Introduction:
Maintenance therapy after dental implant surgery is crucial for implant dentists to assess the condition of the soft tissue and underlying jaw bone. Regular follow-up appointments with the dentist are essential for effective maintenance therapy, which plays a significant role in promoting healthy peri-implant mucosal (tissue surrounding the implant) and bone health. Neglecting proper care can result in peri-implant mucosal inflammation (mucositis) or inflammation and infection of the peri-implant tissue, leading to long-term dental implant failure.
What Are the Methods of Clinical Evaluation of the Implant Site?
This is done thoroughly by the implant dentist checking for sites of bleeding on probing that would be increased in areas either with peri-implant mucositis or peri-implantitis (infection of soft tissue around implant). These sites are marked and appropriate measures professionally are taken by the dentist either prophylactically or through antibiotic therapies. The plaque and mucosal assessment factors are taken into consideration for clinical assessment of peri-implant soft tissue health. The proposed modified index for the evaluation of the peri-implant marginal health, for assessing the mucosal conditions and plaque assessment in patients with dental implants is as follows:
Based on the score of zero, one, two, or three corresponding to the state of mucosal health and the clinical observations made by the implant dentist
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Zero - This corresponds to a normal or healthy peri-implant mucosa. No bleeding is observed even when the dentist's periodontal probe is passed alongside the mucosal margin that is adjacent to the dental implant.
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One - This score corresponds to the state of minimal inflammation along with a gingival color change or even minor redness or edema. The implant dentist can also possibly observe isolated bleeding spots that are visible to the naked eye, which suggests that a state of inflammation is being initiated in the peri-implant soft tissues.
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Two - This score corresponds to a moderate inflammation characterized in the peri-implant soft tissues with typical redness, swelling, or edema. The dentist can also observe a characteristic inflammatory line upon the mucosal margins or the peri-implant tissues.
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Three - This is the score given for severe inflammation of the peri-implant soft tissue characterized by redness, edema, and ulceration. Patients may report bleeding on brushing from the mucosal margins near the dental implant prosthesis or the observation of spontaneous bleeding by the dentist (even without probing) signifies poor peri-implant tissue health.
Similarly, the occlusal (contact between upper and lower teeth) status of the implant and its prosthesis also needs to be evaluated on a time-to-time basis. Dentists should check for occlusal disharmonies, premature contacts or interferences, and occlusal overloading that can lead to prosthetic implant failure in the long term.
What Is the Importance of Radiographic Evaluation After Dental Implant Surgery?
The dental implant specialist or implantologist is required to perform regular radiographic evaluation alongside clinical evaluation for determining or keeping track of the patients' peri-implant soft tissue health, and post-dental implantation. Ideally, the protocol that is recommended in dental implant literature, keeping in focus on improving the long-term survival rates of dental implants, the dentist ideally evaluates the state of dental implants every three months or six months maximum, that is called the maintenance phase therapy.
Keeping track of the patient's implant health, especially the underlying jaw bone health, and estimating whether any bone loss is occurring every few months would help the dentist advise the patient either professional or at-home implant care instructions that can be beneficial in preserving the primary stability of the dental implants. It should be emphasized that neglecting to regularly assess or evaluate the primary stability of dental implants through periodic dental follow-ups can potentially jeopardize the long-term survival rates of these implants. Current dental research highlights various local and systemic risk factors related to the patient's health that contribute to this risk.
According to current dental implant research, a mean crestal bone loss (bone around implant) of more than or equal to 1.5 millimeters (0.05 inches) is usually observed in even healthy patients with dental implants (having no other systemic or local risk factors of history) during the first year after implant loading. A more than or equal to 0.2 millimeters (0.008 inches) per year of mean crestal bone loss would be occurring every year post the first year of dental implant loading even in healthy subjects.
What Is the Significance of Crestal Bone Loss in Dental Implant Patients?
The significance of radiographic assessment during regular dental check-ups is once again emphasized, particularly about the maintenance of peri-implant crestal bone height over the long term. A decrease in crestal bone height can eventually lead to instability or hinder the initial stability of dental implants over time.
In general, most dental surgeons across the globe prefer the long-cone paralleling technique for radiographic evaluation, which is supported by positioning devices. Preventive maintenance appointments are always recommended and should be ideally scheduled every three to four months apart. A periapical or a vertical bitewing radiographic modality can be performed every six to eight months. These 2D (two-dimensional) radiographs or 3D (three-dimensional) radiographic imaging like CBCT (cone-beam computed tomography) gives a sectional analysis that should be preferred by dental practitioners to compare the post-operative dental implant health with the baseline, to assess crestal bone changes that would keep occurring especially often during the first year of loading.
With the advent of modern dentistry and radiographic advances, noninvasive devices that are based on the principles of resonance frequency analysis (RFA) have been now developed. These devices can not only effectively measure the primary implant stability, but also are of scope to the implant dentist for monitoring the implant stability over a while. This method using RFA that is used by advanced practitioners aims to primarily evaluate the integrity of the bone-implant interface and also allows for the detection of either an increase or decrease in the primary implant stability. The dental implantologist usually uses varied diagnostic parameters to assess or evaluate the peri-implant soft tissue health.
Conclusion:
Peri-implantitis refers to the inflammation of the soft tissue surrounding a dental implant. It is a crucial factor in determining the long-term success of the implant, making it essential for the implant dentist to assess various clinical, radiographic, and implant parameters. Patients may experience peri-implantitis postoperatively, within different time frames such as six months, one-year, five years, or 10-year intervals, as indicated in the dental literature. Symptoms include gingival or tissue bleeding, suppuration (pus formation), increased depth of probing, implant mobility, and crestal bone loss.
