Dentists know that dental implantation is a complicated and multistage process. A key factor for the success of the operation is the responsibility of the doctor and patient. Its insufficiency can cause the most unpleasant disease – peri-implantitis, and, as a consequence, an implant failure. Unfortunately, many patients often neglect oral hygiene and are confined to standard procedures.

Fig. 1. Graphic representation of peri-implantitis

Why is hygiene so important?

It a well-known fact that the gingiva consists of the connective tissue and keratinized epithelium (mucosa). Lack of the latter leads to the hypersusceptibility to pathogenic bacteria. That significantly increases the risk of peri-implanititis.

Fig. 2. Inflamed gingival tissue around the inserted implant

Neglecting oral hygiene after implantation leads to the lack of keratinized epithelium. It results to the exposure of the implant-abutment connection, bone tissue decreases.

Fig. 3 Exposed implant-abutment connection with the loss of bone tissue

That is why the main task of the dental surgeon (or hygienist) is to give the patient appropriate instructions for saving the keratinized mucosa and maintaining a healthy oral cavity.

Fig. 4. Healthy gingivae

Fact: Gingival tissue that surrounds the implant must be pink, hard, keratinized and have no signs of infection.

Items of care in case of implantation and dental prosthetic

The main rule is to follow doctor’s instructions. That means to start taking care about oral hygiene well ahead long time before the operation, maintain it on the surgical and orthopedic stages and not to neglect it in the following months and years.

A life service of implants depends directly on the quality of the oral hygiene. Many dentists have faced the cases of the peri-impaltitis after 10 or even 20 years of the implant life service. The most widespread cause is neglecting the hygiene.

Oral care before implantation

At the preparatory stage, it is recommended to maintain hygiene as carefully as possible, because a sterility in the implantation area is an important condition for the operation. That is why it is advisable to clear the enamel from plaque and dental tartar. Apart from mechanical methods (professional and daily dental cleaning), an antimicrobial therapy can be prescribed.

Fig. 5. Schematic representation of a dental plaque composition

An early postoperative period

The most important thing at this stage is not to irritate the oral mucosa and to maintain its condition.

• • Taking antibiotics and pain medications;
  • Diet: soft and liquid food that does not damage the mucosa. Strictly kept the first 2 weeks after the operation.
  • Obligatory care of the dentures with the help of a special brush with very soft bristles.
  • Very careful tooth brushing 2-3 times a day.
  • Use of oral antiseptic – foam, spray or rinse.

Fig. 6. High care zones – areas of adjacency of the prosthesis and its surfaces

Post-implantation care in the following years

Taking care of the prosthesis still differs from taking care of natural teeth even after the implant success. If neglecting a special hygiene protocol, the risk of peri-implantitis increases because of the constant accumulation of microorganisms. The same factor can also damage adjacent teeth.

Fig. 7. A standard kit for oral care after prosthesis

Important: the most accurate care is needed in the morning and in the evening, as the saliva secretion decreases at night (saliva has an antibacterial effect).

Standard set of post-implantation hygiene rules:

• Everyday teeth cleaning with the help of special brushes and toothpastes in the morning and in the evening.
• Teeth cleaning after every meal with the means of dental floss thread, floss or antibacterial rinse.
• Using irrigators after every teeth cleaning.
• Dentist’s examinations at least once every 6 months.
• Professional hygiene at the dentist – once every 6-12 months.

Oral care and hygiene products in the post-implantation period

Important: Every good post-implantation care product obligatory includes chlorhexidine or other effective antiseptic.

Toothpaste

A special toothpaste is used in order to remove a bacterial plaque and for a simultaneous denture antiseptic cleaning. For the effective cleaning the paste is applied to the dental floss. An ordinary toothpaste is not recommended, as it can damage the surface of crown dentures. During the planned visits to the dentist, a special protective paste is applied to the teeth.

Fig. 8. Toothbrush and paste for dental prostheses cleaning

Toothbrush and interdental brushes

Special soft toothbrushes which are appropriate for cleaning artificial ceramics are also used for cleaning prostheses on the implants. The second stage is an interdental cleaning with the use of interdental flosses or floss threads. It is recommended to use them after every meal.

Fig. 9. Individual interdental cleaning after implantation with the use of floss

Irrigators

This is a tool for cleaning the area near gingivae and interdental spaces with the help of a directed water jet. Advantages are the soft and effective removing uneaten food and microbes as well as gingivae massage, which contributes to the normal blood circulation.

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Fig. 10. Cleaning teeth with the help of irrigators

Dental magnifying mirror

The obligatory condition for a good hygiene is a regular oral examination. Dentist’s examinations are not enough that is why a magnifying mirror should be rightly used.

Fig. 11. A magnifying mirror for the individual examination

Bio3 Care Foam

Foam can effectively clean the oral cavity and contributes to its regenerative process. Its advantage over spray is hidden in its ability to enter microholes. That is why it accurately cleans the oral cavity from bacteria, microbes and microorganisms that can cause inflammation, peri-implantitis and implant failure. In its turn, it simplifies postoperative period and reduces recovering terms.

Foam or spray are especially important, if it is impossible to use oral rinses due to the results of recovering process of a dental arch. These means have a low abrasiveness and the teeth enamel is not damaged.

Bio3 Care Foam is acknowledged by the Association of Dental Implantologists as the best dental care product after implantation.

Fig. 12. Perfect gingiva condition in 2 months after implantation with the use of Bio3 Care Foam for oral care

Our verdict

Insufficient attention to the hygiene and neglecting doctor’s advice is the most widespread cause of peri-implantitis and implant failure even after a long life service of the installed dental system. That is why it is important to take accurate prophylactic measures with the patient. It deals not only with the preparation for operation, but also with the communication. Provide the patient with all the required materials about hygiene, show him or her all the examples of the neglected cases and help to choose all the available care products.