by Karen Kaiser
Caring for landscape plants requires not only help from Mother Nature, but careful maintenance from a skilled gardener to help plants thrive. Recently deposited plants have special needs because their root systems are not fully established, and dry weather can rapidly dry them out. Until the roots broaden and settle into the soil, plants should not be overwatered, as this will lower soil oxygen levels and damage tender roots. Similarly, newly placed dental implants require special home care attention as they settle into their “new soil.”
Much like caring for new flora and foliage, hygienists have an important role in maintaining the landscape of newly planted dental implants. As the patient’s chewing function improves and the implant continues to integrate, the implant and its superstructures require special cleaning to ensure the “plant’s” success rate. The patient should make every effort to keep the “garden” clean through diligent home care. The peri-implant tissue surrounding an implant should be free of inflammation because the connective tissues have a reduced natural repair ability and lack a periodontal ligament to receive stimuli on occlusal traumatic forces. When patients present for implant maintenance visits, instruments designed specifically for the implant area will allow the clinician to help and not harm the area.
Maintenance Following Planting
At implant recare appointments, the doctor radiographically evaluates the successful biological bone integration and observable implant area tissues. When calculus and harmful bacteria collect on the implant’s collar, the hygienist can safely use instruments designed for implants to remove debris. Traditional steel scalers and curettes are not indicated for abutments made of titanium because stainless steel instruments may scratch the malleable surfaces and are not considered implant-safe. Standard metal scalers are made of a stronger stainless steel, and when placed on an implant’s soft titanium may unintentionally scratch the implant and provide an area for biofilm to harbor and build up. By and large, bacterial deposits do not attach firmly to the implant’s cuff. The implant has a smooth, nonporous titanium surface so deposits are removed more easily from the uniform surface. The hygienist should use the implant-safe instruments with gentle pressure and light strokes.
Hu-Friedy, which manufactures many dental hygiene instruments, has a line for implants called the Implacare system. The Implacare scaler handle is a familiar steel type with sturdy and removable white Plasteel TM twist tips. The Implacare system easily adapts to the curvature of the implant abutments and porcelain prosthetics without marring the titanium shaft. The twist-type tips are available in an assorted pack, or with H6/7, 204S and Columbia 4R/4L, which are twist-off and disposable. For a resharpenable option, try the Implant Prophy+ System by AIT Dental, which can be resharpened with the special ceramic stone supplied in the kit. Because the instrument is made of a high density material, sharpening will not dull it but will provide a sure edge to remove debris. The sturdy instruments are unlike most flexible plastic scalers because they are a polymer with a Gracey design, and are available in 5/6, 11/12, 13/14, and the Columbia 13/14.
Premier Dental also has a resharp enable which is constructed from carbon plastic. This black implant scaler is double-ended and has working ends tiny enough to maneuver and reach any intricate area of the titanium abutment. These are available in a universal 4L/4R Columbia design, as well as a type similar to a Goldman Fox curette for the facial. Ultrasonic instrumentation is possible with new insert entries for implants. Cavitron SofTip implant insert works around implants and offers water washing benefits through a disposable tip attached on the special insert’s tip. Another insert, the T.I.S. (titanium implant scaler) by Tony Riso Company has a reusable blue tip, with external water lavage from the insert to act on the implant.
Clinicians may safely polish implants by following the guidelines for polishing on natural dentition. A standard latex or nonlatex cup with a nonabrasive polishing paste is recommended. Clinicians should avoid medium to coarse grit paste and stick with either a fine, tin oxide, or the recommended cosmetic polish paste.
Taking Care of Plants
With the growing number of implants being placed, customized home care is a must. In many cases, the patient’s hygienist is part of the treatment planning prior to placement and therefore knows the oral care level the patient is capable of maintaining, and can suggest ways to keep the implant thriving.
Sunstar Americas has conveniently packaged this custom care all in one kit called the GUM implant care kit, which contains a postsurgical toothbrush with nondamaging gentle bristles for the newly placed implant, and a micro tip sensitive brush for the established implant. An End Tuft Brush and Proxabrush address spaces, while special Postcare floss removes plaque without damaging the posts. A Dual Action Tongue Cleaner and Rincinol complete the kit. The recently introduced Soft Picks, also by Sunstar Americas, are safe for implant use and feature a tapered design with 76 latex-free, rubbery-feeling bristles.
Another effective home care product is Sulcabrush, by Sulcabrush, Inc., a tufted bristle brush with angulation capable of working around the implant area. Waterpik Pik Pocket is also designed with implants in mind, and works with the Waterpik systems. The Proxi-Tip interdental tool by AIT Dental, which is totally plastic and boasts no metal, works well for multiple-placed implants. For floss-type recommendations, consider Thornton interproximal implant cleaners by Thornton International Inc.. These have firm threaders and brushy filaments to conform to the implant.
Implants are increasingly commonplace and all the rage. For an excellent implant landscape program, clinicians should select clinically fit implant scalers and exceptional home care devices with a nonscratching design. With the right maintenance equipment and proper protocol, implants will continue to take root and flourish.
The author did not receive compensation for products mentioned. For more implant information, visit www.hu-friedy.com, www.aitdental.com, www.premusa.com, www.sulcabrush.com, www professional.waterpik.com, www.tonyriso.com, www.thorntonfloss.com, www.jbutler.com, and www.dentsply.com.
About the Author
Karen Kaiser, RDH, graduated from St. Louis’ Forest Park dental hygiene program in 1994 and currently practices at the Center for Contemporary Dentistry in Columbia, Ill. She has written several articles for RDH and other publications, sits on dental hygiene panels, and is an evaluator for Clinical Research Associates. She can be contacted at [email protected].