Dental News - Guidance evolving on cleaning dental implants

Stacy Ewing, USA

Wed. 25 January 2012

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As a dental implant sales rep, I speak with many clinicians on a daily basis about implants. Coming from a background of 28 years as a dental hygienist, the topic of cleaning dental implants always seems to come up in conversation. These communications suggest that the majority of dentists and hygienists are experiencing a great deal of frustration and misunderstanding about the biology and the armamentarium used when maintaining dental implants.

This article attempts to provide helpful information to the practicing professionals from evidence-based and anecdotal sources.

Initially, it is important to understand terminology. An implant, also referred to as the “fixture,” is the titanium screw, which inserts into the bone to replace the natural root. The most coronal part of the implant, often referred to as the collar, may have a smooth or rough surface.

The structural component or attachment, which fits into the implant and provides the foundation for restoration, may have various names depending on the type of restoration (also called prosthetics or reconstruction). This attachment has a smooth surface. In the case of a single crown or bridge, this component is called the abutment or cuff. Restorations (crowns), which attach to abutments, may be screw-retained or cemented. Multiple abutments may be referred to as a roundhouse or multi-units. These multiple types may be standalone or attached to a bar (may be called a hybrid or high water). They may support single crowns, bridgework, fixed partial denture or fixed full denture. Components that engage with a removable denture may be ball attachments or locator attachments. The implant prosthetic restoration terminology is the same as that used for natural teeth.

It is important to understand that biofilm and calculus may accumulate on all these structures, just as with natural teeth. Also, whenever cement is used and residual amounts remain, it will cause irritation and needs to be effectively removed.

The periodontium around an implant/attachment/restoration is different than around a natural tooth. In very simplistic terms, there are two important biological characteristics of the tissue surrounding the implant, attachment and restoration.

First, there is no connective tissue “attachment” between tooth and bone. The implant integrates directly with the bone.

When inserting an instrument around a natural tooth, the resistance encountered by connective tissue “attachment” creates a barrier to direct engagement with bone.

The second biological characteristic of importance is that the gingival fibers surrounding an implant abutment comprise a horizontal/circular band, called the perimucosal seal, or the tissue cuff. There are no gingivodental or transeptal fibers or periodontal ligament as with a natural tooth. The perimucosal seal creates a barrier against bacterial introduction. It is easily possible to insert an instrument through the seal and directly contact bone. Therefore, one of the key considerations during instrumentation is to go carefully within the perimucosal seal.

Another significant aspect to consider with instrumentation around the implant/attachment is that these components are primarily made of titanium, a soft metal. Titanium is harder than plastic, Teflon and enamel. But it is softer than plastic that has been reinforced by carbon, glass or graphite and it is significantly softer than stainless steel.

All the research agrees that stainless steel instruments and ultrasonic tips leave scratches and gouges on the titanium surfaces, which may harbor any subsequent accumulation of biofilm, in addition to potentially altering the biocompatibility of the titanium surface. Graphite, glass and polymer-reinforced plastics or resins also show scratching to some degree. However, some studies and anecdotal reports indicate that roughened abutment surfaces have not been shown to increase implant complications.

It is also generally reported in the literature that plastic and Teflon can leave a surface residue that may interfere with the biocompatibility of titanium.

Additional research is needed regarding the effects of surface scratching and residue. Even though the literature states that non-reinforced plastic or resin hand-instruments are the best choice, clinicians agree that such instruments, alone, are not effective for the complete removal of calculus, residual cement and biofilm.

New products are appearing based on the premise that materials of similar hardness to titanium will be more effective at removing calculus with less scratching. These include solid titanium, carbon composite or carbon-reinforced plastic and copper alloy. Even though some of these products are already in the marketplace, the research about their performance is limited. For example, a review of the literature conclusions about titanium scalers ranges from no effect to surface scratching similar to stainless steel scalers.

More details on plastics needed to improve clinicians' armamentarium

Studies need to specifically define the type of plastic used in implant products. There is a decent amount of research over the past 20 years about the effects of plastic instruments on dental implants/attachments, but rarely is the type of plastic stated. This is an important detail, which may influence the clinician’s choice of armamentarium. For example, a non-filled type of plastic is flexible and does not hold an edge for sharpening, whereas the filled types are more rigid and do hold an edge for sharpening.

Dental applications with biocompatible polymers such as PEEK (polyetheretherketone) and Ultem PEI (polyetherimide resin) are being studied and used in implant dentistry.

Hand instruments

Non-filled resin

Hu-Friedy Implacare
Sabra Dental Implant Solutions

Filled plastic

Premier Universal/Facial carbon reinforced
Tess Implant Prophy+ polymer reinforced
PacDent ImplaKlean carbon reinforced

Solid titanium

A. Titan Titanium Implant Scalers
Nordent Implamate
PDT Wingrove Series
Kohler Implant Cleaning Curettes
Karl Schumacher Bionik TI
American Eagle Titanium Implant Cleaning Kit

Ultrasonic tips

Magneto

Dentsply Cavitron SofTip single-use plastic twist-on
Advanced Ultrasonics single-use plastic screw-on
Tony Riso multi-use plastic screw-on
G. Hartzell & Son-multi-use silicone screw-on (also for use on piezo inserts)
Parkell GentleCLEAN single/multi-use Ultem wrench-on

Piezo

Satelec/ACTEON PerioSoft multi-use carbon composite screw-on
EMS PI Instrument multi-use plastic insert with chuck
Brasseler USA/NSK Varios multi-use plastic insert with holder

Studies also vary on use of air abrasives and implants. Most agree that this is a safe and efficacious procedure; however, there is a great deal of variation in operator technique. Too much time on titanium surfaces can scratch. Some research indicates that a glycine-based powder will scratch less than sodium bicarbonate or aluminum oxide powders. More definitive research is needed in this area.

Air abrasive devices

Kavo Prophyflex
Deldent Jetstream, Jetpolisher and Jetsonic
Dentsply Prophyjet
Satelec/ACTEON AirMax
EMS Air-flow
EMS Air-flow Powder Soft & Perio: glycine-based

Rubber cup polishing is indicated on titanium surfaces with fine prophy paste, nonabrasive toothpaste or tin oxide. Abrasive polishing pastes are contraindicated.

Finally, many periodontists I have spoken with on this topic have what I consider the most important observation: Each patient must be treated on an individual basis and given the necessary amount of education and recall frequency so that the amount of accretions do not accumulate to the point of having to make questionable armamentarium choices.

Note: This article was originally published in Hygiene Tribune U.S. Edition, Vol. 5 No. 1, January 2012. A list of references is available from the publisher.

About the author

Stacy Ewing, BS, RDH, has been in dentistry for 30 years, with experience in clinical practice, education, research and public health. Her clinical and creative writings have been published in RDH magazine and various journals. She works as a professional representative for MIS Implants Technologies.

3 thoughts on “Guidance evolving on cleaning dental implants”

Emily Bennette says:

August 29, 2020 at 3:39 am

My father will need to get a dental implant later this fall. It is good to know that a titanium screw will get put into his jaw for the base of the implant. It does seem like a good thing to get a dentist to help him know when to get the implant put in.
Dr. Shapiro says:

March 4, 2020 at 6:45 pm

Many of the dental patients are worried about their pale and damaged teeth. iSmile dentists have been providing the best dental implant treatment to the dental patients in NYC. I have also get treatment of my pale teeth by Dr. Shapiro at the iSmile clinic.
Penelope Smith says:

January 16, 2019 at 4:21 am

My father is going to be needing to get a few implants soon. So, it is good to know that he should be really good about cleaning his implants. It might also be smart for him to get them professionally cleaned on a regular basis. https://lagunahillsprosthodontics.com/full-mouth-reconstruction-laguna-hills-ca/

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