Soft tissue, hard tissue, adjacent teeth
- The key to long term success of the dentition and soft tissue is maintenance.
- The longevity of any dental restoration is directly related to the commitment of the patient.
- All things being equal, well cared-for dental restorations provide function and esthetics for many years.
Following the placement of the final restoration the next phase of therapy begins. This is termed maintenance, and it broken down into daily maintenance and periodic maintenance.
The daily maintenance is performed by the patient at home. The patient has a variety of options and tools to accomplish this. At the very least, daily brushing (2-3x) a day, and flossing once a day is the minimum. The patient should be instructed in the use of a manual tooth brush and proper flossing techniques. This can be accomplished with the dental hygienist, an integral part of the dental care team. In addition to the above there are inter proximal brushes, floss threaders, and electric tooth brushes that can be uses to augment hygiene. Of note is there is some evidence that electric tooth brushes can loosen the abutment / prosthetic screws of implant supported restorations. Therefore it is recommended that the brush be turned off when one is attending to the implant supported restoration. In addition an oral rinse that reduces plaque accumulation would be recommended.
On the professional level the patient should be engaged in a routine hygiene program consistent with standard procedures. This is dependent upon the specific philosophy of the health care provider, the patients performance of daily hygiene, the existing clinical presentation of the patient, systemic health and other factors.
Professional hygiene should be performed at least twice per year by a trained oral hygienist if possible. The hygiene procedure should include the specific instruments designed for caring for implants. At every visit the restoration should be carefully examined to make sure there is no movement, soft tissues are healthy, occlusion is proper, and interproximal bone height should be evaluated radiographically.
Patients should also be instructed that in the event they feel any type of movement or change in the feel of the restoration they should report this immediately. This will minimize the potential for more serious complications such as screw fracture.