant’s surface leading to microroughness and plaque accumulation. The stainless steel tip may also lead to gouging of the implant’s polished collar (Figure 4). However, some clinicians advocate using a sonic instrument with a plastic sleeve over the tip for scaling dental implants. Air powder polishing units may also damage the implant surface and should be avoided during hygiene appointments (Figure 5). Even the use of baking soda powder in these units may strip off any surface coating on the implant. Additionally, the air pressure may detach the soft tissue connection with the coronal of the implant possibly leading to emphysema. Titanium or titanium alloy surfaces of dental implants can be polished
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 sought-after 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.
Volume 14 Number 2
Figure 1: Plastic curettes for scaling dental implants and demonstration of the implant surface after use. Note: No alteration to surface of the implant
Figure 2: Plastic scaler used for recall maintenance
Figure 3: Demonstration of surface alteration of implant surface after use of stainless steel scalers. Note: Alteration to surface texture
Figure 4: Demonstration of gouging of the implant surface that may occur following use of an ultrasonic scaler Implant practice 21
CONTINUING EDUCATION
Oral hygiene and dental implant maintenance: part 2