Survey: Dental hygienists’ use of hand scalers for implant maintenance
Editor's note: Read Lynn's previous survey results articles.
Survey: RDH understanding of air polishers and powders for implant maintenance growing
Survey: Implant boom outpaces hygiene education and training
The dental implant practice experiment continues with a variety of players who have a variety of different experiences. What we choose to use for dental implant maintenance is based on what was presented during our formal education, our employer's education, whether our practice has an implant specialist with extended formal training on implants, and continuing education.
Product choices for implant maintenance can be based on the relationship between an office and its sales representatives. This may be directly related to the sales representative's education and experience, as the dental team will relate to the products for implant maintenance in their sales representative's product line. Some product reps will offer access to dental implant maintenance education and have a better understanding than others.
Metal versus plastic
Plastic scalers are inexpensive and an easy choice for buyers who are not informed about the current protocol for implant maintenance. At one time, plastic scalers were considered the instrument of choice for implant maintenance. There is concern about the use of metal scalers producing defects in titanium implant surfaces. However, all scalers of all compositions, metal or plastic, caused detectable surface changes to polished surfaces of implant abutments.1
Reported to be ineffective in removing biofilm, unfilled resin has consistently been found to be the least damaging to abutment surfaces.1 Plastic-coated scalers can leave plastic deposits behind on the implant surface.2 This plastic residue is not biocompatible with the titanium implant and may lead to the collection of biofilm and inflammation.
Plastic scalers lack the strength to efficiently remove calcified deposits or cement and are no longer considered the instrument of choice in comparison to air polishers and implant-safe ultrasonic/piezo scalers.
The comprehensive breakdown
Plastic scaler: 42% (174 of 413 hygienists) use this nonmetal option, at one time valued for its gentleness on titanium dental implant surfaces. Among 174 who reported using plastic scalers, 52 (90) report plastic scalers to be effective for biofilm removal; 10% (17 respondents) find it not effective, often citing inadequate debridement; and 38% (66 people) offer no opinion, suggesting uncertainty or limited feedback.
Graphite/carbon scaler: 20% (83 of 413 hygienists) report using this one-time popular alternative to plastic scalers. This softer metal became popular due to the reduced risk of scratching dental implants. Among the 83 who reported using graphite scalers, 96% (80 people) find it effective, and 4% (three people) find it not effective.
Stainless steel scaler: 28% (116 of the 413 hygienists) report using the same stainless-steel instruments they use on natural teeth on dental implants. Among the 116 who reported using stainless steel, 95% (110 people) find it effective, and 5% (six people) find it not effective.
Titanium scaler: 51% (210 of the 413 hygienists) report using titanium instruments on dental implants. Among the titanium scaler users, 95% (199 people) find it effective, and 5% (11 people) find it not effective.
Comparison with historical data
In 2020, Zelmer et al. surveyed 1,646 hygienists on dental implant maintenance protocols.3 Sixty percent (987 hygienists) reported using plastic scalers. Of the 987, 7% (69 people) reported feeling the plastic scaler was effective in removing biofilm.3
There is a significant difference in hygienists' reporting effectiveness in removing biofilm with plastic scalers between the two surveys. This may be related to how the questions were interpreted when filling out the survey, or whether the hygienists who reported using plastic scalers had experience removing calculus or cement on an implant with a plastic scaler.
Education is the driving force behind safer clinical choices and the adoption of biocompatible instrumentation. In the 2024 survey, 57.4% of dental hygienists (278 out of 413) reported receiving formal training in implant maintenance.
The majority of survey participants graduated between 2015 and 2024 and were educated on the risks and limitations of plastic scalers in their curriculum. This shift in education directly influences instrumentation selection and clinical outcomes.
In the 2024 survey, 42% (207 out of 413) reported having no formal implant training, which may contribute to continued use of plastic scalers.
Titanium scalers: Usage increased to 51%, reflecting growing awareness of titanium’s biocompatibility and safety for implant surfaces.
Plastic scalers: Usage dropped from 60% to 42%, while reported effectiveness in this 2024 survey rose to 52%.
The difference in the two surveys
The inspiration for the 2024 survey was to compare data and demonstrate the growth of trends for implant maintenance. In the 2020 survey, 5% (82 of the 1,646 hygienists) reported using air polishers, with 71% (58 of the 82 respondents who used air polishers) reported finding the use of air polishers effective.
In 2020, the article highlighted use of plastic scalers dominated at 60% (987) with a reported 7% of respondents finding plastic scalers to be effective, and ultrasonic scalers were used by 51% (839), with 87% effectiveness, showing a reliance on traditional tools. Air abrasives agents like baking soda, erythritol, and glycine were not detailed in this article.3
The 2024 data mark a significant shift from the 2020 results. The 2024 study reports a higher concentration on the reporting of the use of air polishers and reporting higher effectiveness compared to 2020.
Dental implants have become the standard of care for tooth replacement. It is common for hygienists to express frustration and confusion relating to implant maintenance because there is no standard for education on dental implant maintenance.
Dental hygiene students do not see many patients with implants during formal training. It is my suggestion that state boards mandate education on dental implant maintenance as part of license renewal.
References
1. Hasturk H, Nguyen DH, Sherzai H, et al. Comparison of the impact of scaler material composition on polished titanium implant abutment surfaces. J Dent Hyg. 2013;87(4):200-211.
2. Mann M, Parmar D, Walmsley AD, Lea SC. Effect of plastic-covered ultrasonic scalers on titanium implant surfaces. Clin Oral Implants Res. 2012;23(1):76-82. doi:10.1111/j.1600-0501.2011.02186.x
3. Zellmer IH, Couch ET, Berens L, Curtis DA. Dental hygienists' knowledge regarding dental implant maintenance care: a national survey. J Dent Hyg. 2020;94(6):6-15.
About the Author
Lynn Pencek, MS, RDH
Lynn Pencek, MS, RDH, has a unique balance of industry knowledge and clinical experience. As a member of the Nobel Biocare team, she helped dental implant teams develop efficient patient care workflows. As a dental hygienist, Lynn wanted to unravel the common questions and misunderstandings dental hygienists have about implant care and maintenance. She is the founder of Practice at Your Best, Learn more at practiceatyourbest.com or contact her at [email protected] .