The Patient’s Guide

The long-term success of your implant is fundamentally dependent upon both your effective home care routine and on the dental team’s administration of professional procedures in the dental office. You are considered a co-therapist in maintenance therapy and your contribution is indispensable.

As soon as your implants are placed and restored, the immediate care you will be responsible for is:

Thorough at-home oral hygiene

Your first checkup at no more than 6 months

Reports of any discomfort

Report any:

Tissue Soreness

After the implant supported prosthesis is placed, it takes a little time for the tissues to adapt to the new situation. Therefore, slight pain and light bleeding in the tissues may occur.

Most often, the symptoms gradually disappear after a period of time or after simple adjustments performed by the doctor.

Discomfort When Chewing

Pain or discomfort when biting down on something, most often concludes that the bite needs to be adjusted. The same is true when a part of the restoration is “too high”.  It is important to consult the doctor. It is essential that the restoration/prosthesis fits perfectly in the bite so all chewing forces are evenly distributed on the implants.

It is important to know that adjustments are normal after receiving your dentures, overdentures or prosthesis. It can take a while for your tissues to become used to the new prosthesis. Therefore, it is not uncommon to require a few adjustments within the first couple of weeks. As time goes on, the underlying bone structure will change as well. Because of this, you may require an adjustment every couple of years for maximum fit and comfort.

Adjust Your Diet Accordingly

Once you have your new dentures, overdentures or prosthesis , there are certain foods you will want to avoid, such as hard nuts or corn on the cob. Most patients do quite well with softer foods in the beginning, such as eggs, yogurt, cooked vegetables, fish, potatoes, ice cream, and more. However, it is important to maintain proper nutrition as well, so be sure you are eating well-balanced meals and healthy snacks.

Clean Regularly

You will accumulate plaque and tartar just like your natural teeth. They can also stain. Therefore, it is important to brush your removable prosthesis using a toothbrush or denture brush. You should also use a denture cleanser soak daily to eliminate debris, food particles, and bacteria. Be sure to rinse them well before reinserting them. It is also crucial that you keep brushing your gums, tongue, and cheeks with a soft toothbrush and toothpaste twice a day. This will not only eliminate the bacteria that causes bad breath, it will also prevent fungal infections.

Speak More

Typically, there is a slight learning curve when it comes to speaking with dentures or overdentures. While some patients become used to them right away, others may require a few weeks before talking feels natural. We encourage you to speak as much as possible during the first couple of weeks. Even reading out loud helps. The more you can practice, the faster your tongue and soft tissues will become accustomed to your new teeth.

Stay Hydrated

Drinking lots of water is a good idea for anyone. However, if you suffer from dry mouth, it is even more important to stay hydrated. Certain medications can lead to dry mouth. If you think this could be the underlying cause of your condition, speak to your medical doctor about the possibility of adjusting your prescriptions or dosages.

Give Your Tissues a Rest

We always recommend sleeping without your dentures. This will give you plenty of time to soak them, and it will also give your gums a break and allow them to heal from any soreness or irritation.

Generally, it takes time to get used to any new restoration. However, after a period of time, the implant-supported prosthesis should look, function, and feel like regular teeth.

Periodic Monitoring

Implants should be professionally evaluated at least twice a year during regular checkups. Criteria for the success are the absence of pain, stability, mobility, bone integration around implants, the lack of infection or bleeding in the soft tissues, adequate function, and aesthetics in the prosthetic. X Rays are taken annually, the oral mucosa is checked and a cleaning is performed. The patients should report any pain, discomfort or unusual signs. Necessary adjustments will be made.

Maintenance of Removable Dentures and Overdentures

Removable dentures and overdentures require continuous maintenance.

Replacement of Worn Attachments

The attachments that are housed in the denture need to be changed or refreshed every one to two years because they wear. The operation is extremely simple and quick.

Relining

Relining is indicated when a removable denture fit has worsened due to the manufacturing material (normally acrylic) from the base of the denture wearing and/or the bone beneath the denture has diminished in height. This results in an unstable denture causing tissue trauma. A denture reline involves the replacing and refitting of the tissue side of the denture to custom fit to the mouth. This is done at the dental lab and the procedure typically takes 2 appointments. It is not very expensive.

Oral Hygiene

At-Home Implant Care

Proper and thorough oral hygiene is a prerequisite for a successful dental implant. Poor oral hygiene greatly increases the risk of failure.

Patients with dental implants generally have a history of less-than-ideal home care, resulting in the partially or edentulous state. These patients may moreover have improper oral hygiene practice due to postsurgical fear of causing damage, on the one hand, or overzealous home care trying to stay absolutely plaque free, on the other hand. Either of these situations can lead to detrimental consequences. Therefore, oral hygiene instructions should include detailed verbal guidance and visual demonstration for the long-term success of the implant and its restoration. Also, the oral hygiene techniques and aids used by patients should be reevaluated during every hygiene visit.

Removable dentures, overdentures, fixed prostheses and implant crowns and bridges will accumulate plaque and tartar just like your natural teeth. They can also stain. Therefore, it is important to brush using a toothbrush.  On a removable denture, use a denture brush. You should also use a denture cleanser soak daily to eliminate debris, food particles, and bacteria. Be sure to rinse them well before reinserting them.

Even if you are missing all of your natural teeth, it doesn’t mean you should stop brushing. On the contrary, it is crucial that you keep brushing your gums, tongue, and cheeks with a soft toothbrush and toothpaste twice a day. This will not only eliminate the bacteria that causes bad breath, it will also prevent fungal infections.

Brushing

Twice daily cleaning of implants to remove bacterial plaque accumulations should be accomplished using a soft toothbrush or a power brush. A tapered brush to access the undersurface of connector bars or to aid with interdental cleansing is also recommended.

Several powered toothbrushes have been shown to not cause hard or soft tissue damage and to effectively reduce plaque and inflammation around the adjacent periodontal tissues. These brushes are considered superior to a manual toothbrush in removing plaque and they contribute to the improved interproximal cleaning due to bristle shapes. A patient with limited dexterity should use a power toothbrush.

In difficult-to-access areas smaller-diameter toothbrush heads such as end-tufted brushes or tapered  brushes may be of benefit. An end-tufted brush can accommodate the shape of the prosthesis and is especially useful in posterior regions where a conventional toothbrush might not reach. You can use the interdental brush heads to clean under hybrids

Interproximal Cleaning

There are many flosses, interproximal cleaners, and water irrigation systems commercially available and safe for use around implants.

Floss choice should be based on the clinical indication. The following types of floss may be used to remove interproximal plaque.

Braided flossing cord, such as PostCare is more rigid than conventional floss and suitable for open areas and places where a floss threader may be too fragile to remove denser plaque, debris, and calculus.

Satin Floss or Glide is particularly appropriate for a single tooth implant with tight tissue adaptation.

Woven, such as Thornton Bridge & Implant Cleaners or GUM Expanding Floss is indicated where there are large interproximal spaces or long expanses of a bar retained prosthesis.

Yarns can be used to access and cleanse larger embrasure spaces and under connector bars, but these should not be considered if there is the possibility of the fibers being retained on rough surfaces or around the restorations.

Dental Tapes are available in different “widths” and are used to clean the exposed abutment.

Other types include tufted, coated, and gauze thicker dental floss. All of these can be used in a “shoe-shine rag” fashion to facilitate optimal home care procedures around the abutment post. Threader floss may also be needed to access bridgework or around connector bars.

Interproximal brushes, aka “proxabrushes” can be selected and recommended considering the size and shape of the space, when patients are unable to use floss.  Whereas larger spaces can be properly cleaned with a proxabrush, smaller proxabrushes, such as Go-Betweens Cleaners are helpful in narrower interproximal spaces. However, caution must be used with interproximal brushes that have an exposed tip of metal wire or if enough pressure is exerted, as that can easily scratch the abutment’s titanium surface.

Rubber tip stimulators and disposable picks are among the many auxiliary devices that can assist in plaque removal.

Water Irrigation

A water flosser is a must for implant maintenance. However, care must be taken to direct the stream interproximally and horizontally between implants, as improper positioning can cause inadvertent damage to the peri-implant seal. Keep the unit at a low to medium setting and spend 3 seconds per implant site.

Tablets that contain Xylitol that can be added to the water flosser. Xylitol starves the Streptococcus Mutans bacteria that are the source of plaque and acid.  

Locally Applied Chemotherapeutics

For implant patients especially those prone to occasional tissue inflammation, an at-home regimen of daily cleansing with chemotherapeutic agents in the form of rinses, gels, or solutions is extremely essential. CrestPro Health or StellaLIfe is typically what our office recommends for healing or sore tissues. Another option is rinsing with a salt water solution. Dissolve ½ to one teaspoon of salt in a glass of warm water. This solution helps to soothe irritated tissues as well as draw out infection, allowing your gums to heal.

Professional Hygiene Care

Routine maintenance, professional evaluations, cleanings and radiographs are necessary to insure the long life of these restorations. These procedures are performed at selected intervals to assist you in maintaining oral implant health.  Typically, every 6 months.

During your hygiene appointment, our hygienists and doctor will evaluate these 8 items:

1. Assessment of peri-implant and gingival tissues=color and consistency
2. Palpate for presence of exudate/suppuration=signs of infection
3. Probe depths are taken=bone loss or peri-implantitis
4. Oral hygiene evaluation=presence of plaque and calculus
5. Mobility of the implant or prosthetic components=loose abutments or screws
6. Radiographic evaluation=bone levels around the implant(s)
7. Occlusal evaluation=correct bite
8. Prosthetic assessment=retention of attachments, missing or worn attachments

Implants necessitate intensive care that goes far beyond mere brushing of teeth. Natural teeth are anchored to the socket via periodontal ligament, which has an inherent protective defense mechanism, and hence are better protected against outside attacks than the implant. Despite the long-term predictability of implants, complications do occur in a percentage of cases and can ultimately result in loss of implants and failure of prostheses. Regular professional hygiene care for patients with dental implants as well as treating peri-implantitis in a timely manner can minimize and prevent implant loss/failure due to such complications.

The dental hygienist has an important role to play in keeping dental implants infection-free, and there are many factors to be considered in selecting the right instruments for a professional cleaning. They include: the nature of the debris, meaning whether soft (biofilm, foods) or hard (calculus or tartar); the location of the deposits; the type of surface on which they accumulate; and the stubbornness with which they adhere.

Your hygienist will select instruments for cleaning that will not damage the crown, abutment, or the implant itself. Maintaining the highly polished, smooth surface of the abutment and crown are critical. If they are scratched they can attract and harbor bacteria. That’s why the instruments used in our office, called scalers and curettes, are made of solid titanium. Medical grade titanium instruments are biocompatible and soft enough to avoid scratching implants. Natural teeth don’t scratch in the same way, and therefore metal instruments can be used to clean them.

Another method we use to clean around implants is with an ultrasonic scaler.  The ultrasonic instruments have plastic tips to minimize implant damage. They clean by using high-frequency vibration, which may be necessary if large quantities of debris have accumulated. They are used on a low power setting with a lot of water irrigation, and sometimes antibacterial solutions, to clean and flush debris.

If any part of the implant body itself is visible, this may mean there is infection that has resulted in tissue and/or bone loss. The implant surface becomes exposed following loss of its fusion to the bone. Implant surfaces are generally microscopically “roughened” to increase surface area for bone attachment. But this surface roughness makes implants difficult if not impossible to clean and disinfect. Additionally, some implants are screw-shaped and their threads just add to the cleaning dilemma.

Brushes are used to clean biofilm from exposed areas of an implant wherever possible. If calculus or dental cement (used to secure the crowns) is present on an implant surface, the hygienist needs to use instruments that are effective in removing these contaminants. In such cases the clinician must ensure no scratching or damage is caused by completing the task.

Risks and Complications

Within the First 6 Months

These complications occur in the first 6 months after implant placement. The most common complication is the failure to integrate. However, the risk of complications is considered to be very low – less than 5 percent, according to current statistics. Problems are rare and when they do occur, they are usually minor and easily treated. Please, contact us if you are experiencing any pain or tenderness.

Long Term Complications

Long-term implant failures may be caused by an improper design of the prosthetic restoration or by inappropriate care and maintenance. Regardless of the cause, implants fail due to either loss of bone around them or a mechanical failure of the implant.

There are also risks associated with the prosthetic components which over time can wear off, chip, break or cause a lack of satisfaction on the part of the patient.

The good news is that about 95% of implants today are successful. Moreover, a well-integrated implant with appropriate biomechanical loads can have long-term success rates for the fixture and close to 15 years lifespan for the prosthetic teeth.

The professional implant maintenance you will receive at our office, coupled with your diligent home care are critical factors that will ensure the long-term success of your implants.  We pride our practice on providing an exceptional dental experience and we give our patients the compassion we would offer our own family members. You deserve to be proud of your smile and confident in life. Thank you for choosing our office to provide you with your dental implants. We look forward to many more years together as we maintain your optimal dental health.