In our opinion, one of the most innovative trends in modern dentistry is the dental implant. Dental implants are medical devices that are surgically inserted in the jawbone. While they provide support for crowns, bridges, or dentures, they also help to keep the jawbone from shrinking due to bone loss, keep adjacent teeth stable, and preserve the health of surrounding bone and gums.
As amazing as dental implants are, one thing they CAN’T do is care for themselves. Implant care is just as essential as caring for natural teeth, dentures, crowns, and bridges. In order to keep implants in good shape, here are a few things patients should know.
General facts about dental implants
In 2005, there were an estimated 90,000 dental implant procedures performed in Canada. While we haven’t seen any similar Canadian studies published more recently, we would expect that the number of dental implant procedures in Canada in 2022 was exponentially greater than 90,000.
Survival rates of osseointegrated dental implants are fairly high: 95.7% at 5 years and 92.8% at 10 years. However, it’s wise to reflect that with 90,000 implant procedures done in 2005 in Canada, this still means that 6,480 of those procedures eventually failed.
What accounts for these failures? How could we have prevented them?
In most cases, patients with good implant care have lower rates of complications leading to implant failure. These patients have good oral hygiene, manage risk factors associated with implant failure, and schedule regular implant examinations and maintenance. These implant care behaviours result in less oral trauma and lower costs related to interventions needed to save at-risk implants or, in some cases, remove failed implants.
How problems with implants progress
The accumulation of bacteria and biofilm around a dental implant can lead to inflammation of the tissues surrounding the implant, called peri-implant mucositis. If the biofilm can be brought under control, the peri-implant mucositis can be reversible.
If allowed to progress, peri-implant mucositis can lead to bone loss (peri-implantitis) which is not reversible.
Untreated peri-implantitis can lead to advanced bone loss which may require the implant to be removed.
To help ensure that inflammation is kept in check, practice basic implant care:
- Monitor the implant site for bleeding, soreness, visual swelling, redness, and shininess of the soft tissue surface. These are all signs of inflammation (peri-implant mucositis).
- If you notice any of these signs or symptoms, schedule an appointment with your oral surgeon as soon as possible.
Risk factors associated with peri-implantitis
There are several risk indicators associated with mucositis and peri-implantitis. Here are 3 of the most common:
- Smoking has long been a known risk factor for periodontal disease.
- It negatively impacts the immune system and the body’s ability to heal from wounds.
- Smoking also alters the mouth’s microbial flora, leading to chronic inflammation of oral tissues and allowing implants to be colonized with various periodontal pathogens.
- Compared to nonsmokers, smokers are twice as likely to develop peri-implantitis and to have their implants fail.
- All forms of smoking are a concern when it comes to implant health. The links between periodontitis/peri-implantitis and water pipes, smokeless tobacco and vaping have long been established. While the association between cannabis use and peri-implantitis is still lacking, research does support an association between cannabis use and periodontitis.
- If you have implants and you smoke, consider quitting. If quitting is not possible for you, ensure that you keep up with oral care, regular examinations of your implants, and any maintenance work that your oral surgeon recommends.
- Diabetics may have higher than normal blood glucose levels (hyperglycemia). This leads to constricted blood vessels which slows the body’s ability to heal and combat infections.
- The disruption of glycemic levels plays a key role in the progression and severity of peri-implantitis and diabetics who have poorly controlled glycemic levels have a 46% higher risk of developing peri-implantitis.
- If you have implants and you are diabetic:
- Ensure that you know what the symptoms of hyperglycemia are: tiredness, thirst, and the need to urinate more often than usual, especially during the night.
- Monitor your blood glucose levels and talk to your health care provider about how best to maintain your glucose levels within your target range.
- Keep your implants clean and free from plaque buildup by brushing with a soft electric or manual toothbrush.
- Brush in the morning to remove bacterial buildup that occurs while you sleep.
- Brush at night to remove bacteria and food debris that builds up throughout the day and to reduce the risk of increased buildup overnight.
- If your toothpaste contains baking soda or whitening agents, it can damage your implants. Use a low-abrasive toothpaste that is made specifically for implants, crowns, or sensitive teeth.
- Make sure to thoroughly clean your implant-retained denture at the same time. This will ensure that your oral environment is as clean as possible.
- Periodically, use disclosing tables to show you where plaque is accumulating. Disclosing tablets will physically highlight spots that you should be paying more attention to when you brush and floss.
- See your denturist annually for denture checkups and your oral surgeon as required for implant checkups.