When looking at tissue health requirements for implants, both before placing them and ongoing, lot of things to consider. Before, what I want you to think of is two millimeters.
Leave two millimeters of attached gingiva
You want two millimeters of attached gingiva around the implant and you want 2 millimeters of thickness around the implant and the abutment. There were studies that show that the implant and the abutment color can show through the gingiva if it's less than two millimeters.
How to maintain the implant
As far as ongoing maintenance with implants, there's an excellent article written by a periodontist from the University of Toronto, Dr. Peter Fritz. The article was called Supportive Implant Therapy Protocol for the Patient with Single or Multiple Implants from Oral Health Journal in 2012. Armamentarium that you want for your hygienist, when they're seeing patients' implants, they need to have a periodontal probe, a titanium scaler, hydrogen peroxide, chlorhexidine, and prophy with prophy paste or even toothpaste.
Things to ask the patient at that hygiene visit
Has there been any changes in your implants since the last time you came in? What is your oral hygiene protocol? Oral hygiene protocol with patients, things that they should use or would be beneficial to use. Things like an electric toothbrush, interdental picks or soft picks to clean between the implant crown and the other teeth or other implant crowns while using a crossover flossing technique.
Things for the hygienist to do
When they're doing that exam and doing treatment for that implant, crown, or restoration, they need to be looking at a few thing.
- Do probing.
- Check if there's any bleeding in any of the pocket areas.
- Check the plaque and calculus score.
- Check the amount of intact gingiva there. Again, if it's less than 2 mm, that then should be considered for some form of soft tissue augmentation, a gingival graft.
- Check for mobility. Mobility's a huge issue with an implant crown. Hopefully, it's just that the screw or the connection's loose. But it potentially could mean that the implant's loose.
- Check for percussion tenderness and the contacts between adjacent teeth.
Chemical and Mechanical Debridement Protocols
The first thing they recommended is rubbing that restoration with a cotton pellet soaked with hydrogen peroxide. Why? Peri implantitis can cause a breakdown of the epithelium and the connective tissue. What happens is the metabolites will leak into that gingival crevicular fluid. If those metabolites come into contact with hydrogen peroxide, a lot of bubbling can occur. Simply, if you're rubbing that restoration with a hydrogen peroxide pellet, and you see bubbling around it, that's a sign that there could be peri implantitis. After that, then:
- Do a prophy supragingivally around that crown
- Do a prophy subgingivally around your titanium scaler
- Rub a cotton-soaked pellet of chlorhexidine to rub around their restoration.
Hopefully, this quick tip will help you guys in terms of what to consider both before the implant's placed and with maintaining implant restoration when it comes to soft tissues.