Implant Maintenance and Aftercare

As increasing number of dental implants are being placed in the general population, the need to develop a maintenance protocol that caters to the needs of the patients has become essential. Historically, dental implants were predominantly placed in the early edentulous population; however, the shift of placements to the wider population means that a patient-focused approach to peri-implant maintenance therapy (PIMT) and the effect this has on biological complications and implant survival need to be considered. This has been considered in the new periodontal classification (2017), which includes peri-implant diseases and conditions for the first time. Lang et al. [7] discussed Cumulative Interceptive Therapy (CIST), which suggested that the prevention of implant disease was better than the management of the disease itself. However, it is crucial to acknowledge that implant disease does not arise purely from microbes and the body’s inflammatory response to them. As stated by Albrektsson and his colleagues, there are numerous additional factors that contribute to implant failure and disease, encompassing various clinical and patient-related factors. Clearly, it is imperative that we educate our implant patients on how to clean their implant superstructures and abutments; however, as clinicians, we need to be cognizant of the fact that the pellicle that develops on titanium, either the implant surface itself or the implant abutment, differs from that which develops on enamel and cementum. In 1996, Edgerton demonstrated that a high-weight proline-rich glycoprotein pellicle forms on the dental implants, and this may contribute to the difference in the adhesion rates of the pellicles and also the type of specific bacteria found in implant crevices and surfaces.