Regular periodontal maintenance is absolutely essential for preserving teeth, but also for increasing the success of implant placement and its therapy. Read the main takeaways from Curaden Academy’s webinar The art of perio-implant maintenance by Dr. Javier Rojas, and his answers to questions from the audience about periodontal therapy.
Dr. Javier Rojas is a private-practice dentist, researcher and lecturer who focuses on prevention, periodontal plastic surgery and implantology. In his lecture for the Curaden Academy he spoke about:
- periodontal maintenance options
- how efficient SPT (supportive periodontal therapy) is for implants
- how often dentists should see their patients
- what the risk factors are
- clinical cases
- how problems can be prevented
Dr. Javier Rojas stresses the need for professional support after every implant treatment. “Long-term effectiveness relies on the maintenance of an equilibrated ecosystem compatible with healthy clinical parameters. The balance is difficult to maintain by the patient, so there’s a need for regular SPT (supportive periodontal therapy). Good compliance of SPT promotes plaque and bleeding reductions, minimises progressions, reduces tooth loss and reduces the recurrence of periodontal disease,” Dr. Rojas sums up.
According to the research, SPT has a really high impact on the health and durability of a mouth with implants. “The role of SPT is well-documented to prevent peri-implant diseases and to prevent biological and mechanical complications,” Dr. Rojas says.
The most common risk factors for biological complications on a patient’s level are poor oral hygiene, lack of supportive care, residual periodontal pockets, history of periodontitis, tobacco use and diabetes. “Research shows that poor oral hygiene indicates 14 times more risk factors of biological complications,” Dr. Rojas says.
How can the problems be prevented?
Nowadays there are plenty of tools for home oral care, which patients with implants should use daily. There are toothpicks of various materials (plastic, silicon, wood), floss, water flossers and interdental brushes.
“Based on the evidence – including a meta review by Sälzer – the gold standard for cleaning interdental spaces are interdental brushes. The good thing about using interdental toothbrushes is that they have a cleaning radius. Implant and perio interdental toothbrushes have a bigger radius than ordinary interdental brushes. They are great tools for cleaning implants,” says the expert, who also advises using a special probe with colour coding to define the correct size of interdental brush for every patient.
According to Dr. Rojas, the secret to preventing problems is ensuring patients have a precise home oral-care routine. “If we want to succeed in our patients maintaining implants or teeth and having healthy gums, we need to do regular scalings plus provide the patient with oral hygiene instructions during every recall. The patient needs to have the skills to use a toothbrush and an interdental brush very well.”
For the patients having problems following the instructions of mechanical plaque control, chlorhexidine mouthwashes can be recommended. “We have high quality evidence indicating a large reduction in plaque when chlorhexidine is used as an adjunct to oral hygiene procedures,” Rojas says.
“People older than 70 years who may have problems with fine motor skills and can’t clean their teeth properly can use a water flosser or implant floss. If not, we can still adjunct a chlorhexidine protocol.”
According to protocols, 0.12% CHX is recommended to be used twice a day for a period of 7 to 14 days, or 0.05% CHX twice a day for 1 to 6 months.
Five questions for Dr. Javier Rojas
In the Q&A session of the webinar, dental professionals from all over the world raised various questions. We have selected some of those most relevant to perio-implant maintenance, along with Dr. Javier Rojas’ responses.
How much time do you spend on giving oral hygiene instructions to your patients?
The first time I see a patient I spend about 30 minutes on oral instructions. During the next appointments I spend about 10 minutes changing their techniques, correcting some mistakes. We don’t have to teach everything again, we just need to adjust the technique.
What are your thoughts on using ultrasonics around implants?
Is peri-implant treatment predictable? The answer is no. But the evidence says we need to try everything: curettes, polishing, using air abrasion, antibiotics and also ultrasonic devices. Simply because we don’t have a predictable protocol for treating peri-implantitis yet.
Do you do irrigation on implants?
As I said – try to use everything because we don’t have one predictable protocol for treating peri-implantitis. We have a lot of evidence on the benefits of using chlorhexidine, citric acid, tetracyclines and other irrigations. There are many innovations, but not much evidence on which one is better. So we need to use everything that we have in our treatment portfolio to treat peri-implantitis.
Do you recommend to use a single tuft toothbrush for implants?
It depends on the patient. Some patients are very good at oral hygiene and they accept a single tuft toothbrush. But most patients don’t want to invest their time into proper oral hygiene. To the patients who don’t want to spend too much time cleaning their implants, crowns or teeth in general, I recommend a sonic toothbrush. But if the patients have the skills and the time and are motivated to do proper oral hygiene, I prescribe them also a single toothbrush.
What do you think about the CS 12460 velvet toothbrush to improve dental cleaning?
The velvet is a very efficient toothbrush, but a 5,460-filament toothbrush is also highly recommended because ultimately results are related to the technique. Whether you use the CS 5460 or CS 12460 does not make a big difference. It is important to have a proper technique, spend enough time brushing and use the correct pressure. So don’t think that if you use the velvet toothbrush there’s suddenly more perfection in cleaning – it won’t be the case if the technique is not good.