<strong>Implants</strong>
Implants

A dental implant is a component that is inserted into the jaw bone to artificially substitute a tooth root. Losing a tooth can be the result of many factors, including caries, periodontal disease, endodontic complications, trauma and genetic predisposition for dental agenesis (absence of teeth).

In order for an implant to securely attach to the bone, the implant must be made with special materials that do not cause rejection by the body itself; therefore, if there are no complications and proper oral hygiene exists, it will last a lifetime. Some time after being placed, osseointegration occurs and the thread naturally integrates in the bone, so that the implant is impossible to extract. 

Still, there are certain external factors that may possibly lead to implant loss. These include, for example, specific and uncommon diseases or infections that weaken the force that the bone needs in order for the implant to remain in place.

Implant placement is a procedure that normally does not require admission to a clinic, but rather can be done right in the dental office.


ASSOCIATED PROBLEMS

The mucosa that forms around implants (peri-implant tissues) is similar to the gums surrounding teeth: their function is to protect against environmental stressors, such as, for example, microorganisms. Still, the peri-implant mucosa is more sensitive to the accumulation of oral biofilm (bacterial plaque) which can cause an inflammatory response. Therefore, peri-implant tissues are less tolerant to the aggression of oral biofilm when compared to periodontal tissues.

The presence of microorganisms on dental implant surfaces can lead to the development of peri-implant diseases, including peri-implant mucositis and peri-implantitis.

Peri-implant mucositis is an inflammatory lesion that occurs in the mucosa surrounding implants. Its most common characteristics include oedema, redness and hyperplasia of the mucosa and bleeding without loss of the bone surrounding implants. The continual presence of pathogenic oral biofilm on implants causes this inflammatory reaction, which if not treated properly, may evolve into peri-implantitis. This too is an inflammatory lesion of the mucosa surrounding implants, but which is also associated with loss of supporting bone. The lesions caused by peri-implantitis are hardly encapsulated and extend toward the marginal bone tissue. If they progress, they may cause implant loss. The occurrence of inflammation, bleeding, implant mobility and suppuration are signs associated with peri-implantitis.

CLEANING FOR IMPLANT PATIENTS

The successful outcome of an implant and the prevention of peri-implant disease are directly related to the absence of complications in the intraoperative and maintenance phases, but just as importantly to the daily oral hygiene of the patient, since implants are more susceptible to oral biofilm build-up. That is why it is important to make sure that peri-implant tissues are kept healthy.

The most dangerous prosthetic complications include loosening of the screw, implant breakage and the level of the last thread of the inner screw, fracture of the porcelain and cement dissolution. In cases where no therapeutic complications arise, regular check-ups of the implant condition by a specialist will be an essential requirement to ensure good adaptation of the component in the patient’s oral cavity. Over the first year, it is recommended to visit the dentist every three or four months, although this frequency will vary depending on each individual case. During these check-ups, the dentist will normally check the condition of implants and then perform specialised hygiene with rubber cups and a bicarbonate spray to leave implant surfaces as smooth as possible. After the second year, it is advisable to continue with regular check-ups.

As for specific care performed by the patient, the aim is to carry out a more rigorous and stricter oral hygiene regime than someone who has not undergone this type of operation. It is important to use specific, latest generation brushes, because they help to prevent peri-implant mucositis and peri-implantitis, as they are specifically designed to mechanically disrupt oral biofilm from around implants with maximum precision and they are able to penetrate between the implant and crown. 

It is advisable to supplement toothbrushing with oral irrigators and mouthwashes that help to sweep away food debris that have accumulated under the implants. It is also necessary to use dental floss or tape and interproximal brushes to remove oral biofilm from interproximal spaces. Also, for a better guarantee, it is good to receive professional cleaning two times per year.

Lastly, prevention and treatment of peri-implant disease should focus on applying anti-infectious measures with combined therapies that include both mechanical and chemical treatment. Mechanical treatment disrupts the oral biofilm; although it has certain limitations, especially in non-compliant patients. That is why antiseptics like Chlorhexidine and Cetylpyridinium chloride are essential as a chemical adjunct to the mechanical treatment for controlling oral biofilm.

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